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40th Parliament, 3rd Session
March 3, 2010 -
March 26, 2011
About this Committee
Like other standing committees, the Standing Committee on Health is appointed under the Standing Orders of the House of Commons for the life of a specific Parliament. It was first established in this form in 1994 to reflect the fact that the Department of Health and Welfare had been separated into two components: Health and Human Resources Development. By November 1995, this departmental restructuring was formally recognized in Bill C-95 (Department of Health Act).
The House of Commons Standing Committee on Health is empowered to study and report on all matters relating to the mandate, management, and operation of Health Canada. This includes its responsibilities for the operations of the internal body called the Pest Management Regulatory Agency (PMRA).
The Committee is also responsible for the oversight of five agencies that report to Parliament through the Minister of Health:
- Canadian Institutes of Health Research (CIHR);
- Patented Medicine Prices Review Board (PMPRB);
- Hazardous Materials Information Review Commission (HMIRC);
- Public Health Agency of Canada (PHAC);
- Assisted Human Reproduction Canada (AHRC)
The mandate of the Standing Committee on Health also includes reviewing and reporting on matters referred to it by Orders of Reference from the House of Commons relating to Health Canada and its associated agencies.
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<urn:uuid:d3966269-01e6-4b57-94f8-f40e83294d91>
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http://Ignatieff.M@parl.gc.ca/CommitteeBusiness/AboutCommittees.aspx?Cmte=HESA&Language=E&Mode=1&Parl=40&Ses=3
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Question: How is bipolar disorder different from unipolar depression or 'regular' depression?
Answer: Both bipolar disorder and major depression are typically associated with depressive episodes. So both illnesses are accompanied by depressions. The difference is that in bipolar disorder people also have periods of elevation -- or severe irritability. We call these manic or hypomanic episodes.
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<urn:uuid:e6ba92ad-ed0a-4cac-8e5d-204b78cdd250>
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http://abcnews.go.com/Health/BipolarOverview/story?id=4359993
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Serving diverse populations has never been a strong suit of the health-care system in general; there are huge disparities in the quality of care between whites and African Americans and Hispanics. The law calls for expanded initiatives to increase racial and ethnic diversity in the health-care profession, as well as improved cultural competency. But this will take time. Meanwhile, the existing force of health-care providers will have to adopt a more multicultural mindset -- and that includes increased multicultural intelligence in marketing communications.
Insurance companies will face a different set of challenges. The law stipulates that by 2014 states must set up exchanges through which consumers can directly purchase health insurance, and all legal residents will be required to obtain insurance or pay a penalty. That will likely force a change in the traditional model of marketing health insurance from B2B to a more consumer-oriented approach.
Several major insurers already are adding retail locations and kiosks in shopping malls, as well as sponsoring health fairs, The Miami Herald reports. Humana, for example, is offering its members a 5% savings at Walmart stores on purchases of fresh fruits, vegetables and other products that carry the retailer's "Great For You" label. Though many of the newly insured will be eligible for subsidized health insurance through Medicaid and the Children's Health Insurance Program, to be successful, insurance companies, like providers, will need to be ready to address the unique needs of a very different demographic than what they are used to.
Then there are the pharmaceutical companies. According to Gregg DiPietro, in a blog for Pharm Exec, before the new health-care law, "pharma built its positioning platform almost entirely on two dimensions: efficacy and safety." He adds, "With the approval of the health care law, the conversation has moved ... to one of overall 'value.' ... Efficacy and safety ... are not enough to carry a product's positioning platform."
Dorothy Wetzel, former VP-consumer marketing at Pfizer, offers five questions in a recent blog that any pharmaceutical brand needs to ask itself when considering beefing up its efforts to multicultural consumers:
What is the size of the business opportunity?
Do multicultural patients approach health issues differently than the general-market patients in their disease state?
- Do the current messages in your communications resonate with the multicultural patient?
- Does your current media and tactical plan reach the multicultural patient?
- Are there organizations that could help accelerate access and the impact of your efforts?
"You can't standardize diversity and say that all of our diverse populations need this," says Russell Bennet, Vice President of Latino Health Solutions at United Healthcare. "Each population may need different things."
If we are to count ourselves among the great nations of the world, then Americans have a moral imperative to increase the quality of health care for all. As multicultural marketers, we can help. There is a need to educate about disparities. There is a need to get the word out to medically underserved folks as to how they can take best advantage of the new health-care options. And there is clearly a need for more research that looks into the impact of race, ethnicity and sexual orientation on how one navigates -- and is navigated -- through the health-care system.
Perhaps the greatest challenge faced by advertisers will be to make Americans -- in and out of the health-care profession -- aware that we do indeed have a disparities problem. A study conducted last year found that only 59% of Americans were aware of racial and ethnic disparities in health care. Before the ad industry takes on this issue -- and it's a tough one, given the current political climate -- its first job will be to educate health-care providers as well as the general public. Once that 's accomplished, the industry can tackle the challenge of how best to reach multicultural patients as important consumers.
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<urn:uuid:00c459a3-0bdd-4cd0-b1a8-2f1a0d1c8fa4>
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http://adage.com/article/the-big-tent/health-care-law-poses-multicultural-marketing-challenges/237911/
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Priority diagnosis question from a first time poster.Register Today!
This is a discussion on Priority diagnosis question from a first time poster. in Nursing Student Assistance, part of Nursing Student ... Hello All, I've been using AllNurses since I began in nursing school but this is my first post....by It's Just a Ride Nov 23, '12Hello All,
I've been using AllNurses since I began in nursing school but this is my first post. I had a patient in clinical this week and my priority diagnosis isn't completely clear to me.
This elderly patient was in the CCU after an AMI with CHF ~ 45 days prior, history of hypertension, diabetes, family Hx of heart disease. He has a trach/vent in place and appears to be unable to wean due to the potential for right side heart failure.
His heart is the problem. He's on the vent because his heart can't handle the increased workload, SO, I'm thinking Decreased Cardiac Output as my priority, but they've drilled ABC's into our brains so many times a little voice is telling me "B comes before C," but it's the heart, not lungs, that are the real issue. Right?
Also, could I simlpy use AEB AMI, and ventilator dependency? Your insights are appreciated.
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- 584 Views
- Nov 23, '12 by ImKosherWhat's your related factors? What is your A/E/B? Following your ABC, we need to figure out if the airway and lungs is contributing to his condition at all and if it priority. Tell us a little more about the pt.
- Nov 23, '12 by It's Just a RideAside from the Hx I mentioned (HTN, diabetes, fam Hx of heart disease), the pt had no indication of CHF until he was braught in for the AMI. He was described as a stable, critical patient. Stable on the vent, critical off of it.
I was thinking Decreased Cardiac Output or Inneffective Tissue Perfusion, but he is stable currently so those would be "risk for" at the moment, right? A therefor wouldn't be used as primary diagnoses. He's on bedrest, NPO, trach/vent, and was in between an NG and PEG tube placement when I was work with him. He is dependent, alert and oriented, and denied any pain although he had a nasty ulcer on the posterior left wrist from dopamine infiltration.
His airway has some mucus production so I could go that direction. He required suctioning twice while I was there. His breathing is controlled by the vent. His heart is stable provided his lungs have assistance from the vent.
These diagnoses usually make sense to me but after my first day on CCU I'm not sure what direction this should be going.
- Nov 23, '12 by fireballnursieInsufficient gas exchange related to decreases cardiac function as evidence by inability to ween off artificial life support.
- Nov 23, '12 by It's Just a RideI can see this connection. Thank you very much FireBall.
And thank you Kosher for the input.
- Dec 1, '12 by GrnTeaThat would be "decreased," "wean," and we don't say "artificial life support" for something like this.
Let's back up here.
How do you know he's on the vent because his right heart might not be able to manage without it? It may be that the work of breathing is just more than he can handle, and if he isn't ventilated mechanically he will not be able to move enough air to stay alive. He is old and has a bad heart, and that resulting weakness may be the reason he's on the vent. The vent doesn't decrease right heart workload per se.
However, decreased cardiac output itself would certainly cause him to be weak. Seems to me that he has at least two priority problems: he can't move enough air to support himself, and his heart is too weak to support any activity. Now, go to your NANDA-I 2012-2014, which every nursing student should have even if his/her faculty neglected to put it on the bookstore list (free 2-day shipping from Amazon), and see what nursing diagnoses fit these defining characteristics. That's how you determine nursing diagnoses-- you identify the defining characteristics by your own assessment, then see what diagnoses they point to. It's just like checking a hematocrit to help make the medical diagnosis of anemia.
I hope you haven't already turned this in, because in my opinion you're a little confused about cause and effect here. Hope we hear back from you.
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Myocardial infarction (MI) is relatively infrequent in infants and children, although its association with anomalous origin of the left coronary artery and other congenital cardiac anomalies that result in coronary hypoperfusion is well known.1
Although MI has also been reported in some congenital heart defects without coronary artery abnormalities,2-4 massive MI of the left ventricle in tetralogy of Fallot (TOF) has not, to our knowledge, been reported.
Report of a Case.—An 8-month-old girl had been followed up elsewhere with the clinical diagnosis of TOF. Although moderately cyanotic, she had no history of hypoxic spells. On the morning of admission, she had an hypoxic spell. Because of poor response to conventional therapy, ie, knee-chest position, sodium bicarbonate, and morphine, she was transferred to our institution. On arrival, she was cool and blue-gray; heart rate was 150 beats per minute; respirations, 80/min; and blood pressure, 60/40 mm Hg. There
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<urn:uuid:edbcd273-ea08-44da-a5e7-a5f16d868670>
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http://archpedi.jamanetwork.com/article.aspx?articleid=508251
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We recently reported on the extensive uncontrolled experience at Massachusetts General Hospital (MGH), Boston, suggesting the possible efficacy of cingulotomy for treating obsessive-compulsive disorder (OCD).1 Recent evidence suggests a familial link between OCD and Tourette's syndrome (TS),2 yet there is only one previous report regarding the effects of cingulotomy on the symptoms of TS (in two patients at MGH who underwent surgery to treat concomitant severe OCD).3
We now report the case of a man who had concomitant OCD and TS. He underwent two separate bilateral radiofrequency cingulotomies via burr holes, first in December 1989, and again in June 1991, to reduce his OCD symptoms. This patient's experience is instructive because his OCD symptoms appear to have improved following these cingulotomies, while his tics were unchanged or worse.
Report of a Case
A 35-year-old man had been followed up in our OCD clinic between 1987 and 1988
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To determine the morbidity and mortality of surgical treatment of false (anastomotic) aneurysms, we analyzed the results of 158 consecutive surgical procedures for repair of false aneurysms that were detected as a result of a surveillance program after aortic reconstruction with a prosthesis.
Retrospective analysis of patient data from a vascular registry that included information on the long-term follow-up of our patients.
A university hospital (tertiary referral center) in the Netherlands that has been performing vascular reconstructive surgery since 1958.
We performed 158 surgical procedures on 135 patients with 220 noninfected false aneurysms. Using a yearly surveillance program, the false aneurysms were detected at a mean interval of 8 years after the initial reconstruction. Most patients (60%) were asymptomatic. The operation was performed as an emergency in 25 instances (16%).
The mortality rate of patients receiving nonsurgical treatment was very high (61%) owing to documented rupture (11 of 18 patients). The intraoperative death rate was 7.6% per procedure. This was higher for emergency (24%) than for elective procedures (4.5%).
Conservative follow-up carries a very high mortality rate, as does emergency surgery for a false aneurysm. However, the intraoperative mortality rate of elective reconstruction of a false aneurysm can be in the same range as that of elective primary aortic reconstruction. Therefore, we advocate a surveillance program, including yearly ultrasound studies, after prosthetic aortic reconstruction for the timely detection and elective repair of all false aneurysms.
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<urn:uuid:8442f00f-faac-4e4b-9059-b3b83b084a3e>
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http://archsurg.jamanetwork.com/article.aspx?articleid=211471
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with
the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
Sorry, you have unsuccessfully completed this CME quiz with a score of
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
For CME Course:
A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this
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<urn:uuid:77a0d605-5106-4a4b-af45-670bbcdd19c3>
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http://archsurg.jamanetwork.com/article.aspx?articleid=596141
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The vaunted protection that intellectually active adults get from Alzheimer’s disease has a dark downside, a study released Wednesday has found. Once dementia symptoms become evident and Alzheimer’s disease is diagnosed in such patients, their mental decline can come with frightening speed.
That finding, published in the journal Neurology, comes from a study of 1,157 Chicago-based seniors who were followed for an average of just over 11 years. Six years after gauging the extent to which the study participants engaged in activities that challenged their mental capacities, researchers from Rush University Medical Center Alzheimer’s Disease Center made periodic assessments of the study participants’ cognitive health and traced the trajectories of their brain health.
All told, 148 of the participants were diagnosed with Alzheimer’s disease during the follow-up period, and 395 were found to have mild cognitive impairment—intellectual problems that are less severe than Alzheimer’s disease, but which often precede such a diagnosis.
While all participants’ mental function showed yearly declines, the steepest downward trajectories belonged to those who had been diagnosed with Alzheimer’s disease, but who had reported high levels of mental engagement at the outset of the study. Fellow Alzheimer’s sufferers who had not sought out much intellectual stimulation at the study’s outset showed a more gradual decline in their function.
“In effect, the results of this study suggest that the benefit of delaying the initial appearance of cognitive impairment [in Alzheimer’s disease] comes at the cost of more rapid dementia progression,” the author wrote.
The findings support a common observation of those who treat intellectually minded patients who go on to be diagnosed with Alzheimer’s disease—that once diagnosed, their decline is rapid. It also underscores a growing body of evidence that the bright and mentally-active may not beat Alzheimer’s disease, but can hold off its ravages for months or years longer than those who are not so engaged.
Dr. John M. Ringman, a UCLA neurologist and assistant director of the Mary S. Easton Center for Alzheimer’s Disease Research, said he sees regular evidence of the phenomenonen in his clinical work, as well as in brain-imaging scans that can detect the physical signs of Alzheimer’s disease while a patient is still alive: Patients with a history of intensive mental engagement seem to develop a “cognitive reserve,” said Dr. Ringman. That mental strength frequently allows them to function almost normally, he said, even as the amyloid plaques and neurofibrillary tangles that are the hallmarks of the disease have advanced upon the brain.
By the time such a patient comes to his office complaining that his memory and mental function are not what they used to be, the disease has progressed significantly, said Ringman. The decline from that point can be precipitous.
In a disease that evidence now suggests takes years, perhaps decades, to show up in everyday behavior, Ringman said “it’s hard to quantify this cognitive reserve.” The strength of the study published Wednesday is that it gathered copious evidence of participants’ mental status and activity at the outset and followed them for more than a decade, he added.
--Melissa Healy/Los Angeles Times
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<urn:uuid:5d156165-181a-4195-a926-d51850c7b599>
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http://articles.latimes.com/2010/sep/01/news/la-heb-alzheimers-20100901
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/* Style Definitions */
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Have you ever thought about what it would be like to loose someone so close, like a partner or a direct family member or a worse thought, what they would do if you weren’t around anymore?? Insurance Helpline – Life Insurance NZ company, is a simple, affordable way to help make sure your family’s life can go on even if you’re not around. Surely having this piece of mind makes total sense. Life Insurance will pay out in the event of death of your breadwinner. You can find Insurance helpline as a best online life insurance broker in different domains like… NZ Life Insurance, Life Insurance NZ, Life Insurance, Health Insurance, Medical Insurance, Funeral Insurance, Life Insurance Quotes, Insurance Brokers.
Life insurance, life cover, life assurance. Whatever you call it, life insurance is about leaving money for loved ones on your death. Very few people are fortunate enough to have no need for life insurance. Life Insurance NZ provides a lump sum payment on a tax free basis upon your death. This is the best way to offer your family a sense of security if you are unable to be there for them. Every personal situation is unique. Each individual has different needs. When it comes to choosing a life insurance policy that is right for you and your family, there are several factors that need to be taken into consideration. Think about your age, your general health and the financial needs of your family. Anyone can apply for life insurance, especially those under the age of 68-70.
Two major factors affect Life insurance premium rates. The foremost influence is the policy holder’s personal health or family health history. The next is the age of the insured. There are three parties in life insurance – the insured person, beneficiaries, and the insurance company. Initial interview will be conducted by the insurer to check blood pressure, weight draw blood and collect a urine sample as well as ask dozens of health related questions. These questions often include specific queries regarding family history with high blood pressure, heart disease, cancer, diabetes, cardiovascular disease and other serious health risks.
Death is a reality of life. Hence, one should be prepared all the time. This is the reason most people are availing Life Insurance. Once you have spent a moment entering your requirements, you are immediately presented with a list of quotes from all the different NZ Life Insurance providers including the big name companies like Sovereign Insurance, One Path, TOWER Insurance, Accuro Health Insurance, Southern Cross Healthcare, Pinnacle Life, Dorchester Life, AIA Life, Fidelity Life, Southern Cross Travel and others.
Exact life insurance rate is determined by the health examiner depending on the result of health examination. There are different terms involved in paying your premium. You can have onetime payment. You can also make it once a year, twice a year, quarterly, or monthly depending on your agreement with the insurer. Basically, life insurance covers the funeral expenses, mortgages, taxes, debts, and many more. You also need to think of your family. You have to consider their basic needs, education, expenses, and adjustment cost.
Insurance Helpline handles Life Insurance NZ together with Health Insurance, Medical Insurance, Funeral Insurance…Insurance Helpline is a free service that is always at hand to assist you with your Life Insurance enquiry. You will receive personalized, one on one service from highly experienced, fully accredited and helpful insurance advisors with absolutely no obligation.
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<urn:uuid:d276065d-d8f9-4d08-9f88-43c4d38921d9>
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http://articles.org/nz-life-insurance-broker-offers-life-insurance-with-life-insurance-nz-quotes/
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In the spirit of patriotism, authorities in Broward County are drafting a program that would link veterans facing criminal charges with specialized veterans' services.
The Broward County VA Outpatient Clinic, in Sunrise, and the Miami Department of Veterans Affairs also are involved in the project, with organizers aiming to complete a blueprint by Veterans Day.
"The idea is not to treat veterans differently, just if they need services and are eligible for services we can get those to them," said Judge Melanie May, of the 4th District Court of Appeal.
Its organizers were inspired by a similar initiative in Buffalo. Judges there started the country's first veterans' court in January 2008.
Local officials don't want to go so far as to establish a separate court for veterans. The organizers instead want to develop a partnership between the criminal justice system and veterans' mental health and medical providers.
Officials estimate that as much as nine percent of the Broward jail population may be veterans.
They pose a different set of challenges for the justice system because some return home with post-traumatic stress disorder, develop substance abuse problems or face other mental health problems that contribute to them winding up in the criminal justice system, project organizers said. Many veterans also might not be aware of the services available to them.
Also among those involved in the collaboration are social workers, doctors, and nurses, and members of the Broward State Attorney's Office, the judiciary and the Broward Sheriff's Office.
Sofia Santana can be reached at svsantana@SunSentinel.com or 954-356-4631.
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<urn:uuid:e776f1c3-a084-4f5b-8891-064499cf98b4>
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http://articles.sun-sentinel.com/2009-07-04/news/0907030104_1_veterans-day-veterans-affairs-justice-system
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Ahhh!!! Could it be??? My bf and I have been trying for a little over a year now. This is my 3rd cycle on 100MG Clomid. Today is 6dpo and just a half hour ago, I went to the bathroom. After wiping... there was PINK on the toilot paper.... Just pink!!!! Could it be IB???? It's wasn't heavy or anything.. just pink when I wiped.
OOh I'm soo excited - I thought I was OUT alrdy b/c at 1dpo, I wiped a bit of pink as well... I googled it, and I found that it could have been what they call Ovulation Spotting and its actually a good sign of fertility!
After almost 9 years of trying - I've never had pink spotting at 6dpo... I really really hope this is it...
Hi! I am not at 6 days yet but I too had light pink on the toilet paper the first day I had a positive ovulation test. Fertility friend thinks I ovulated the following day though (I honestly think I ovulated late Thursday/early Friday). It was quite alarming as I never had it before. It wasn't blood. Almost like a hue or tint. We had sex the night before so it could very well be attributed to that. We'll see!!
I had blood streaks in my CM when I wiped at what MyMonthlyCycles said was 4dpo, but I'm thinking now that I might have O'd later than it said. I felt a sharp cramp like feeling on my left hand side while laying in bed in the morning, then the blood tinged CM was in the afternoon. I had some more blood streaks in my CM again 5 days later.
Any opinions, advice, statements or other information expressed or made available on BabyandBump.Momtastic.com by users or third parties, including but not limited to bloggers, are solely those of the respective user or other third party. They do not reflect the opinions of BabyandBump.Momtastic.com and they have not been reviewed by a physician, psychologist or parenting expert or any member of the BabyandBump.Momtastic.com staff for accuracy, balance or objectivity. Content and other information presented on BabyandBump.Momtastic.com are not a substitute for professional medical or mental health advice, counseling, diagnosis, or treatment. Never delay or disregard seeking professional medical or mental health advice from your physician or other qualified health provider because of something you have read on BabyandBump.Momtastic.com. BabyandBump.Momtastic.com does not endorse any opinion, advice, statement, product, service or treatment made available on the website. If you think you have a medical emergency, call your doctor or emergency services immediately.
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<urn:uuid:07da3721-2605-4a38-ae07-f42a62f9cb46>
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http://babyandbump.momtastic.com/two-week-wait/941003-6-dpo-implantation-bleeding.html
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Friday, July 27, 2012
Petra Anderson is a name landing in headlines as the young woman appears to be making an amazing full recovery after being shot multiple times during the Aurora, Colorado shooting.
Anderson, age 22, was at the midnight premiere of "The Dark Knight Rises," when James Holmes opened fire, shooting the aspiring music professor four times in the crowded theater, the Associated Press reports.
Three shotgun pellets hit Anderson's arm and another went through her nose, riding up the back of her cranium and hitting the back of her skull.
"Her injuries were severe, and her condition was critical…The doctors prior to surgery were concerned because so much of the brain had been traversed by the bullet," Anderson's pastor, Brad Strait, wrote in his blog.
Strait, who was in the hospital during the young woman's surgery, added that doctors were worried that Anderson's injuries could impair her speech, motor and cognitive abilities.
But incredibly, during the five-hour surgery, doctors soon found that Anderson's brain sustained very little damage and the pellet was removed cleanly.
According to Strait, Anderson was saved by a miracle birth "defect" that no one could have anticipated.
The doctor explains that Petra’s brain has had from birth a small “defect” in it. It is a tiny channel of fluid running through her skull…Only a CAT scan would catch it, and Petra would have never noticed it.But in Petra’s case, the shotgun buck shot…enters her brain from the exact point of this defect. Like a marble through a small tube, the defect channels the bullet from Petra’s nose through her brain. It turns slightly several times, and comes to rest at the rear of her brain. And in the process, the bullet misses all the vital areas of the brain.
Anderson has already started to speak and walk again -- is expected to make a full recovery.
"She could have lost all kinds of function (if) the bullet traversed her brain," her mother Kim Anderson told the Sacramento Bee. "I believe that she was not only protected by God, but that she was actually prepared for it."
To support the young woman and her family, the Hope Rises Relief Fund has started a campaign for the Andersons. So far, more than $32,000 has been raised.
Anderson's injury has come at a difficult time for the young woman's family. Her mother is battling terminal breast cancer and the cost of medical bills for both women has proven to be a daunting challenge.
“If the pellet had wavered a millimeter, really in any direction from what it actually took, then she would have likely either died or been severely injured,” said Dr. Michael Rauzzino, a neurosurgeon at The Medical Center of Aurora who operated on Anderson to remove the pellet. “I would say this is definitely a miracle,” he said, while showing an MRI of Anderson’s brain.
The MRI reveals a faint trace of the pellet’s path after it entered the left side of Petra's nose, broke through the front
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<urn:uuid:5fd01ae4-2dfc-4392-b594-85449e45e851>
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http://brandon7221.blogspot.com/2012_07_01_archive.html
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9e350b498fd94896c19df69b78758724420c791be7cded675c3d4899d4fa293d
| 1,752,484,216.889515
|
Use quotes to search an exact phrase: e.g. "occult fiction"
Use * or ? to search for alternate forms of a
word. Use * to stand for several characters, and ? for a single
character: e.g. optim* will find optimal, optimize or optimum; wom?n
will find woman and women.
Use AND and OR between words to combine
them with Boolean logic: e.g. (heart OR cardiac) AND surgery will find
items about heart surgery or cardiac surgery. Boolean terms must be in
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<urn:uuid:3050f686-4058-4a58-98e2-7336729bb38a>
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http://catalog.hathitrust.org/Record/001486213
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en
| 0.715459
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70b52280bdca436ad31e3e4461466a7009d6ca24f033b4d2440cb7ab25d5b8e6
| 1,752,484,217.127355
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Welcome to the Child Health in the 21st Century Website. This site is currently for the use of the Child Health in the 21st Century working group, to document progress on the four goals that were identified in the November 17 - 18, 2006, workshop proceedings.
This site identifies the four goals and 19 objectives from the proceedings and provides the working group with an opportunity to identify work that has been completed or is in progress, that contributes to these goals. Projects and other work identified here does not necessarily indicate work done by this committee. The work identified here reflects any work, projects, or other resources that would be seen as useful to, or relevant to, individuals who may read the Child Health in the 21st Century proceedings and are interested in how this work ties in with other activities in the child and youth health sector.
The authors have attempted to assure the information contained in these pages is accurate however we cannot be sure that we might have included something that is not correct . The information contained in these webpages may have some inaccuracies or be out of date. We would greatly appreciate receiving any comments, updates, information on other relevant activities or corrections you might have.
Goal 1:To promote the best healthcare services for all infants, children and youth in Canada.
Goal 2:To promote the improved health and healthcare of vulnerable infants, children and youth including, but not limited to, those of aboriginal descent, new immigrants, those living in poverty, those who are maltreated, and those living with chronic illnesses or disabilities.
Goal 3:To improve access to mental healthcare services for infants, children and youth.
Goal 4: To improve healthcare that is provided to infants, children and youth through interdisciplinary cooperation and collaboration.
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<urn:uuid:936862de-2f03-4c13-b3c9-4388a0aed869>
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http://childhealth21.caphc.org/
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2013-05-18T05:26:54Z
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| 0.954504
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| 0.601115
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142ec1e83967b9370a50fdcdcb7ac7be92cca9cdbbe66bd21b444ec55677ae85
| 1,752,484,217.218551
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Center for Inflammatory Bowel Disease Treatment and Research
Corticosteroids (Prednisone, Prednisolone)
Generic Names: prednisone, methylprednisolone
Brand Names: Solu-medrol, Medrol, Deltasone, Orapred
Drug Class: Corticosteroid
What do these medications do?
Corticosteroids are used to treat patients with active Crohn’s disease or ulcerative colitis. Corticosteroids decrease inflammation in the lining of the intestine by suppressing the activity of the immune system. These medications are effective in treating about 80% of patients with Crohn’s disease and ulcerative colitis, and patients will typically experience a reduction of symptoms within 1-2 weeks. Because of the potential for long term side effects, corticosteroids are usually given at full dose for a short period of time, and then the dose is gradually reduced.
What are the side effects?
Most side effects of corticosteroid use are temporary and resolve once you/your child stops taking this medication. The effects are variable from patient to patient. The most common side effects include:
- Weight gain
- Puffy cheeks
- Mood disturbances
- Sleep disturbances
Less common side effects include acne, stretch marks, or hair growth. Rare side effects of corticosteroids include stomach ulcers, headaches, or cataracts. Because corticosteroids suppress the activity of the immune system, they can also increase the risk that patients will have complications of certain infections, especially viral infections like chicken pox or mononucleosis (mono)*. However, most patients taking corticosteroids have no problem managing routine illnesses, including colds, earache, or strep throat.
Long-term use of corticosteroids can lead to decreased growth and bone thinning, which can cause an increased fracture risk and/or hip pain. For this reason, physicians typically prescribe them on a short term basis to get the inflammation under control quickly during times of disease flare.
You should never stop taking corticosteroids abruptly! Your doctor will discuss how to gradually taper your dose over many days. This gradual reduction will prevent a serious side effect known as adrenal insufficiency. Taking steroids affects the adrenal gland’s ability to produce a hormone known as cortisol which helps your body deal with physical stress. Therefore, you should tell your doctor or emergency personnel if you/your child needs surgery or is involved in an accident because you may need a stress dose of steroids.
*You should report fever or any signs of infection to your doctor immediately.
How to take your medication and miscellaneous facts:
- Corticosteroids can be given by mouth or through the vein (IV).
- You should take this medication at the same time everyday, preferably in the morning if taken once a day.
- You should take this medication with food to reduce GI upset. • While taking this medication, you may also need to take an antacid medication to help prevent stomach ulcers.
- If you miss a dose, take it as soon as you remember.
- Check with your doctor or nurse practitioner before starting any new medications, herbs, or vitamins while taking this medication.
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<urn:uuid:e87cfff0-e63d-4806-aa70-e52e5eb3ac49>
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http://childrenshospital.org/clinicalservices/Site1966/mainpageS1966P68.html
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| 0.908941
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| 0.885339
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a5b642a8eeb5aceae78c4d6a4016986c085ba8eb2e3b5ebfddc2c05a3ddcb816
| 1,752,484,217.222923
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Inherited Metabolic Disease Clinic
The Inherited Metabolic Disease Clinic at Children's Hospital & Medical Center provides specialized medical expertise for the diagnosis and treatment of pediatric inherited metabolic diseases in Nebraska and the surrounding region. Inherited metabolic diseases are genetic disorders of metabolism, also known as inborn errors of metabolism. There are hundreds of inherited metabolic diseases in children, each individually rare, but together accounting for about one in 1,000 children in this country. The Inherited Metabolic Disease Clinic at Children's treats approximately 400 patients a year, helping many of these patients effectively manage their disease.
The clinic medical director is William Rizzo, M.D., a pediatrician, board certified in medical genetics and biochemical genetics. Richard Lutz, M.D., a pediatrician who specializes in medical genetics, endocrinology and metabolism, is medical director of Children's Bone Metabolism Clinic. There are just three medical geneticists in the state with expertise in inherited metabolic diseases.
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<urn:uuid:33c912ea-7c30-4068-88d9-01faec8cf7f0>
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http://childrensomaha.org/MetabolicDiseaseClinic
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2013-05-18T06:20:37Z
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| 0.950283
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36db7c661891fde903ed3d6cddab65a14ffde0fcb1967f78e0d559d498f3ad24
| 1,752,484,217.22365
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Genomic/ Proteomic/ Metabonomic Profiling in Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by progressive airflow obstruction, chronic cough and dyspnoea in advanced stages.
Techniques such as genomics, proteomics and metabonomics, Technologies that aim to identify and quantify the dynamic set of all small molecules and metabolites present in an organism or a biological sample, offer the prospect of efficiently distinguishing individuals with particular diseases. The advantages of proteomics and metabonomics is that it can be carried out on a standard preparation of serum, plasma or urine, circumventing the need for specialist preparation of cellular mRNA required for genomics This methodology is based on mass spectrometry (MS), gas chromatography-mass spectrometry (GC-MS), and nuclear magnetic resonance (NMR) to analyze metabolites. High-performance liquid chromatography (HPLC) may also be applied. Several peak alignment algorithms have been developed to match the chromatograms before applying pattern recognition. Based on the pattern recognition, several potential biomarkers may be found and further identified by MS.. Finally, a number of potential biomarkers will be identified for distinguishing asthma and COPD.
We hope to develop a better understanding of lung disease. Information from these studies will only be used for research purposes, to help develop safer and more effective treatments for asthma and COPD.
Pulmonary Disease, Chronic Obstructive
Procedure: sputum, blood, urine, exhaled breath, lung function
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||A Non Interventional Study to Asses the Utility of Genomic/ Proteomic/ Metabonomic Profiling Approaches to the Classification and Pathological Basis of Inflammatory Lung Disease in Smokers, and ex-Smokers vs. Non-Smokers and Asthmatics|
|National Heart and Lung Institute|
|London, United Kingdom, SW3 6LY|
|Principal Investigator:||Sergei A Kharitonov, MD PhD||National Heart and Lung Institute|
|
<urn:uuid:f1b34362-4009-41b0-a1a4-5d9931781b62>
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http://clinicaltrials.gov/ct2/show/NCT00655694
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2013-05-18T06:51:50Z
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CC-MAIN-2013-20
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en
| 0.851548
| 454
| 19
| 0.935681
|
afa0e769a6962f20658b7d0b879bb2e5879a9dd2eb2e1745d263c045e4f19e7e
| 1,752,484,217.314107
|
Multicenter Study on Fibrotic Valvular Heart Disease in Patients With Parkinson's Disease Treated With Dopamine Agonists
Fibrotic valvular heart diseases are known as rare complications of long-time therapy of Parkinson's disease with ergot-derivatives including some ergot-dopamine agonists. The aim of this study is to assess the incidence of valvular heart disease, which may be an ergot-drug agonists side-effect or an overall complication of all dopamine agonists. Incidence, prevalence and addiction of dose or intake duration are not known so far. The reversibility of the changes is unknown too. To answer these questions the present study is designed as a cross sectional study followed by a 2 year follow-up prospective cohort study.
Heart Valve Diseases
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||A National, Multicenter Study on Fibrotic Valvular Heart Disease in Patients With Parkinson´s Disease Treated With Dopamine Agonists|
|Study Start Date:||March 2005|
|Estimated Study Completion Date:||December 2013|
Rare incidence of pleuropulmonary and retroperitoneal fibrosis are known complications during the long-time therapy of Parkinson's disease (PD) with ergot-drug derivatives including some ergot dopamine agonists. Particularly the appearance of fibrotic valvular heart disease of Parkinson patients under Pergolide therapy caused an intense discussion about the safety of dopamine agonists at all. Single case reports of similar heart valve changes under the therapy of Bromocriptin and probably Cabergoline pointed to an effect of the whole substance class of the ergot-dopamine agonists.
Cross-Sectional Study (part I):
Within this study an initial cross-sectional analysis of the prevalence of fibrotic heart valvular disease will be done. Patients with Parkinson's disease with different exposition status will be recruited. An transthoracal echocardiographic examination (TTE) of the heart will be performed.
- patients with ergot-derived dopamine agonists
- patients with non-ergot-derived dopamine agonists
- After the TTE-report the study population is divided in affected (= pathological TTE-report: fibrotic valvular heart diseases) and healthy persons (= non-pathological TTE-report: no fibrotic valvular heart diseases). The therapy with dopamine agonist will be stopped in patients with a pathological TTE-report. Instead these patients will be treated with an equivalent dose of L-Dopa with or without COMT-inhibitors. The existing therapy regime will remain in patients without pathological findings.
Longitudinal Section (part II and III):
The cross-sectional study (part I) is followed by a two year follow-up study.
- patients with pathological TTE-report: fibrotic valvular heart disease
- patients without pathological TTE-report: no fibrotic valvular heart disease
Part II: Within cohort I the reversibility of fibrotic valvular heart disease will be analysed with regard to the previously taken cumulative dose of dopamine agonists.
Part III: Within cohort II there will be a prospective analysis of the (cumulative) incidence of fibrotic valvular heart disease in PD patients with different exposition status. If fibrotic valvular heart disease occurs, a patient will be changed from cohort II to cohort I.
Cross-sectional study (part I):
- What is the prevalence of fibrotic valvular heart disease in PD patients under therapy with ergot-derived dopamine agonists and non-ergot-derived dopamine agonists?
- Is there an influence to the cumulative dose of dopamine agonists?
Longitudinal study (prospective cohort study):
- (Part II) Is fibrotic valvular heart disease under therapy of ergot-derived dopamine agonists and non-ergot-derived dopamine agonists reversible?
- (Part III) What is the (cumulative) incidence of fibrotic valvular heart disease under the therapy of ergot-derived dopamine agonists and non-ergot-derived dopamine agonists?
|Contact: Karla Eggert, Dr.||+49 (0)6421 firstname.lastname@example.org|
|Contact: Wolfgang M. Oertel, Prof. Dr.||+49 (0) 6421 email@example.com|
|Universitätsklinikum Marburg und Gießen, Neurologische Klinik||Recruiting|
|Marburg, Hessen, Germany, 35033|
|Contact: Wolfgang H. Oertel, Prof. Dr. + 49 6421- 28 66278 firstname.lastname@example.org|
|Contact: Karla M. Eggert, Dr. + 49 6421- 28 65443 email@example.com|
|Principal Investigator: Wolfgang H. Oertel, Prof. Dr.|
|Principal Investigator: Karla M Eggert, Dr.|
|Study Chair:||Wolfgang Oertel, Prof. Dr.||Universitätsklinikum Marburg und Gießen|
|
<urn:uuid:902618a3-19ab-441e-80d0-dfb010d901a7>
|
http://clinicaltrials.gov/ct2/show/study/NCT00196898?show_desc=Y
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2013-05-18T06:52:03Z
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en
| 0.771007
| 1,150
| 50
| 1
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f932036ac3d910034dbd146af2e030d33d4a2767da1fc4a231ad632e74da361a
| 1,752,484,217.31728
|
The jobs of four elected Oneida County coroners are on the chopping block.
This comes after the Health and Human Services Committee has voted to abolish the corner system and replace them with a single appointed medical examiner.
The Oneida County Executive says the county needs a more efficient and accountable system.
But, one coroner says the County hasn't given him a chance to suggest improvements.
"The system is broken. We can fix it. Give us a chance," said David Julian, one of the four coroners.
Julian says he isn't too happy about the recent six to three vote to abolish the coroner's system and instead appoint a medical examiner. The only real difference between the two is that an medical examiner can actually perform autopsies.
But, Oneida County Executive Anthony Picente says the system has been an on-going issue for a number of years.
"It's about the process it's about the system that is in place. I believe the system is inefficient. No one is in charge," explained Picente.
Mr. Picente says the job requires a high level of supervision. He says it's not about the coroner's performance. Picente says a requirement of good documentation in the terms of cause of death, investigations and how it all gets processed are all factors that fall into play.
"I think it's about taking the next step into the 21st century into a medical examiner vs. the antiquated four coroners," said Picente.
But, David Julian says Picente is not giving them a chance to improve the coroner's system.
"I came on board and asked to be a help to make this more efficient. I was shut out of the county executive office," said Julian.
Mr. Julian says if the County decides to change the system they will be losing money, instead of saving it.
He says he has been thinking of various ideas like appointing a head coroner as well as finding an office for the coroners to make the job run more smoothly.
The County Executive says making the switch is not a savings or added expense.
Mr. Picente says the legislation must go through the Ways and Means Committee in order for the full Board of Legislators to vote on it come May.
|
<urn:uuid:3c29b9f2-fc36-43d2-a080-ba43dc3c4b73>
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http://cnyhomepage.com/fulltext?nxd_id=150702
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2013-05-18T05:59:08Z
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en
| 0.968041
| 461
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| 0.642002
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55ab42771b25928c1b99b1e1b2fa7fc7bc429f6daa8dc16379d16de810951ff7
| 1,752,484,217.358536
|
View Full Version : Went to the doctors office today....
13-03-09, 04:57 PM
And got some really bad news.
As some of you know, I was diagnosed with kidney problems. I was given treatment with medications and a dietplan, but to no avail
The treatment was unsuccessful, and now I face the prospect of maybe having to go through dialysis or even a transplantation. My doctor wants to go for a final option, which might hold me being hospitalized for some days on end, with another big dose of Prednison's big cousin running through my system. But the doc thinks this might not work at all...
So...well...anyone wanna donate a kidney?
13-03-09, 06:46 PM
oh shit oh shit oh shit
Thats really really bad. OMG. Are you going to die Enthilza?
I know I like CDG, but i don't want YOU to be a CDG, not yet no no no man!
13-03-09, 07:02 PM
Entilzha is not going to die feetboy, One of my mates, two years ago had the same prognosis with his kidney problems, yes he had a tough time for 8 months with the heavy duty medication and the trips to the hospital twice a week for dialysis and after being told he might have to wait up to 5 years for a suitable transplant, he did get very depressed, but now only two years on he has had his transplant is fit and healthy and is getting married in july, so stay posotive, things will turn out fine i'm sure. All it takes is time. P.S. YES I said he's getting married, unfortunatly he is straight and after his illness he lost a lot of weight and is fit as fuck and has a realy cute ass - for a straight guy.
13-03-09, 11:26 PM
ho no!!! sad! sad! sad!....hope you get better.
14-03-09, 02:26 AM
i am so sorry, entilzha. don't worry. you are not going to die. there's a saying in Chinese: people who think about death all the time never die easily. you are a necro who love death as much as sex. i am sure you won't die so easily.
17-03-09, 07:13 PM
Go Entilzha (http://cutedeadguys.1stfreehosting.com/forums/member.php?u=4) man for that final option your doc suggested, you are young and strong, I am sure you will make a full recovery.
Be patient and think positive, sometimes it takes months but you will get over this shit.
Keep us updated.
Powered by vBulletin® Version 4.2.1 Copyright © 2013 vBulletin Solutions, Inc. All rights reserved.
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<urn:uuid:fed8c338-e5c5-4d29-a6c1-45db4cde8e39>
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http://cutedeadguys.net/archive/index.php/t-1991.html
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2013-05-18T05:53:58Z
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CC-MAIN-2013-20
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en
| 0.964136
| 618
| 12
| 0.61973
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bc845d8bc12fdfe3427e87d6fc07603c094f8ad933a6edf3d7cbf0542c9e6693
| 1,752,484,217.678448
|
Date: June 29, 1962
Creator: Yakowitz, Harvey, 1939-
Description: Report presenting a bibliography of about 550 references of the soft X-ray literature since 1950 and through 1960. The emphasis is on the application of soft X-ray spectroscopy to the study of valence band electronic states in metals and alloys. Therefore, the spectral region of 25 to 800 angstroms involving ruled glass grating spectrometers is of principal interest. In addition to soft X-ray data, references on all pertinent aspects of the apparatus and experimental problems are included. Also listed separately are references of value in corroborating soft X-ray data with other results. Subject, author, X-ray band, material, and other indices are included.
Contributing Partner: UNT Libraries Government Documents Department
|
<urn:uuid:44bdc37e-6a34-4b8a-9b81-ef997b034330>
|
http://digital.library.unt.edu/explore/partners/UNTGD/browse/?fq=untl_decade%3A1960-1969&fq=str_title_serial%3ANBS+monograph&fq=untl_collection%3ATRAIL
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2013-05-18T07:26:10Z
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CC-MAIN-2013-20
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en
| 0.897448
| 166
| 5
| 0.657062
|
84643e67d568a83c6b62fa6c86aa851ad9da79db6068d4afad158f01c55b2353
| 1,752,484,217.893249
|
Children of substance abusers: Observations and their mothers' reports of childrearing practices
The widespread use of drugs includes women who are mothers and of childbearing age. A review of the literature shows that women who are substance abusers suffer from depression, low self-esteem, have poor health and nutrition, and histories of family violence and abuse.^ During pregnancy, addictive women often lack prenatal care. In utero exposure to drugs is associated with multiple postnatal outcomes which include prematurity, low birth weight, neonatal abstinence syndrome, and Acquired Immunodeficiency Syndrome (AIDS). Intelligence testing found that the children scored within the normal range but significantly lower than the children of drug-free controls.^ Conflicting views on the parenting of mothers who are substance abusers exist. Deprived and poorly nurtured in childhood themselves, they feel inadequate as parents. However, they love their children, are capable of learning developmental issues of childhood, and can respond with sensitivity to their needs.^ The purpose of this study was to examine the child-rearing attitudes and parental style of addicted mothers and the impact of their drug use, parental attitudes, and demographic variables on their interactions with their children. Forty-four mothers, forty-one drug users and three non-drug users, and nineteen infants participated in the study. Participants attended the Infant and Toddler Schools of the Center for Comprehensive Health Practice, Inc. Subjects completed the demographic sheet and the modified Child-Rearing Practices Report (CRPR). The child data was obtained from the agency and included the scores of the Bayley Scales of Infant Development, the Checklist for Caregiver-Infant Observation, and the Home Observation for Measurement of the Environment-Short Form (Home-SF). Generally, greater parental control and less expression of affection were adhered to as values by the participants of the study. Correlations as a function of drug usage and demographic variables suggested that the participants held both sound and inappropriate child-rearing attitudes. Length of treatment and the age of the youngest child emerged as the demographic variables most related to the parental attitude variables. The children scored within the average range of intelligence, however, the range of variation was highly significant. ^
Health Sciences, Mental Health|Women's Studies|Psychology, Developmental
Sarai Ramona Padilla-Rafalsky,
"Children of substance abusers: Observations and their mothers' reports of childrearing practices"
(January 1, 1993).
ETD Collection for Pace University.
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<urn:uuid:288bae5d-f267-40ac-bd2c-195909577617>
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http://digitalcommons.pace.edu/dissertations/AAI9406436/
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2013-05-18T05:25:04Z
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en
| 0.938669
| 516
| 12
| 0.619149
|
72f606feece5f45bf03d4608600fe44d4ebd7baf99ed777997a93e3fcc672b35
| 1,752,484,217.89717
|
Surgery Lite: Understanding Endoscopic Surgery
When is minimally invasive surgery better than traditional surgery? What are the risks?
It's not often that a surgical technique becomes a national craze. But
endoscopic or minimally invasive surgery has, albeit a minor one. It's in the
newspaper. It's on the lips of your uncle, who can't resist showing off his
tiny scars at every family function. Even on your commute to work, billboards
trumpet the minimally invasive surgery centers at competing local
"For patients, 'minimally invasive' are the hot buzzwords," says
Michael Argenziano, MD, director of minimally invasive cardiac surgery and
arrhythmia surgery at New York Presbyterian Hospital. "And surgeons are
responding to their patients' demand. I don't think that there's a single
surgical field that hasn't tried some sort of minimally invasive
While the term is pretty vague, "minimally invasive" - or endoscopic
or "keyhole" surgery - generally means operations that are less
traumatic than traditional surgery. By using special instruments, the approach
can allow for smaller incisions, quicker recovery, and fewer side effects.
Since it was first used in the late 1980s, minimally invasive surgery has
changed the standards for how many operations are done.
It makes intuitive sense to patients. Why get cut open if you can avoid
But minimally invasive surgery isn't right for everyone. Despite what you
hear, "minimally invasive" doesn't always mean "better."
"People have this idea that minimally invasive surgery is not painful or
that it's not really surgery," says Marshall Z. Schwartz, MD, professor of
surgery in pediatrics at St. Christopher's Hospital for Children in
Philadelphia. "Neither is true. It's not Star Trek technology, where we
wave a wand over someone and they're healed."
Getting the Facts on Minimally Invasive Surgery
When it comes to deciding whether to get minimally invasive surgery, the key
is to make an informed decision.
|
<urn:uuid:cad525bb-58bd-4a5c-97d8-bf20285b4ebc>
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http://doctor.webmd.com/local/texas/dallas/surgeons.htm
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2013-05-18T07:18:15Z
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| 0.946317
| 440
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| 1
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3e9228eb24db599c93c8f2dd3cd3d55046257a717e308fb69130131a20c306a7
| 1,752,484,217.974297
|
Although uncommon, an entirely different group of factors plays a role when an athlete suffers a stroke.
Head and neck trauma are often factors in stroke during athletic competitions. Direct head trauma can result in leakage from blood vessels, depriving large regions of the brain of necessary nutrients.
Violent forward and backward movement of the head can result in tearing the inner lining of vital arteries responsible for directing blood to the brain. This condition, known as arterial dissection, can form a clot within the affected blood vessel or become a source of small clots. These smaller clots often move toward the brain as emboli and block other arteries.
Treatment for arterial dissection involves the use of blood thinning medications and avoiding violent collision sports.
Another common risk factor for stroke in athletes is the existence of a patent foramen ovale (PFO). A PFO is a hole between the upper chambers of the heart, the right and left atria. The foramen ovale forms in the fourth week of embryonic development and should close in the first three months after birth. When it does not close, it is considered patent or open.
This abnormal channel allows direct passage of blood clots to the brain. These clots often originate in the legs and may result from immobilized lower extremities.
PFOs can be treated with equal success by surgical closure or blood thinning medications. Athletes appear to do better with surgical closure and usually make a full recovery to return to sports.
While considered rare, strokes do occur in athletes and treatment requires a different approach.
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Tables with many operations feel cluttered and focus is lost on the most common operation(s). For example, in the Views interface there are 4 possible operations, but "enable" is the most commonly used.
Used to group related operations, most commonly used in tables. Other interfaces where there are multiple operations with one clear primary operation may also benefit from the drop button pattern.
- Choose a sensible primary operation, the 80% operation. Often this is "edit".
- Keep the task link text short; preferably 1 to 3 words.
- Avoid similar labels such as "Edit menu" and "Edit menu links".
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Survey data is a snapshot of a population, a moment captured in numbers, like vital signs: height, weight, temperature, blood pressure, etc. People build trend lines and watch for changes, shifting strategies as they make educated guesses about what’s going on. What’s holding steady? What’s spiking? What’s on the decline?
Just as a thermometer makes no judgment, the Pew Research Center provides data about the changing world around us. We don’t advocate for outcomes or recommend policies. Rather, we provide an updated record so that others can make those pronouncements and recommendations based on facts.
The latest in our health research series is being released today. Health Online 2013 finds that internet access and interest in online health resources are holding steady in the U.S. For a quick overview, read on…
What is new?
1 in 3 U.S. adults use the internet to diagnose themselves or someone else – and a clinician is more likely than not to confirm their suspicions. This is the first time we – or anyone else – has measured this in a straightforward, national survey question.
1 in 4 people looking online for health info have hit a pay wall. This is the first data I know of that begins to answer the important question: what is the public impact of closed-access journals?
We added three new health topics:
- 11% of internet users have looked online for information about how to control their health care costs.
- 14% of internet users have looked online for information about caring for an aging relative or friend.
- 16% of internet users have looked online for information about a drug they saw advertised.
(A full list of all the health topics we’ve included, 2002-10, is available here.)
What has changed?
The percentage of people who have consulted online reviews of drugs and medical treatments dropped (and I don’t know why — do you have a theory? Please post a comment.)
Related: why aren’t health care review sites catching on? Pew Internet has tracked a boom in consumer reviews of other services and products — why not health care?
What to keep an eye on?
One of my favorite survey questions is asked of all adults and attempts to capture a broad portrait of health care resources that someone might tap into when they’re sick.
It’s a useful question for keeping online resources in perspective. I think it’s also going to prove useful in the coming years as the landscape shifts and people have more opportunities to connect with clinicians online. How fast will that ”Yes, online” group grow? Or will care always be hands-on at its core — and therefore we should see growth in the “Yes, both” category?
Speaking of keeping things in perspective, I think it’s important to remind ourselves that there are pockets of people who remain offline. Internet access drives information access.
Here’s a table from the Appendix that digs even deeper:
In other words, 64% of college educated adults in the U.S. have researched a specific disease online, compared with just 16% of U.S. adults who have not completed high school.
These are just a few highlights — please read the report, ask questions, and tell us what you think: How’s the patient doing, based on this new set of vital signs? What do you prescribe?
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The landmark Sheraton San Marcos Resort and Country Club in Chandler, known to attract the rich and famous, has been shut down since Tuesday after the discovery of a potentially fatal bacteria that infected an elderly man.
Management for the historic hotel brought in an environmental testing service after they were recently served legal papers charging that an elderly man contracted Legionnaires’ disease while staying at the resort.
The man, who does not live in Arizona, stayed at the country club about six months ago, said Gary Stougaard, executive vice president for Sun Stone Hotel Properties. Stougaard said he does not know how many people have stayed at the resort in the past six months, but added there are no reports of guests falling ill with the disease.
The popular hotel and golf resort learned Tuesday that a boiler in the east wing of the resort tested positive for Legionella pneumophila, a bacteria that can cause Legionnaires’ disease. Stougaard would not say why information was not released to the public sooner.
San Marcos reported the detection of Legionella to the Maricopa County Department of Public Health on Thursday, said Doug Hauth, spokesman for the department.
Since then, the department has been looking through records for reports of Legionnaires’ disease from doctors’ offices or medical facilities over the past six months. But so far, no reports have been found, he said.
The possible exposure at San Marcos could be an isolated incident, Hauth said. Infected people would have reported the flulike symptoms and pneumonia associated with the illness, which appear within 10 days, he said. Full-blown Legionnaires’, which is what the man reported to San Marcos, lands people in the hospital.
"If it had been a true outbreak, you would have known by now," Hauth said.
Legionellosis, commonly known as Legionnaires’ disease, can develop from exposure to the common bacteria, Legionella. Infection occurs through the respiratory system, according to the U.S. Centers for Disease Control and Prevention.
Those with compromised immune systems, middleaged and older people, and smokers are most susceptible to the disease, which infects 8,000 to 18,000 people in the United States each year. An estimated 5 percent to 30 percent die from Legionnaires’, according to the CDC.
Reports of the disease are rare in Arizona, Hauth said.
Employees have continued to work at the resort. A hotline, staffed with health professionals, has been set up for them.
A similar hotline for visitors has not been set up, Stougaard said. And there is no effort under way to contact former guests, he added.
Hotel guests were quickly relocated after learning of the bacteria, Stougaard said. Testing continued throughout the resort, which will remain closed until it is safe to reopen, he said. He did not know how many people were staying at the resort when they temporarily closed their doors, but he estimated that the building was 30 percent to 40 percent full.
Environmental crews will "superheat" the water in the boiler that pumps chlorine through the plumbing system for two days to kill the bacteria, Stougaard said. After disinfecting the boilers, health crews will conduct more tests to determine if the resort is safe to reopen. Stougaard said he expects the hotel to be back in business within 10 days.
The San Marcos Resort, which has lost some of its luster over the years, has spent $6 million renovating itself into one of the East Valley’s historic jewels.
Legionnellosis, or Legionnaires’ disease
• Infects 8,000 to 18,000 people in the United States each year
• Symptoms include fever, chills and cough.
• Bacteria is found in many water systems.
• Exposure comes from breathing bacteria-contaminated mists from a water source.
• Disease is not spread from person to person.
• Time between exposure and onset of disease is two to 10 days.
• Recommended treatment is the antibiotic Erythromycin. Source: U.S. Centers for Disease Control and Prevention
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The staff and volunteers of Grace Clinic would like to offer heart-felt thanks to you, our community, for your fantastic support of our recent Soup Sale.
We were absolutely blown away by the amount of resource donations from local businesses, from the media, local restaurants, churches, HCMH, the Elkin High School Interact Club and from the many volunteers who made our soup sale possible. Thanks to all of them and all of you who came to buy soup!
As this was our first soup sale, we underestimated the crowd of local soup-lovers and apologize to those of you we had to turn away after all the soup was gone. We promise to work hard to have more soup next year and so appreciate your support.
Grace Clinic provides medical care for those without health insurance, helping our community be a healthier one. God bless all of you who once again demonstrated that this is a community that supports its most vulnerable.
Bob Spencer is the executive director of the Grace Clinic.
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Información sobre riesgo, prevención, detección, síntomas, diagnosis, tratamiento y apoyo para el cáncer.
Información sobre el tratamiento del cáncer incluyendo quirúrgica, quimioterapia, radioterapia, estudios clínicos, terapia con protón, medicina complementaria avanzadas.
OncoLink se complace en ofrecer una amplia lista de lista completa de los agentes quimioterapéuticos más comúnmente usados??. Esta guía de referencia incluye información sobre la forma en que cada fármaco se administra, cómo funcionan, y los pacientes los efectos secundarios comunes pueden experimentar.
Maneras que los pacientes de cáncer y las personas que le cuidan puedan enfrentar el cáncer, los efectos secundarios, nutrición, cuestiones en general sobre el apoyo para el cáncer, duelo/decisiones sobre el termino de vida, y experiencias compartidas por sobrevivientes.
S. Jack Wei, MD
Updated by: Lara Bonner Millar, MD
The Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 12 de diciembre del 2011
The pituitary gland is a small gland, approximately the size and shape of a pea. It is located between the eyes, behind the bridge of the nose, just below the brain. The pituitary lies within a bony depression in the skull called the sella turcica, which sits below the optic chiasm, the area where nerves from the eyes (the optic nerves) cross and enter the brain. It is often referred to as the "master" gland of the body, because it produces hormones (proteins that are released into the body that influence the function of other organs) that control several other glands throughout the body, including the thyroid gland, the adrenal glands, and the sex organs (ovaries and testicles). The pituitary gland is divided into two main portions: the larger anterior pituitary (at the front) and the smaller posterior pituitary (at the back). Each of these portions has different functions, producing different types of hormones. It is rare for tumors to develop in the posterior lobe of the pituitary gland.
The pituitary itself is controlled by another gland called the hypothalamus, which sits just above the pituitary gland. In response to various signals from the body, the hypothalamus sends hormones directly down a channel to the pituitary gland, telling the pituitary to produce and release its hormones into the bloodstream so they can act on various organs throughout the body.
In the posterior lobe, two different hormones are produced:
In the anterior lobe, several different types of hormones are produced:
Normally, cells in the body will grow and divide to replace old or damaged cells. This growth is highly regulated, and once enough cells are produced to replace the old ones, normal cells will stop dividing. Tumors occur when there is an error in this regulation, and cells continue to grow in an uncontrolled manner. Tumors can either be benign or malignant. Benign tumors represent uncontrolled growth; however, unlike malignant tumors, they typically do not invade into surrounding tissues or break off and spread beyond where they started. Malignant tumors, however, will grow uncontrolled in such a way that they invade and damage other tissues around them. They also gain the ability to break off from where they started and spread to other parts of the body, usually through the blood stream or through the lymphatic system where the lymph nodes are located.
The vast majority of tumors in the pituitary gland are benign, and most of these are pituitary adenomas (see below). Other types of tumors (both benign and malignant) can develop in the pituitary gland, and these include teratomas, germinomas, and choriocarcinomas. Although malignant cancers can develop in the pituitary gland, they are very rare. In fact, only about 100 cases of malignant pituitary cancer have been reported in the medical literature.
Pituitary adenomas are benign growths of glandular tissue that almost always grow from the anterior lobe of the pituitary gland. Pituitary adenomas can be either non-secreting adenomas, meaning that they do not produce excess levels of hormones, or they can be secreting adenomas, meaning that they produce an excessive level of one or more of the hormones normally produced by the pituitary gland.
There are two general types of pituitary adenomas. Adenomas that are at least 1cm in maximum dimension are called macroadenomas. These can exert pressure on nearby structures due to their increased size. Most commonly, because the pituitary gland sits right underneath the optic chiasm, macroadenomas can affect vision. This usually presents as loss of peripheral vision on both sides, but can also present as other patterns of vision loss. The pressure of pituitary macroadenomas can also lead to headaches, and invasion into nearby nerves can cause other neurologic signs, such as loss of motion of the eye.
Most pituitary adenomas are microadenomas. These are small adenomas, less than 1 cm, in maximum dimension. If these cause symptoms, it is because they produce excessive amounts of hormones, although macroadenomas can also secrete and produce hormones. Depending on which hormones they secrete, the signs and symptoms of these adenomas can differ. For example, prolactin-secreting adenomas can result in milk production from the breast, while growth hormone-producing adenomas can cause acromegaly.
Some adenomas do not produce any symptoms at all. Most of these are found incidentally during the workup of another unrelated problem. Many people may have pituitary adenomas and never know it because they do not have symptoms. In fact, some reports state that up to 16% of people undergoing autopsy after death have been found to have pituitary adenomas that they never knew about because the tumor did not cause any symptoms.
Pituitary adenomas are indolent (slow growing) tumors, which account for 10–15% of all diagnosed intracranial neoplasms (tumors in the brain). Each year, there are approximately 2,000 cases of pituitary tumors in the United States. The cause of most pituitary tumors is unknown, although there may be a genetic factor. For example, there is a mutation in a specific gene that is associated with increased risk for developing pituitary adenomas. Pituitary tumors develop in 30% percent of patients with multiple endocrine neoplasia type 1 (MEN-1). Mutations in the MEN-1 gene are rarely found in sporadic cases (which means cases that do not run in families) of pituitary tumors, but are almost always found in cases of familial pituitary tumors. Patients with MEN-1 are also at increased risk for developing parathyroid and pancreas tumors.
Another gene called gsp may be involved in sporadic cases of pituitary tumor. Mutations in the gsp gene have been found in 10% of non-secreting pituitary adenomas, 40% of pituitary adenomas secreting growth hormone, and 5% of pituitary adenomas secreting ACTH.
Aside from these genetic mutations, no other cause is known for pituitary tumors. Pituitary tumors are not associated with smoking or drinking and have not been linked with any viral infections. The risk of pituitary adenomas does increase with age, and they are slightly more likely to occur in women than men, although the exact reason for this is unknown.
Given that the only known cause of pituitary adenomas is genetic mutation, there are no specific interventions that would be expected to reduce the risk of pituitary tumor formation.
Most pituitary adenomas are discovered because they produce symptoms, either from direct pressure due to their large size (in the case of macroadenomas), or due to the hormones that they secrete. Occasionally, pituitary adenomas are detected when the brain is imaged for an unrelated reason. When a pituitary adenoma is suspected, the physician should perform a thorough history and physical examination. The physical exam should consist of a complete neurologic evaluation and examination for signs of excessive hormone secretion.
A number of blood tests can be performed to look for excess production of hormones. Often, these hormones can be measured directly from a blood sample, although in some cases, additional tests are needed to distinguish if abnormalities on a blood test are due to a pituitary tumor or due to some other cause. Many of these tests are specific to the hormone that is being produced. These tests include a glucose suppression test used to detect pituitary adenomas that produce growth hormone, and a cortisol-stimulation test used to distinguish if abnormal blood cortisol levels are due to a secreting pituitary adenoma or due to a problem in the adrenal glands.
In addition to blood tests, imaging of a suspected pituitary adenoma will be ordered. The most common type of imaging used is Magnetic Resonance Imaging (MRI), which uses magnets to produce a very sharp picture of the inside of the head. Despite the high resolution of MRIs, small microadenomas may not be detectable on an MRI. In those cases, the only way to confirm the diagnosis is by obtaining a biopsy or by removing the tumor and examining it underneath a microscope.
Less commonly, Computed Tomography (CT or CAT) scans are used. CT scans use x-rays to form a three-dimensional picture of the inside of the body. The ability to detect pituitary tumors on CT scan is significantly worse than on MRI; however, large macroadenomas can sometimes be seen on CT scan. With the use of modern imaging techniques the diagnosis of pituitary adenoma is increasing.
Ultimately, the only way to confirm a diagnosis of a pituitary adenoma is to examine the tissue underneath a microscope. In most cases of tumors or cancers in other parts of the body, this is done by obtaining a biopsy of the tumor. A biopsy is where a small piece of the suspected tumor is removed (i.e. with a needle, etc.) and examined underneath a microscope. Pituitary adenomas are an exception to this general rule. The accuracy of diagnosing pituitary adenomas through blood tests and radiographic imaging is very good, and often makes a biopsy unnecessary - especially since the pituitary gland is in a difficult area to reach and near a number of critical structures, such as the optic chiasm. Since many pituitary adenomas can be treated without surgery, by using medications or radiation, the issue of accessing this area of the body for biopsy may be irrelevant.
There is no official or widely used staging system for pituitary adenomas. In general, pituitary adenomas are classified as either macroadenomas (larger) or microadenomas (smaller), and by whether they are secreting (adenomas that produce hormones, also called functional) or non-secreting (adenomas that do not produce hormones, also called non-functional ).
Currently, the most common therapy for pituitary adenomas (excluding prolactin-secreting adenomas, also known as prolactinomas) is surgical resection. For non-secreting macroadenomas, surgery removes excess tissue and relieves pressure from the adenoma on surrounding tissues. For secreting adenomas, surgery often results in a rapid drop in the excessive hormone production.
Surgery for pituitary tumors can be performed in several different ways. The most common approach is the transsphenoidal approach. In this procedure, an incision is made on the inside of the upper lip just above the teeth, or along the septum of the nose. The pituitary gland is accessed by cutting through the bond of the sphenoid sinus, which lies behind the nose and just in front of the pituitary gland. For microadenomas, this procedure has high overall cure rates with few complications. Occasionally, this surgery can lead to decreased hormone production from the pituitary gland, leaks of cerebral spinal fluid leading to meningitis, and possible loss of vision. These complications are rare and occur in less than 1% of transsphenoidal surgeries performed by an experienced neurosurgeon. The transsphenoidal approach is less optimal for larger tumors, particularly macroadenomas that are very fibrous or extend too far towards the back of the head.
Recently, more pituitary surgeries have been performed endoscopically. Endoscopic surgery is performed by using a fiberoptic camera (the endoscope) to access the pituitary fossa (usually through the nostril in a transsphenoidal approach). Small instruments are passed through the small hole made by the endoscope and used to remove the pituitary adenoma. This procedure works well for small tumors and has the advantage of being less invasive than a transsphenoidal surgery, with a quicker patient recovery time and a low complication rate. However, this procedure may not be appropriate for larger tumors or tumors that are not in the appropriate position.
For larger tumors with a large amount of extension beyond the normal pituitary gland, a craniotomy can be performed. A craniotomy requires the neurosurgeon to cut through the bones of the skull to access the pituitary gland. Although it may be the only type of surgery possible in some cases, there is a higher risk of neurologic complications and a longer recovery time for the patient as compared to the other surgeries.
With any surgery to the pituitary gland, the development of central diabetes insipidus is fairly common. In diabetes insipidus, the pituitary gland does not produce enough anti-diuretic hormone (ADH), which leads to excessive loss of water in the urine. In most cases of post-operative diabetes insipidus, the problem goes away by itself after one to two weeks. Occasionally, however, this problem can be permanent. Treatment requires taking replacement ADH (also known as vasopressin), usually as a nasal spray.
Radiation therapy can also be used in the treatment of pituitary adenomas, although in the majority of cases, it is not used as the first line of treatment. The radiation comes in the form of high energy x-rays that are delivered to the patient only in the areas at highest risk for cancer. These x-rays are similar to those used for diagnostic x-rays, only of a much higher energy. The high energy of x-rays in radiation therapy results in damage to the DNA of cells, causing the tumor cells to die. Although the overall control of pituitary tumors with radiation therapy is high, radiation does not remove the pressure that macroadenomas can exert on surrounding structures as surgery does, and hormone levels fall more slowly after radiation therapy than they do after surgery. In most cases, radiation therapy is reserved for patients who have disease left behind after surgical resection, for patients who have their pituitary adenoma come back after surgery, for patients whose adenomas are in a location such that surgical resection would carry a high rate of complications, or in patients who are not medically operable.
Standard radiation (also called conventional radiotherapy) for pituitary adenomas is given daily, Monday through Friday, usually for 5 to 6 weeks. The radiation treatments themselves are short, lasting only a few minutes. Like diagnostic x-rays, radiation treatments cannot be seen, heard, or felt, and they do not hurt. Generally, the side effects of treatment are limited to the areas being treated. Most commonly, standard radiation treatment for pituitary adenomas can result in loss of hair and fatigue. Because the pituitary gland sits very closely to the optic nerves and optic chiasm, there is a risk that radiation treatments can cause loss of vision, although this is unusual in the hands of a skilled radiation oncologist. Compared to surgery, patients receiving radiation can experience hypopituitarism, where the pituitary has decreased production of one or more of the hormones that it usually releases. If this occurs, these hormones can be replaced in the form of medication. Finally, although the risk is low, radiation for pituitary tumors may cause cancers to form in the radiation field years after the radiation has been given.
Stereotactic radiosurgery is a way of delivering radiation therapy to brain tumors in a very precise way. Often, this is done in order to treat a tumor with large doses of radiation over a few days, or even in a single treatment, rather than spreading the treatment out over a number of days as is done with standard radiation therapy. When performed in other parts of the brain, this technique can deliver high doses of radiation to a specific area of the brain while reducing the amount of radiation that is delivered to normal, healthy brain tissue. This treatment is generally considered only if the tumor is less than 3 to 4 cm in maximum dimension. Stereotactic radiosurgery has been tried in pituitary adenomas, and compared to standard radiation therapy, it results in more rapid decrease in hormone levels of secreting adenomas. However, because higher doses are delivered with each treatment, a higher rate of complications has been seen with stereotactic radiosurgery, particularly with regards to damage to the optic nerves and the optic chiasm. For this reason, stereotactic radiosurgery is not often used to treat pituitary adenomas. Occasionally, stereotactic radiosurgery can be used in situations where a pituitary adenoma has recurred after previous treatment.
For some pituitary adenomas that secrete hormones, treatment with medication rather than surgery or radiation can be effective, and is often the first treatment tried for these types of adenomas. For pituitary adenomas that produce the hormone prolactin, the medication most commonly used is bromocriptine (Parlodel). Other drugs such as cabergoline (Dostinex), lisuride, and pergolide mesylate have also been used with some success. These drugs are similar to a chemical normally produced in the brain called dopamine that normally prevents the pituitary gland from producing prolactin until it is needed. These drugs result in reduced prolactin production in the pituitary adenoma and can actually lead to shrinkage of the tumor in the majority of patients. The rate at which these tumors shrink in response to medical therapy can be very variable, taking anywhere from days to months. If the medication is stopped, the adenoma will resume producing prolactin and can grow again. Therefore, medical therapy as the only treatment for a prolactin-secreting pituitary adenoma requires lifelong treatment. Approximately 10% to 20% of patients taking bromocriptine experience side effects from treatment. These can include nausea, vomiting, dizziness, low blood pressure, and headaches.
Pituitary adenomas that produce a few other types of hormones can also be treated with medication. Adenomas that secrete growth hormone can be treated with drugs such as octreotide and lanreotide. These drugs can also be used to treat some adenomas that secrete thyroid-stimulating hormone. While these drugs are being used in several studies, surgery still remains the treatment of choice in most of the US for these types of adenomas, with medical treatment reserved for cases where surgical resection has been unsuccessful.
Occasionally, small non-secreting tumors are found in the pituitary gland when a patient is undergoing workup with an MRI scan for an unrelated reason. In these cases, where there are no symptoms from the adenoma, it is reasonable to simply follow these tumors with periodic physical examinations and MRIs.
In general, treatment with a combination of surgery and radiation therapy is used for pituitary carcinoma. These are rare cancers, and unfortunately the ultimate outcome with either of these modalities is often poor, especially in the setting of disease that has spread to other part of the central nervous system (metastasized). Chemotherapy has been tried but has demonstrated little benefit. It is occasionally used to help palliate symptoms from pituitary carcinoma that has metastasized.
Shortly after treatment for functional (secreting) pituitary adenomas, blood will be drawn to measure hormone levels in the body. If the hormone levels have returned to normal after therapy, the main follow-up will be repeat blood draws, measuring for hormone levels every 3-6 months for several years after treatment. MRIs of the head may also be performed as part of follow up for these tumors. For patients who are taking medication to treat a functional pituitary adenoma, follow-up visits to the doctor and blood draws may be even more frequent. In the case of non-functional (non-secreting) adenomas and pituitary carcinomas, follow-up MRIs of the head will be obtained for the first few years.
The side effects of treatment, particularly radiation therapy, may take quite a while to develop, and it is not unusual for new side effects, such as decreased hormone production from the pituitary, to develop several years after treatment. Therefore, it is important to continue regular follow-up with your doctors after treatment. If side effects such as hypopituitarism do develop, you will need to take medications that will replace these hormones.
The treatment of pituitary tumors should be a cooperative effort involving the patient, radiation oncologist, neurosurgeon, and neurologist. It is important that all patients with pituitary tumors know about their disease so that they can make an informed decision about their treatment. This article was intended to help answer some of the common questions patients face when they have a pituitary tumor. If you have any additional questions, please contact your doctor.
Asa SL and Ezzat S. The pathogenesis of pituitary tumours. Nat Rev Cancer 2: 836-849, 2002.
Della Casa S, Corsello SM, Satta MA, et al. Intracranial and spinal dissemination of an ACTH secreting pituitary neoplasia. Case report and review of the literature. Ann Endocrinol 58 (6): 503-9, 1997.
Ezzat S, Asa SL, Couldwell WT, et al. The prevalence of pituitary adenomas: a systematic review. Cancer 101 (3): 613-9, 2004.
Mitsumori M, Shrieve DC, Alexander E 3rd, Kaiser UB, Richardson GE, Black PM, et al. Initial clinical results of LINAC-based stereotactic radiosurgery and stereotactic radiotherapy for pituitary adenomas. Int J Radiat Oncol Biol Phys1998; 42(3):573-80.
Endocrine System Cancers
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Newly Diagnosed Patients
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Cancer Resource List
Resources for Young Adults
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Carondelet Health Network has announced the addition of Dr. Donald Denmark to its senior leadership team in the role of Chief Medical Officer at Carondelet St. Joseph’s Hospital, effective Jan. 10. He will serve as a liaison with the medical staff and
administration in all facets of medical staff affairs and hospital operations.
Denmark comes to Carondelet from the Bay Area after more than two decades of distinguished leadership in healthcare administration, research, academics and family medical practice. Previously, he served as vice president medical affairs of NorthBay Healthcare Group in Solano County, Calif., where he provided expertise on medical staff affairs, healthcare delivery issues, clinical informatics and oversight of its Disease Management Division.
Denmark also served as medical director for NorthBay’s Managed Care Plans, a role that included oversight of the Case Management, Utilization Management and Quality Assurance departments. In addition, he spent 13 years with Integris Health in Oklahoma City, where he served as both medical director and director of clinical
research for the Physician Services division.
“Dr. Denmark will be a wonderful addition to our leadership team. His vast knowledge of medical affairs is integral to our collaboration with our physician partners,” said Odette Bolano, Carondelet St. Joseph’s chief executive officer. “His solid background in utilization and case management will be a key component in our commitment to elevate Carondelet St. Joseph’s to a tertiary facility, where Southern Arizonans can feel confident that all their specialty care needs can be met with the highest quality care.”
Dr. Denmark received his medical education and early training in Canada. He earned his Doctor of Medicine at the University of Alberta, Edmonton, Alberta, and completed a rotating internship and family practice residency at University of Western Ontario/St. Joseph’s Hospital, London, Ontario. Board-certified in Canada and the U.S., he is a fellow of the American Academy of Family Practice and College of Family Physicians of Canada. Dr. Denmark also earned a Masters of Medical Management from Tulane University earlier this year.
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by +Richard Holbrooke – Schwann cells boost and amplify nerve growth in animal models, but their clinical use has been held back because they are difficult, time-consuming and costly to culture.
A University of Sheffield team, led by Professor John Haycock, has developed a new technique with adult rat tissue which overcomes all these problems, producing Schwann cells in less than half the time and at much lower cost.
“The ability of Schwann cells to boost nerve growth was proved many years ago in animals, but if you want to use this technique with patients, the problem is: where do you get enough cells from?” said Professor Haycock, from the University’s Department of Materials Science and Engineering.
“To reduce immune rejection, the cells have to be grown from the patient’s own tissue. Of course, you want to take the smallest amount of tissue necessary, so the technique must be efficient. It must also be fast, so treatment can begin as soon as possible after injury. For clinical use, it must also provide pure Schwann cells. And finally, to make it viable, it has to be at a reasonable cost.”
Existing methods for growing Schwann cells from adult tissue promote the growth of another type of cell, called fibroblasts, which swamp the Schwann cells, reducing the speed they grow and their numbers. This means that large amounts of tissue are needed at the outset, to grow sufficient cells for therapeutic use. It also requires extra purification stages added to the process, making it slow and costly – taking up to 3 months to complete.
Professor Haycock and his team have come up with a very simple solution: feed the Schwann cells but starve the fibroblasts. The research, published today in Nature Protocols, uses an amino acid that only the Schwann cells can break down and feed off, and are able to produce a 97 per cent pure population of Schwann cells in a much shorter space of time – just 19 days – from a small sample of adult tissue.
Professor Haycock is confident the technique can be replicated in humans. His team are trialling the same method using human nerve tissue, with results expected within the next six months.
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2013-05-18T06:43:12Z
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A national accrediting organization has named Twin Lakes Regional Medical Center as one of the top performing hospitals in the country in pneumonia and surgical care.
The award from The Joint Commission recognizes the hospital’s performance during 2011 in using “evidence-based clinical processes” that are shown to improve care for certain conditions. Out of more than 3,400 hospitals reporting data, TLRMC is one of 620 nationwide designated as “Top Performers on Key Quality Measures.”
An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States.
“This recognition is a result of a concentrated and dedication effort on behalf of our employees and members of our medical staff, said hospital CEO Stephen Meredith. “When presented with the challenge of documenting our hospital is committed to providing the highest level of patient care possible, our healthcare professionals want to prove to their community, Twin Lakes Regional Medical Center is one of the top performing hospitals, not only in this state, but nationally as well. I commend our employees and our medical for their commitment to excellence and congratulate them on this achievement.”
It’s the third patient care award for TLRMC in three months. In July, the hospital was recognized for its clinical performance achievements by Alliant Management Services, and in August the hospital received an “A” Hospital Safety Score by The Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits.
Those awards are the outgrowth of a constant focus on quality improvement by the hospital’s staff, said chief nursing officer David Logsdon and quality director Michele Vincent.
Logsdon said the hospital has been steadily reviewing and stressing improvement for several years now. “It’s really nothing new for us,” he said.
Part of TLRMC’s focus on improvement deals with meeting “Core Measures.” Those are nationally standardized performance requirements, based on clinical studies that have demonstrated improved patient outcomes.
The goal of Core Measures, which are tracked by the Centers for Medicare & Medicaid Services and the Hospital Quality Alliance, is to lower the risk of surgical complications, lower the risk of mortality and morbidity rates, and implement healthcare standards that will improve the quality of care provided to hospital patients.
Logsdon and Vincent said the hospital has a safety committee that looks at issues pertaining to safety of patients, visitors and employees, and some patient care initiatives arise from that.
Others are outgrowths of reviewing, discussing and following Core Measures and other clinical processes related to patient care.
“Healthcare is taking this turn toward preventative measures,” Vincent said, “designed to help patients get better outcomes.”
They said the hospital is constantly working to improve patient care and satisfaction. Over the years, for example, it has cut its “door-to-door” time — the time between patients’ entering and leaving after treatment — in the emergency room to a little over two hours.
Adding to patient safety and staffing efficiency is the hospital’s computerized records system, which has physicians entering medical orders into computer files rather than generating pages of handwritten notes. That’s complimented by patient identification bands that contain scanable bar codes. Those codes help reduce the chances of incorrect medications being given to patients or incorrect procedures being performed on them.
“We’re constantly working to improve patient care and satisfaction,” Logsdon said.
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2013-05-18T07:24:44Z
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…to a future free of liver disease. That is the goal the volunteers and staff of the American Liver Foundation® work toward every day. You can join them and make a difference as a participant in the Liver Life Walk®. Your participation will keep us moving forward in the fight against one of America's fastest growing public health concerns -- liver disease.
This year's walk/5K run will incorporate a registration fee for runners and walkers. The registration fee provides all participants with a BornFit Tech Style T-shirt along with other race day benefits for both runners and walkers. Whether a person participates as a runner or walker, the registration fee will be $25 before August 2, 2013 at 12 noon and $30 the day of the event.
A discount registration fee of $20 ($25 on day of event) is available for walkers or runners 17 years old and younger; and 60 years old and older.
Deadline for online registration is August 2, 2013 at 12 noon.
City Park Pavillion
Event Contact Information:
Event Manager: Joseph McCormack
Event Manager Phone:
(303) 988-4388 x10
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Continuing Medical Education (CME)
Continuing Medical Education activities at Good Samaritan Hospital have been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through Good Samaritan Hospital, Los Angeles.
Good Samaritan Hospital is accredited by the ACCME to sponsor continuing medical education for physicians. It is the policy of Good Samaritan Hospital to ensure fair balance, independence, objectivity and scientific rigor in all its sponsored programs. All faculty participating in sponsored programs are expected to disclose to the audience any real or apparent conflicts of interest related to the content of their presentations. Participating physicians should only claim those hours actually spent in each educational activity.
CME Mission Statement
Good Samaritan Hospital’s purpose of the CME Program is to broaden and enhance the competence and performance of physicians so they can provide and help facilitate high quality, evidence-based, and culturally relevant care to the patients they serve in the community.
The content of our CME activities will be designed so that it disseminates current, relevant, practical, evidence-based, cultural and linguistic competent, medical and scientific information. This information will be based on physician core competencies, hospital performance improvement initiatives, practice gaps in the knowledge, competence, or performance of our medical staff, and/or practice gaps in the current systems used in the hospital to facilitate the improvement of patient care.
Our target audience consists of physicians who practice at Good Samaritan Hospital, community physicians who use the hospital as a tertiary center, and physicians who on a national level desire to take advantage of the experience and expertise offered from the various specialty departments of care at the hospital. Other Healthcare professionals who serve as team members with physicians will be invited and included in the educational event.
The types of activities we plan fall into these categories:
- Live, 1 hour to multi-hour courses targeted at the primary care level
- Regularly Scheduled Series’ mainly for specialties and sub-specialties
- Enduring materials (if the need arises)
- Joint-sponsor CME
We expect that when we design our CME activities based on an identified gap analysis, our 2013 CME outcomes will be:
- Improved physician knowledge & competence by 20%
- Improved physician performance as measured by hospital collected data
- Improved hospital-wide systems used to improve patient outcomes
To submit a Good Samaritan Hospital CME Program/Activity Proposal click here.
Medical Grand Rounds
Wednesdays 12:00 PM – 1:15 PM
(Not scheduled in August or December)
Sequoia Room in the Moseley-Salvatori Conference Center
Contact: Andrea Harrow (213) 977-2331
CME Special Events
Check back for special events.
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Work HardeningWhat is work hardening?
Our hands allow us to hold the hand of a child, to plant beautiful gardens, to perform activities which support our communities and our families, to make a living and enjoy life. When injuries occur, we quickly realize how often we take our hands for granted.
At Columbia Physical Therapy our headache program includes a variety of approaches to aide in the reduction of your headaches and the pain associated with them. First, we identify individuals whose headaches are appropriate for treatment by a physical therapist. Next, we focus on locating areas that may be contributing to your headaches. Once a thorough evaluation has been completed you will be given an individualized treatment program that is right for you. Treatment options often include self management techniques, postural education, exercises, cervical traction, and a variety of hands on techniques to help you get control of your headaches and restore your quality of life.<\p>
MVA and Whiplash Services
After a person is in an automobile accident or sustains a whiplash injury their symptoms can become intense. Feelings of neck pain, headaches, muscle weakness, and fatigue often occur.
This is usually referred to as a soft tissue injury, as no bones are broken, but muscle tissue and ligaments are stretched too far. These tissues can heal, however they may need special help.
Physical therapy is used to help the healing process. The treatments may include ice or heat, stretching, modalities such as ultrasound or electrical stimulation, and strengthening activities. Posture and good body mechanics play a critical role in the healing of soft tissue injuries.
Your physical therapist will help guide you through the healing by instructing you in the appropriate stretches, strengthening, and posture activities.
Sports Injury Prevention
Prevention of sports related injuries is just as important to the competitive athlete as it is to the weekend warrior. You want to be able to perform your best and avoid an injury in the process. Many sports related injuries are due to lack of preparation and can be avoided. Our physical therapists have had extensive training and we can assist you in developing a training program specifically geared to your goals. This will not only reduce your risk of injury but improve your speed, power, and agility, which will ultimately improve your overall performance. So whether you are preparing for an upcoming marathon, want to bulk up before football season, would like to increase your vertical leap to get more rebounds, or would just like to lose a few pounds; let our physical therapists set up the perfect training and injury prevention program just for you.
Physical Therapy plays an important role in your rehabilitation following surgery. Some of the most common surgeries requiring physical therapy include total and partial joint replacements of the knee, hip, or shoulder. Although all of these surgical procedures continue to improve with time and are now less invasive, patients still require early and comprehensive physical therapy for the best possible outcomes to be achieved.
Work ConditioningWhat is work conditioning?
Whirlpool therapy is a common physical therapy modality and is one of the oldest forms of medical treatment. Typically, a treatment will consist of placing an injured body part into the jetted whirlpool or Jacuzzi for 15 minutes. Whirlpool therapy has many healing and recuperative properties such as reducing stress, improving circulation, decreasing pain, loosening tense muscles, and promoting wound healing. The jetted water will massage the injured body part and calm and soothe your pain away.
Balance problems, dizziness, and vertigo can interrupt daily life and put you at an increased risk for falls. One of the services we offer is treatment to improve your balance, increase your independence and safety, and treat vertigo (if needed). One of the principles of treatment is challenging your balance in a safe environment. We offer a variety of activities including balance on foam rollers, rocker boards, rebound trampolines, and many floor exercises. As always, you will be assisted by a licensed physical therapist in progressing your activity and learning a home program to improve your balance and safety.
We also provide treatment for vertigo. This is done by a licensed physical therapist and can be highly effective in just 1 or 2 treatments.
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Created 07/14/2012 - 10 months ago
Ailing Bollywood superstar Rajesh Khanna was admitted to a Mumbai on Saturday again after his health condition worsened. Earlier, the superstar was admitted to Mumbai's Lilavati Hospital following kidney ailments on June 24.
News - Rajesh Khanna admitted to Mumbai hospital again: Rajesh Khanna has been suffering from kid... http://t.co/g2oAWzwp #breakingnews
Rajesh Khanna hospitalised again. Admitted to Lilavati aftr complaining of weakness,being treated fr low Blood pressure http://t.co/qXQRgghh
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Welcome to HCV Advocate’s hepatitis blog. The intent of this blog is to keep our website audience up-to-date on information about hepatitis and to answer some of our web site and training audience questions. People are encouraged to submit questions and post comments.
For more information on how to use this blog and search the HCV drug pipeline click here; for more information on HCV clinical trials click here
Be sure to check out our other blog: Hepatitis & Tattoos
Monday, September 10, 2012
Hepatitis epidemic must be tackled to stop liver cancer cases doubling
A physician with the Victorian Infectious Diseases Service, Benjamin Cowie, said liver cancer cases were expected to double to about 2500 a year if more was not done to tackle the underlying causes. Hepatitis B and C were the primary causes of liver cancer, with hepatitis B the most significant single cause of cancer worldwide, after tobacco, Dr Cowie said.
Hepatitis B affected about 200,000 Australians, most of them Aboriginal or born overseas in countries where there was an epidemic. Hepatitis C affected about 230,000 Australians and was most commonly caused by drug users sharing needles.
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To learn more about cholesterol, browse any of the cholesterol topics below.
About Cholesterol Cholesterol itself isn't bad. We all have and need this wax-like substance in our bodies. Learn about the so-called "good" and "bad" cholesterol, where it comes from, and why it's important for your health.
Why Cholesterol Matters High cholesterol is one of the major risk factors leading to heart disease, heart attack and stroke. Discover the reasons to keep your cholesterol controlled.
Understand Your Risk for Cholesterol High cholesterol levels can run in families, and women generally tend to have higher levels of HDL than men. Find out more about who has high cholesterol, and discover why managing cholesterol is important even for children.
Prevention & Treatment of Cholesterol You can lower your cholesterol and reduce your risk of heart disease and stroke. Take responsibility for managing your cholesterol levels with healthy lifestyle choices and a sound medical treatment plan when prescribed.
Cholesterol Tools & Resources Learn more with our online tracking resources, downloadable information pages and personal stories from people like you.
Watch, Learn and Live
Our Interactive Cardiovascular Library has informative illustrations and animations to help you learn about conditions, treatments and procedures related to heart disease and stroke.
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The Medical Mission Program is such a blessing to the families with children who have no other way to afford medical care. We provide free medicine, medical checkups and routine/minor medical treatment to indigent patients in the area as medical staff and funds are available. Because of his years of involvement with MTTM, Brother Humphrey has been able to obtain medical supplies and, most importantly, to have military physicians come to the campus to perform these medical procedures. This is one of many reasons we need a new multi-purpose building to provide room for a clean sterile area for this service.
Eye ClinicFree eye checkups and cataract removals, in cooperation with the Philippine Cataract Foundation Inc., is provided to indigent patients. We have been able to conduct this humanitarian service, not only in the Angeles City area, but also in different rural areas. This service we provide as funds are available.
Medical Mission Pictures+ click on a picture to view larger image.
Home | About Us | Mission Programs | Humphrey Center | Vision | Leadership | Contact Info
Copyright 2005 © Humphrey Humanitarian Ministries. All Rights Reserved.
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From the Wires
IEHP Launches Health Home Model in 10 Community Clinics
By: PR Newswire
Jan. 17, 2013 12:00 PM
SAN BERNARDINO, Calif., Jan. 17, 2013 /PRNewswire-USNewswire/ -- To strengthen the partnership between patients and their healthcare team, Inland Empire Health Plan (IEHP) has kicked off a pilot program utilizing the proven health home model in ten Riverside family care center clinics.
As a joint effort between IEHP and Riverside County Health System (RCHS), the pilot helps enhance care for approximately 12,500 patients in the following clinics:
Each clinic applies health home components in the care setting focusing on team-based care, data exchange and access to care.
IEHP enlisted Colorado-based Health Team Works to assist in the development of a robust implementation plan, starting with a comprehensive assessment of each clinic. Assessments included on-site visits to evaluate workflows, processes, average length of time for scheduled visits and interviews with physicians and clinic staff.
Clinics were shown how to design a multi-disciplinary team that collectively shares the responsibility of managing patient care, specifically preventive care and chronic disease management. According to their role in the clinic, team members, including physicians, nurses and office coordinators received customized training on teaching patients how to effectively manage their healthcare, how to conduct action planning and how to conduct motivational interviewing.
Between the clinics and IEHP, a framework for data exchange was built to support the medical teams, providing essential real-time patient data, such as preventive care and lab results. The second phase of data exchange, expected this winter, includes implementing a new system, enabling clinics to more efficiently improve patient health outcomes in areas such as chronic disease management.
Developing best practices will help IEHP plan for the design and expansion of the health home model across the IEHP provider network.
"Our partnership with RCHS is vital in helping IEHP create a road map to assist our community clinics and providers in achieving health home status," said Dr. Bradley Gilbert, IEHP chief executive officer.
To improve access and maximize the number of patients seen per day, a centralized scheduling department was created whereby patients can call one number to make an appointment at any of the ten clinics, allowing clinics to offer more same day appointments.
"Health homes will help us better integrate systems of care for our members," said Dr. William Henning, IEHP chief medical officer. "Using a team-based approach to care and providing clinics more data from the member's medical history will help us to deliver even better care."
The pilot is supported by a $500,000 grant from Community Clinics Initiative (a joint project of Tides and The California Endowment).
IEHP, Inland Empire Health Plan, a Knox-Keene licensed health plan located in San Bernardino, California, is a not-for-profit public agency. IEHP services San Bernardino and Riverside counties and has over 575,000 members in the following programs: Medi-Cal (including seniors and people with disabilities), Healthy Families, Healthy Kids, and a Medicare Advantage Special Needs Plan. Through a dynamic partnership with providers, award-winning service and innovative products, IEHP is fully committed to providing members with quality, accessible and wellness based healthcare services. www.iehp.org.
Health TeamWorks is a non-profit multi-stakeholder collaborative, working to redesign the healthcare delivery system and promote integrated communities of care, using evidence-based medicine and innovative systems. Our goals are to optimize health, improve quality and safety, reduce costs, and improve the care experience for patients and their healthcare teams.
SOURCE Inland Empire Health Plan (IEHP)
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Hospitals across the country are diligently working to reduce infection rates. According to the World Health Organization, hospital-acquired infections affect as many as 1.7 million patients in the United States each year. These infections come at an annual cost of $6.5 billion and contribute to more than 90,000 deaths.
Proper hand hygiene is essential in helping to prevent hospital-acquired infections. A recent study performed by French researchers examined three types of healthcare workers. The first type spent a large amount of time with a discreet group of patients like a nurse would. The second group saw more patients but spent less time with each one - similar to doctors. Group three consisted of healthcare workers who interacted with every patient every day like therapists. The study found that if a healthcare worker in group three failed to wash their hands, the spread of disease was three times worse than if someone from group one or two didn't. The study was published online in Proceedings of the National Academy of Sciences. To read more about the study, continue here.
To read another take on hand hygiene and about the Joint Commission's national hand hygiene project, click here.
Photo Credit: Jessica Flavin
Almost two million patients hospitalized in the U.S. each year develop an infection. These infections occur in as many as one in every 10 patients, result in close to 100,000 deaths and cost upwards of $6 billion. The Wall Street Journal created a top 10 list of infection prevention strategies based on interviews with medical professionals, administrators a non profit company and the Association for Professionals in Infection Control and Epidemiology.
- Undercover Operations - Dr. Philip Carling, an epidemiologist at Caritas Carney Hospital in Dorchester, Mass. developed a solution to uncover how well patient rooms are cleaned. His invisible solution contains fluorescent markers which glow in black light. After spraying patient rooms with the solution, cleaning crews were brought in to perform their normal routine. Later, rooms were examined with a black light and areas missed by the cleaners glowed fluorescent. Sharing results with cleaners helped boost compliance with proper cleaning techniques.
- High-Tech Cleaning Systems - When hospital equipment is disinfected by hand, bacteria often remains. For more thorough disinfecting hospitals are utilizing machines such as Bioquell which sprays a disinfecting hydrogen-peroxide vapor.
- Data Mining - Many hospitals are tracking data to determine how to prevent infections. Lee Memorial Health System in Florida tracks infection rates by surgeon and reports on the results. Low ranking surgeons can then make adjustments to lower their infection rates and improve their ranking.
- Patient Hygiene - Research suggests a daily wash with mild antibacterial soap can dramatically reduce the rate of bloodstream infections. The recommended cleanser is chlorohexidine glutonate.
- Reporting Crackdown - Numerous states have passed laws which require hospitals to report on infection rates. In many cases the reports are publicly available. In addition, Medicare is limiting reimbursement for treatment of hospital-acquired infections.
- Clean hands - Hospitals that utilize strategically-placed dispensers of hand sanitizer have noticed an increase in hand hygiene compliance from less than 50% to more than 80%.
- Embracing the Checklist - Incorporating checklists into bedside medical charts can help reduce rates of infection by requiring shift nurses to answer questions such as: Does this patient have a catheter? If so, is it still necessary?
- Portable Kits - Utilizing all-inclusive kits for common procedures such as intravenous line insertions or dressing changes can limit the possibility for infection. Kits contain all the items needed for procedures and prevent the nurse from running in and out of the patient room during a procedure to find a forgotten item.
- Mouth Maintenance - Regularly cleaning patients' mouths, gums and teeth can help prevent ventilator-associated pneumonia, a common infection found in intensive care units.
- Infection ID - Quick diagnostic tests can identify infected patients in a matter of hours rather than days. This allows for a quick response when patients show symptoms, are tested and found to be infected.
To read the complete article with expanded descriptions of the top 10, click here.
Photo Credit: Presta
Hospitals in Michigan lowered the rate of bloodstream infections in their patients by following a five-step checklist. The study published in the New England Journal of Medicine
found that implementing the checklist reduced the rate of bloodstream infections related to catheter use by 66%. Despite this success, utilization of the checklist remains limited. The checklist itself isn't complicated:
- Wash hands
- Clean patient's skin with chlorohexidine
- Wear protective cap and gown and use a surgical drape during the procedure
- Avoid catheter insertion through the groin if possible
- Remove unnecessary catheters
Peter Pronovost, the patient-safety expert who led the study, spoke with The Wall Street Journal to share insights on why more hospitals haven't benefited from using the checklist. To read excerpts from his interview, click here.
Photo Credit: Adesigna
A recent study published in the American Journal of Infection Control examined the levels of bacteria on healthcare workers' lab coats. The study involved a cross section of medical and surgical grand rounds attendees at a large teaching hospital. Participants completed a survey and cultured their lab coat using a moistened swab on the lapels, pocket and cuffs. Of the 149 white coats in the study, 34 (23%) were contaminated with S aureus, of which 6 (18%) were methicillin-resistant S aureus (MRSA). Providers working with patients had higher contamination levels and the study suggests that white coats may contribute to patient-to-patient transmission of S aureus. Read the entire study in the March 2009 issue of the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC).
Photo Credit: Estherase
Central venous catheters (CVC) are essential for treating children with cancer. They reduce the need for multiple needlesticks and the associated pain and anxiety. In addition, they can be used to deliver chemotherapy, parenteral fluids, blood products and analgesics. Despite the positives, children with CVCs are at increased risk for bloodstream infections. Complications associated with CVCs include pneumothorax, air embolism, nerve injury, catheter malposition, infection and occlusion.
A recent study had four objectives:
1. To decrease CVC-related bloodstream infection rates in children with cancer through a comprehensive educational intervention.
2. To determine if the frequency of catheter hub colonization of CVCs in children with cancer would decrease following the educational intervention.
3. To evaluate nurses' knowledge of CVC care.
4. To determine risk factors influencing CVC-related bloodstream infections in children with cancer.
The study was conducted in the cancer center of a large children's hospital and included patients ranging in age from infancy to 18 years. A 45 minute educational program on CDC guidelines, most frequent guideline violations and information on catheter-related infections was presented to all caregivers. Following the educational presentation, catheter-related bloodstream infections were tracked for six months in order to determine the rate of infection. Study findings showed that the educational program increased nurses' knowledge and instances of catheter-related bloodstream infections decreased. You can read the full article in the March 2009 issue of Oncology Nursing Forum or purchase it online here.
Photo Credit: Gulf Coast Regional Blood Center
According to a 2009 study, approximately 5 million central venous catheters are placed each year. Implantable ports provide reliable venous, arterial, epidural and peritoneal access and can be used to administer IV fluids, medications and to obtain blood samples. However complications including occlusion, infection, catheter migration and catheter separation from portal body can frequently occur.
A recent study conducted in a rural hematology-oncology clinic focused on infection. A port infection can present as local tenderness, pain, erythema, induration or edema at the insertion or exit site or over the port pocket. Patients may also have purulent or serous drainage, fever and chills. To prevent infection, aseptic technique should be utilized for dressing changes. In addition, clinicians should follow accessing and deaccessing procedures and keep the exit clear of potential sources of infection. The 62 patients included in the study were receiving a minimum of two complete cycles of chemotherapy after port insertion. Ports were accessed and deaccessed following outlined protocol.
*Steps for Accessing Ports:
- Wash hands. Assess the port site for erythema, warmth or drainage.
- Palpate the outline of the portal body.
- Wash hands.
- Apply nonsterile gloves. Cleanse port site with chlorohexidine swab in a circular motion for 30 seconds. Allow to dry for 30 seconds.
- Spray ethyl chloride.
- Stabilize portal body with one hand. Insert Huber needle (link to EZ Huber product page) into septum with other hand. Ensure patency by blood return. If no blood return, use interventions to assess port's patency.
- Stabilize port with gauze and tape or apply transparent dressing.
*Steps for Deaccessing Ports:
- Wash hands. Apply nonsterile gloves.
- Inspect exit site.
- Flush device with 20 ml normal saline followed by 5 ml heparin flush (100 units/ml). During final flush, clamp tubing to port.
- Stabilize port and remove needle.
- Apply bandage.
Six of the 62 patients in the study experienced a port infection, with four of the six ports requiring removal. The total number of catheter days for the implanted ports was 7,277. Patient catheter days ranged from 32-288. The study concluded that consistent, routine care is the best preventative measure against port complications. The entire study can be found in the October 2009 issue of the Clinical Journal of Oncology Nursing.
*The port access and de-access protocols are those that were used by the authors for this study. Please follow institutional policies and procedures regarding port access and de-access.
Although many infection headlines are related to hospitals, individual doctor's offices are facing similar challenges. Almost 30 cases of hepatitis B were recently tied to one doctor's office in New Jersey. When health inspectors visited the office they found blood on the floor of a room where chemotherapy was administered, blood in a bin where blood vials were stored, unsterile saline and gauze as well as open medication vials. Inspectors also noticed cross-contamination of pens, refrigerators and countertops, use of contaminated gloves and misuse of antiseptics.
Patients were sent a letter from state epidemiologist Dr. Christina Chan urging testing for hepatitis B. "Evidence gathered at this time suggests that since 2002, some clinic staff provided care in a manner that puts patients at risk for infection caused by bloodborne viruses, including hepatitis B," the letter told patients. "The investigation to date suggests that hepatitis B infections identified may be associated with the method by which medications were administered and procedures performed at the practice."
Numerous checklists and recommendations have been published around infection control. The American Academy of Pediatrics Committee on Infectious Diseases and Committee on Practice and Ambulatory Medicine offers these infection control musts:
- Hand washing
- Barrier precautions to prevent skin and mucous membrane exposure
- Proper handling of sharps and contaminated waste
- Appropriate cleaning and disinfecting of surfaces and equipment
- Aseptic technique for invasive procedures
For the full recommendation on infection control in physician's offices, click here.
To read more about the hepatitis B outbreak in New Jersey, continue reading here.
Photo Credit: Hollywood Pimp
The Joint Commission Center for Transforming Healthcare is working on its first improvement venture: The Hand Hygiene Project. According to the Centers for Disease Control and Prevention, an estimated 2 million patients get a hospital-related infection every year and 90,000 die from their infection.
Causes of Failure to Clean Hands
- Ineffective placement of dispensers or sinks
- Hand hygiene compliance data are not collected or reported accurately or frequently
- Lack of accountability and just-in-time coaching
- Safety culture does not stress hand hygiene at all levels
- Ineffective or insufficient education
- Hands full
- Wearing gloves interferes with process
- Perception that hand hygiene is not needed if wearing gloves
- Healthcare workers forget
Early results of the program found on average that caregivers washed their hands less than 50 percent of the time. "Demanding that healthcare workers try harder is not the answer. These healthcare organizations have the courage to step forward to tackle the problem of hand washing by digging deep to find out where the breakdowns take place so we can create targeted solutions that will work now and keep working in the future," said Mark R. Chassin, M.D., M.P.P, M.P.H., president, The Joint Commission.
By January, 2010, the Joint Commission Center for Transforming Healthcare plans to have data to demonstrate whether the proposed hand hygiene solutions can be sustained to achieve a 90+ percent compliance rate.
Eight hospitals are participating in this project:
- Cedars-Sinai Health System, Los Angeles, California
- Exempla Lutheran Medical Center, Wheat Ridge, Colorado
- Froedtert Hospital, Milwaukee, Wisconsin
- The Johns Hopkins Hospital and Health System, Baltimore, Maryland
- Memorial Hermann Health Care System, Houston, Texas
- Trinity Health, Novi, Michigan
- Virtua, Marlton, New Jersey
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
To read the full release from the Joint Commission for Transforming Healthcare, click here.
Photo Credit: Mag3737
Healthcare providers are on alert due to an increase in a new strain of hospital-acquired infections. A recent study released by Arlington Medical Resources (AMR) and Decision Resources, found that recurrent Clostridium difficile
is difficult to treat in a hospital setting.
Clostridium difficile is a bacterium that can cause symptoms as minor as diarrhea and as life threatening as severe inflammation of the colon. The elderly are most at risk and the Centers for Medicare and Medicaid services is considering adding Clostridium difficile to its list of "never events" or preventable hospital-acquired infections. Hospitals will receive reduced or no Medicare payments for infections on the "never events" list.
Read more about how the study was conducted as well as more information on Clostridium difficile here.
Photo Credit: Big Grey Mare
Jeanne Hahne was working as a nurse in a burn ward when inspiration struck. Because the patients were so vulnerable to infection, Hahne and other healthcare providers had to wear full protective gear including a cap to cover her hair and a mask that covered the majority of her face. Even though she worked with many of the burn patients every day, most couldn't recognize her.
Flash forward almost 30 years and Hahne has designed a face mask made of clear plastic so patients can see her smile. Hahne believes she can reassure patients with a smile and help decrease their anxiety. The masks also have utility for patients and healthcare providers with hearing loss since they allow for lip reading. In addition, the masks have helped improve communication between healthcare workers which can help decrease the chance for mistakes or misunderstanding. To read more and see pictures of the face mask, click here.
Photo Credit: Christiana Care
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"Is the EPO changing Its stance on personalised medicine inventions?
Case law is an important means by which we know what is patentable at the European Patent Office (EPO). However, sometimes the EPO’s view of what is patentable in an area changes before the case law does. This can sometimes be detected when Examiners start raising objections they would not have previously done. Clearly, applicants need to know about such changes as soon as possible so that they can revise their filing strategies and re-evaluate their expectations of the claims they are likely obtain. Meetings between the EPO and the epi (the professional institute for EPO attorneys) are very useful forums for obtaining ‘inside information’ about the EPO’s thinking which is not yet apparent from the case law. The June 2012 issue of epi Information provides a report of such a meeting held on 10 November 2011 between the EPO and the biotech committee of the epi. Discussion item 8 is reported as follows:
‘8. Inventions in the area of pharmacogenomics
Thanks, Suleman, for this most instructive piece, says the IPKat. Merpel is fascinated by this for quite another reason, though. It reflects a growing trend towards what might be termed "mass personalisation". We have it in branding and marketing, where the use of sophisticated software in reading your emails and online purchases enables a personalised dose of advertising to be specifically targeted at the individual. It also exists in the design and fashion sector, where a combination of interactive software and manufacturing improvements produces the result that a purchaser of, say, sports shoes, can determine the style, size, colour and bolt-on features that characterise it, rather than going into some random shop and putting a tentative foot into a sample shoe that might previously have been tried by someone with sweaty socks and fungal growths between the toes ...This concerns cases which are based on a genetic marker to treat a disease, for example methylation profiles. It can involve a new patient group defined by an SNP. The EPO said that often the claims can lack novelty, as one patient will have inevitably been treated with the SNP, even if the art does not explicitly say so.’The EPO’s comments seem to indicate that it is about to change the way it assesses novelty when looking at medical use claims that refer to treatment of a specific patient group.
To give a little technical background to the EPO’s comments, an SNP is a form of genetic marker which varies between individuals. The idea behind the relatively new field of pharmacogenomics is that, if you know which SNP variants a patient possesses, you can personalise the drugs given to a patient in accordance with his genetic makeup. It is now recognised that the genetic makeup of an individual can be very influential as to whether he responds to a drug, and so one application of pharmacogenomics is to only give those drugs to patients who will respond to them.
Personalised medicines can also be based on non-genetic biomarkers, such as the level of virus the individual has.
Personalised medicines offer the potential to use drugs much more effectively. That is clearly of benefit to patients, but should also help to reduce costs in times when many governments feel increasingly dismayed at the yearly increases needed to health budgets. The sector most likely to benefit in the short time is cancer therapy where most of the work in identifying biomarkers is focussed. However, biomarkers are increasingly being sought for many other diseases.
Presently, suitable biomarkers for personalised medicine are proving difficult to find. So it seems that the sector is going to require a lot of investment -- but in investors in biotech do like to see that strong patent protection is available in the relevant sector.
Personalised medicines, and in fact diagnostics in general, has been thrown into uncertainty in the US after the Supreme Court’s decision in Mayo v Prometheus [on which see earlier Katposts here and here] which found that a claim referring to steps that determined the level of a drug in a patient was directed to a law of nature and was thus not patentable. It would be unfortunate for personalised medicines to be dealt a further blow by the EPO, making the test for novelty stricter in this area.
Claims for personalised medicine inventions can have many different forms, but typically they are along the following lines:
Substance X for use in a method of treating condition Y in an individual with biomarker Z’.There is an argument here that perhaps applicants only deserve claims to the method of selecting the individual (by detection of the biomarker), and not to treatment of the individual. However there is a lot more money in therapy, with figures being quoted of 6% versus 94% for the money to be made in selection versus therapy. Since personalised medicine results in therapy being more effective, there is an argument that the applicant deserves claims to the therapy step.
The crux of the present issue is whether limiting a medical use claim by specifying that the individual has biomarker Z will confer novelty where the prior art is silent about patients having biomarker Z, but where patients with biomarker Z will inevitably have been treated, i.e. does limiting a medical use claim to a patient group that overlaps with, or is within, the prior art patient group, make the claim novel?
The earliest case to tackle the issue seems to have been T233/96 which gave a strict two-part test for novelty requiring the patient groups to be non-overlapping and for there to be a functional relationship between the biomarker and the therapy, i.e. the patient group could not be an arbitrary group. However, subsequent case law has not followed the test. In T1399/04 the Board cited T233/96, but took a different view, generously allowing claims which covered more than 50% of a prior art patient group. Decisions T836/01 and T1642/06 also allowed claims where patient groups overlapped with the prior art.
Based on the comments at the EPO/epi meeting and from the experiences of attorneys I know who are handling European patent applications in this area, it seems that EPO is taking a stricter view of the issue, and is probably looking for a test case to change the case law. If the EPO decides on a test which is based on the concept of a patient with the relevant biomarker ‘inevitably’ having been treated, presumably this is a prior use test, in which case it would be burdensome for applicants to locate evidence on what actually happened. However if the test is similar to that used in T233/96, i.e. requiring that patient groups do not overlap, then it will have the effect of severely curtailing patent protection for personalised medicines because most drugs are initially given to everyone with the condition.
I hope that the EPO will be wise enough to recognise that making the test for novelty stricter for medical use claims limited by patient group will have a substantial impact on the patent protection that can be obtained in the area of personalised medicines, at a time when this very promising sector needs all the support it can get".
Your own personalised medicine here and here [not for the squeamish]
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http://ipkitten.blogspot.co.uk/2012/08/taking-it-personally-patents-medicines.html
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2013-05-18T08:09:06Z
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Our objective was to develop a quality improvement project on diabetes mellitus at our internal medicine residency clinic. Residents developed projects aimed at improving an aspect of diabetic care. Continuity of care, achievement of clinical targets, no-show rates, patient knowledge of diabetes, and preventive care were evaluated. Our data was obtained with a questionnaire and a retrospective review of medical records. A different provider was scheduled about every 1.78 visit. The no-show rate was 25.4%. About half of patients identified goal hgbA1c and BPs, and 35% and 60% achieved their hgbA1c and SBP goals respectively. Nearly all of the charts planned for screening exams. We concluded that our clinic needs to improve diabetes education, reaching clinical targets, continuity of care and no-shows. Incorporating a QI project into the clinic with one disease such as diabetes is an efficient way to include practice based learning into an internal medicine residency’s curriculum.
Punzalan, MD, Carmi Santos; Rutherford, MD, Sarah; Lerner, MD, Andrew; Kouvatsos, MD, Tasha; Thakkar, MD, Sneha; Klein, MD, Melissa; Manoff, MD, David; Kelly, MD, Cecilia; Halegoua, MD, Dina; and Kane, MD, Gregory
"Quality Improvement of Diabetic Care at a Resident Clinic,"
The Medicine Forum:
Vol. 13, Article 21.
Available at: http://jdc.jefferson.edu/tmf/vol13/iss1/21
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PCRM has led the way for reforms of federal nutrition policies.
Our clinical research programs are breaking new ground in diabetes, cancer, and other serious conditions.
PCRM’s Cancer Project has provided vital information to tens of thousands of people.
The New Four Food Groups is PCRM’s innovative proposal for a federal nutrition policy that puts a new priority on health.
Our public service announcement series features medical experts on prevention and health.
Research Advocacy We encourage higher standards for ethics and effectiveness in research:
We oppose unethical human experiments. While great strides have been made in eliminating such experiments, problems remain. For example, children are still given synthetic growth hormone in experiments to make them taller, and both children and adults are exposed to unnecessary new drugs which have toxic effects.
We promote alternatives to animal research and animal testing. We have worked to put a stop to gruesome experiments, such as the military’s cat-shooting studies, DEA narcotics experiments, and monkey self-mutilation projects. We also promote nonanimal methods in medical education. Currently, more than three-quarters of all U.S. medical schools have dropped their animal labs for medical students.
Since 1985, PCRM has been influencing advancements in medicine and science. We advocate for preventive medicine, especially good nutrition, conduct clinical research, and advocate for higher ethical standards in research. Our membership includes 150,000 health care professionals and concerned citizens.
PCRM is a nonprofit 501c3 organization headquartered in Washington, D.C.
PCRM’s advisory board includes 18 health care professionals from a broad range of specialties:
Leslie Brown, M.D., Pontchartrain Pediatrics T. Colin Campbell, Ph.D., Cornell University Caldwell B. Esselstyn, Jr., M.D., The Cleveland Clinic Roberta Gray, M.D., F.A.A.P., Pediatric Nephrology Consultant Suzanne Havala Hobbs, Dr.PH., M.S., R.D., University of North Carolina at Chapel Hill Henry J. Heimlich, M.D., Sc.D., The Heimlich Institute David Jenkins, M.D., Ph.D., Sc.D., St. Michael’s Hospital, Toronto Lawrence Kushi, Sc.D., Division of Research, Kaiser Permanente John McDougall, M.D., McDougall Program, St. Helena Hospital Milton Mills, M.D., Gilead Medical Group Baxter Montgomery, M.D., Houston Cardiac Association and HCA Wellness Center Carl Myers, M.D., Sonoran Desert Oncology Ana Negrón, M.D., Community Volunteers in Medicine and family physician Myriam Parham, R.D., L.D., C.D.E., East Pasco Medical Center William Roberts, M.D., Baylor Cardiovascular Institute Joan Sabaté, M.D., Dr.PH., Loma Linda University Nutrition School of Public Health Gordon Saxe, M.D., M.P.H.,Ph.D., Moores Cancer Center, University of California, San Diego Andrew Weil, M.D., University of Arizona
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TOP 5 HEALTH ISSUES FACING AMERICAN PETS TODAY
By Ann Hohenhaus, DVM
1. Pets are becoming medically underserved
Data shows the pet population in the U.S. is climbing, but visits to veterinarians are declining. On an annual basis in 2007, dogs saw a veterinarian 2.6 times per year and cats only 1.7 times, indicating cats are affected more than dogs. This number has continued to decline in the aftermath of the Great Recession of 2008. Taking your cat or dog to the veterinarian allows early detection and intervention before medical problems like obesity cause serious disease.
2. Obesity in pets, like in humans, is skyrocketing
Veterinarians know pets are getting fatter, but research has shown pet owners are not likely to recognize obesity in their pets, perhaps because they themselves are overweight. In dogs, obesity is linked to an increased body mass index (BMI) in their owners. If you love your pet and want it to live a long, healthy life, keep its weight down. Obese pets have a shorter lifespan and increased risk of cancer, heart disease, respiratory problems, bladder disease, and, like humans, diabetes.
3. Diabetes is increasing in both cats and dogs
Banfield State of Pet Health reports a 32% increase in diabetes in dogs and 16% increase in cats, comparing 2006 to 2010. This is likely tied to the obesity epidemic in pets. Diabetes can be treated in dogs and cats, but it involves someone in the family injecting insulin once or twice daily under the skin and monitoring response to treatment. Preventing diabetes by maintaining an ideal body weight is simply easier for everyone.
4. Cancer: a major illness in both cats and dogs
According to the Morris Animal Foundation, 1 in 4 dogs dies from cancer and cancer is the leading cause of death in dogs over 2 years of age.
In dogs, breed is strongly associated with specific types of cancer. Golden retrievers commonly develop lymphoma, German shepherds a splenic tumor called hemangiosarcoma, and Pugs a skin tumor known as a mast cell tumor. Cats get cancer too, most commonly lymphoma. Annual examinations and blood tests by your family veterinarian will help to detect tumors while they are still easily treatable.
5. Dental disease is on the rise
Reluctant is the descriptor for many pet owners when it comes to dental procedures in their pets. I understand their concern for the required general anesthesia, but I am concerned their reluctance is compromising their pet’s health. Periodontal disease is very prevalent in cats and in one study, all cats had evidence of periodontal disease. Over 10% were severely affected and nearly all had bone loss in the jaw as determined by dental x-rays.
Having periodontal disease may cause collateral damage in other parts of your pet’s body. In dogs, periodontal disease was associated with increases in markers of systemic inflammation and indicators of failing kidney function, and
was also associated with endocarditis and heart muscle problems.
For more information on healthcare issues facing American pets today, watch my video interview with Yahoo! Animal Nation.
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Too much shellfish, you say?
One of the absolutely unexpected (and unwanted) side benefits of hanging around a hospital for several hours a day over six and a half months is you get to talk health hypotheticals with people running the full gamut of medical knowledge – all of it more than you have.
In short, they are not necessarily buying the “Jose Reyes developed hyperthyroidism from eating too much shellfish with all that iodine in it.” They are thus also not buying that “all will be well if he switches to tuna and red meat and doesn’t exercise for two weeks or two months.” It may be true that he’s had a lot of shellfish lately, but that doesn’t mean it’s the only cause of his hyperthyroidism.
This is not to say it’s not possible, but none of the medicos to whom I talked think diet is a very likely cause of hyperthyroid problems in a 26-year old guy. More common causes are an immune disorder (Graves’ Disease – his age is correct for that – doctors would look there first, especially if there’s any family history of it), or a virus, or taking medication designed for thyroid deficiencies, or delivering a baby.
I think we can rule the last one out, but the Mets have seemingly been hit by every other injury and malady in the last eighteen months, so what the hell.
The problem, of course, for the Mets is that their recent history on reporting those injuries and maladies is that they have over-promised and under-delivered. Last season, Reyes himself was only to miss a few days, then weeks, then a month, then an indefinite time, then he needed surgery. This is not necessarily blissful incompetence: hamstring and other connective tissue problems can often take a long time to diagnose. The Mets’ training and medical staff may be as much victims here as the players or fans are.
But if it turns out Reyes has a more lingering thyroid problem – one that does not simply go away in two weeks to two months – it will be impossible to believe the team’s next injury report. More importantly, it will be a significant impediment to Reyes’ quick return, or for him avoiding surgery or long-term drug therapy.
Or maybe he consumed 10 percent of the world’s shellfish.
How much could Shellfish could an ex-Shea Shortstop Shovel, if an ex-Shea Shortstop Could Shovel Shellfish?
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http://keitholbermann.mlblogs.com/2010/03/11/a-whole-lotta-lobster/?like=1&source=post_flair&_wpnonce=ae4d6bb289
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Children fill water bottles in the Gaza Strip.
JENIN (Ma’an) — Twenty-four children were admitted to hospital in Jenin on Saturday after drinking contaminated water in their elementary school, police said.
Parents reported symptoms of vomiting and a high fever, a police statement said. Eighteen children are still in hospital and six have been released after treatment.
Police are investigating the incident.
(www.maannews.net / 08.09.2012)
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http://khamakarpress.com/2012/09/08/24-children-admitted-to-hospital-after-drinking-contaminated-water/
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You may associate pneumonia with the melodrama of a soap opera: prolonged hospital stays, oxygen tents, and family members whispering in bedside huddles. It's true that pneumonia can be serious. But more often pneumonia is an infection that can be easily treated at home without a hospital stay.
What Is Pneumonia?
Pneumonia (pronounced: noo-mow-nyuh) is an infection of the lungs. When someone has pneumonia, lung tissue can fill with pus and other fluid, which makes it difficult for oxygen in the lung's air sacs to reach the bloodstream. With pneumonia, a person may have difficulty breathing and have a cough and fever; occasionally, chest or abdominal pain and vomiting are symptoms, too.
Pneumonia is commonly caused by viruses, such as the influenza virus(flu) and adenovirus. Other viruses, such as respiratory syncytial virus(RSV), are common causes of pneumonia in young children and infants.
Bacteria such as Streptococcus pneumoniae can cause pneumonia, too. People with bacterial pneumonia are usually sicker than those with viral pneumonia, but can be effectively treated with antibiotic medications.
You might have heard the terms "double pneumonia" or "walking pneumonia." Double pneumonia simply means that the infection is in both lungs. It's common for pneumonia to affect both lungs, so don't worry if your doctor says this is what you have — it doesn't mean you're twice as sick.
Walking pneumonia refers to pneumonia that is mild enough that you may not even know you have it. Walking pneumonia (also called atypical pneumonia because it's different from the typical bacterial pneumonia) is common in teens and is often caused by a tiny microorganism, Mycoplasma pneumoniae. Like the typical bacterial pneumonia, walking pneumonia also can be treated with antibiotics.
What Are the Signs and Symptoms?
Many symptoms are associated with pneumonia; some of them, like a cough or a sore throat, are also common with other common infections. Often, people get pneumonia after they've had an upper respiratory tract infection like a cold.
Symptoms of pneumonia can include:
unusually rapid breathing
chest or abdominal pain
loss of appetite
vomiting and dehydration
Symptoms vary from person to person, and few people get all of them.
When pneumonia is caused by bacteria, a person tends to become sick quickly and develops a high fever and has difficulty breathing. When it's caused by a virus, symptoms generally appear more gradually and might be less severe.
Someone's symptoms can help the doctor identify the type of pneumonia. Mycoplasma pneumoniae, for example, often causes headaches, sore throats, and rash in addition to the symptoms listed above.
The routine vaccinations that most people receive as kids help prevent certain types of pneumonia and other infections. If you have a chronic illness, such as sickle cell disease, you may have received additional vaccinations and disease-preventing antibiotics to help prevent pneumonia and other infections caused by bacteria.
People with diseases that affect their immune system (like diabetes, HIV infection, or cancer), are 65 or older, or are in other high-risk groups should receive a pneumococcal vaccination. They also may receive antibiotics to prevent pneumonia that can be caused by organisms they're especially susceptible to. In some cases, antiviral medication might be used to prevent viral pneumonia or to lessen its effects.
Doctors recommend that everyone 6 months and older gets a flu vaccine. That's because pneumonia often happens as a complication of the flu. Call your doctor's office to see when these vaccines are available.
Because pneumonia is often caused by germs, a good way to prevent it is to keep your distance from anyone you know who has pneumonia or other respiratory infections. Use separate drinking glasses and eating utensils; wash your hands frequently with warm, soapy water; and avoid touching used tissues and paper towels.
You also can stay strong and help avoid some of the illnesses that might lead to pneumonia by eating as healthily as possible, getting a minimum of 8 to 10 hours of sleep a night, and not smoking.
How Long Does It Last?
The length of time between exposure and feeling sick (called the incubation period) depends on many factors, particularly the type of pneumonia involved.
With influenza pneumonia, for example, someone may become sick as soon as 12 hours or as long as 3 days after exposure to the flu virus. But with walking pneumonia, a person may not have symptoms until 2 to 3 weeks after becoming infected.
Most types of pneumonia resolve within a week or two, although a cough can linger for several weeks more. In severe cases, it may take longer to completely recover.
If you think you may have pneumonia, tell a parent or other adult and be sure you see a doctor. Be especially aware of your breathing; if you have chest pain or trouble breathing or if your lips or fingers look blue, you should go to a doctor's office or to a hospital emergency department right away.
How Is Pneumonia Treated?
If pneumonia is suspected, the doctor will perform a physical exam and might order a chest X-ray and blood tests. People with bacterial or atypical pneumonia will probably be given antibiotics to take at home. The doctor also will recommend getting lots of rest and drinking plenty of fluids.
Some people with pneumonia need to be hospitalized to get better — usually babies, young kids, and people older than 65. However, hospital care may be needed for a teen who:
already has immune system problems
has cystic fibrosis
is dangerously dehydrated or is vomiting a lot and can't keep fluids and medicine down
has had pneumonia frequently
has skin that's blue or pale in color, which reflects a lack of oxygen
When pneumonia patients are hospitalized, treatment might include intravenous (IV) antibiotics (delivered through a needle inserted into a vein) and respiratory therapy (breathing treatments).
Antiviral medications approved for adults and teens can reduce the severity of flu infections if taken in the first 1 to 2 days after symptoms begin. They're usually prescribed for teens who have certain underlying illnesses such as asthma or who have pneumonia or breathing difficulty.
If you have been exposed to influenza and you begin to develop symptoms of pneumonia, call a doctor.
If your doctor has prescribed medicine, be sure to follow the directions carefully.
You may feel better in a room with a humidifier, which increases the moisture in the air and soothes irritated lungs. Make sure you drink plenty of fluids, especially if you have a fever. If you have a fever and feel uncomfortable, ask the doctor whether you can take over-the-counter medicine such as acetaminophen or ibuprofen to bring it down. But don't take any medicine without checking first with your doctor — a cough suppressant, for example, may not allow your lungs to clear themselves of mucus.
And finally, be sure to rest. This is a good time to sleep, watch TV, read, and lay low. If you treat your body right, it will repair itself and you'll be back to normal in no time.
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<urn:uuid:d7bdcf2d-ea1c-4316-a4f7-13bbedd58cdc>
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http://kidshealth.org/PageManager.jsp?dn=K_HovnanianChildrens_Hospital&lic=184&cat_id=20174&article_set=22204&tracking=T_RelatedArticle
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2013-05-18T05:22:30Z
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February 4, 2013, 8:04 am
It’s not too late to get a flu shot!
The flu epidemic is hitting harder and faster this year than in the last decade. So far, Oregon has been spared a severe outbreak, but we’d sure like to keep it that way. OHSU’s Doernbecher Children's Hospital is doing its part to limit the spread of the flu by offering free vaccinations to anyone who is in close contact with a Doernbecher patient.
It’s called “cocooning,” or insulating a child from infection by protecting the most vulnerable patients from infection by immunizing adult caregivers.
This year, OHSU Doernbecher Children’s Hospital has provided more than 1000 immunizations through the Free Vaccine for Parents Cocooning Project.
You can help control influenza activity in your community by getting vaccinated. To find out more, visit OHSU’s Healthy Families Blog.
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<urn:uuid:cc63b106-328c-4fe9-9e28-f18d1c0f9e6a>
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http://kink.fm/02/04/13/bSheilas-Blog-bIts-not-too-late-to-get-a/landing_blog.html?blockID=663353&feedID=9503
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A 64-year-old white female with a long history of poorly treated hypertension was diagnosed by your preceptor with congestive heart failure (CHF) at her last visit when she presented with shortness of breath and lower extremity edema. She was treated with a diuretic and started on an ACE inhibitor and now is clinically well compensated and without edema. Her EKG shows LVH and strain. Her echocardiogram shows an ejection fraction of 35% and left ventricular hypertrophy. The patient is otherwise in good health without any other known chronic conditions. She is a lifelong non-smoker with a cholesterol/HDL ratio of 2.3 (low risk for heart disease). Her only other medication is Prempro (a combination estrogen/progesterone product).
The patient has heard that CHF is a serious disease, and asks what the future is likely to hold for her. Specifically she asks how likely she is to die from this condition in the near future.
| URL: http://library.umassmed.edu/EBM/tutorials/one/index.cfm
Last Updated: October 6, 2010
Send us comments.
Worcester, MA, USA 01655
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<urn:uuid:c087c0a5-1042-4111-bdb3-602590f05750>
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http://library.umassmed.edu/EBM/tutorials/one/index.cfm
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2013-05-18T05:02:21Z
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| 0.946224
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| 0.932136
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5abac5db575b94ac3ea6b5f74d0368ca22d61596e39c1b2a155d7a4d6b43ccec
| 1,752,484,220.323363
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Megha M. Tollefson, M.D.
Megha Tollefson, M.D., is a pediatric dermatologist with research interests in skin diseases of children, particularly the early growth phase of infantile hemangiomas.
Research reveals that infantile hemangiomas grow more rapidly and earlier than previously understood. Exciting new treatment modalities offer a great chance for making an impact on potentially destructive and complicated infantile hemangiomas before significant damage occurs.
Another active area of Dr. Tollefson's research is pediatric vascular malformations. She has conducted research on pediatric psoriasis and pediatric atopic dermatitis and continues focusing on improved outcomes for children who have these chronic and potentially lifelong conditions.
Pediatric Dermatology Fellowship
Human Biology, Graduated with Honors
© 2013 Mayo Foundation for Medical Education and Research. All rights reserved.
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<urn:uuid:3e3f33ac-b061-410e-978c-3a1035ecd65f>
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http://mayoresearch.mayo.edu/mayo/research/staff/Tollefson_MM.cfm
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2013-05-18T06:26:49Z
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f4c8ace2d0e1bb0a68b9ddedb60025682fd106f99275bd9abd685223710cd3e7
| 1,752,484,220.685027
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Hydrocele Operation: aka Hydroceles, Hydrocele Sac, Swollen Testicle, Hydrocelectomy
What is it?
Hydrocele operations or hydrocele surgery is to release fluid that forms in a sac within the scrotum. Typically hydroceles develop when the testicle passes into the scrotum but the passage through which this occur fails to close properly. Fluid can accumulate in this passage from the abdomen, and then enters the scrotum causing it to swell.
This can cause one or both sides of the scrotum to swell and the testicle itself to swell or become damage and inflamed. Fluid can also block the tube where sperm typically flow from. Hydroceles are more common in newborn boys but are not exclusive to newborn boys. To diagnose a hydrocele typically a doctor will look for swelling in the scrotum caused primarily by fluid build up or will look for something solid like a fluid-filled sac in the scrotum.
Typically fluid is removed from the hydrocele sac during a procedure called a hydrocelectomy. For the most part this is a straightforward and uncomplicated procedure that may produce a moderate amount of soreness for a few days following the procedure. The long-term benefits far outweigh any short-term soreness.
Many times the patient is a young patient under the age of 10 or in many cases a newborn baby that is born with a hydrocele defect. Usually a surgery takes placed under general anesthesia. A surgeon will make a small incision in the scrotum that will allow fluid to be drained from the scrotum and then seal the passage from the scrotum to the abdomen. Usually the incision is then closed with stitches that will dissolve on their own so they do not have to be removed later.
Alternatives to Surgery
There are no known alternatives to this surgery currently.
Before the Operation
Prior to the operation the doctor will confirm a fluid filled sac exists by placing a light to the scrotum which will light up the testicles, veins in the scrotum and the fluid filled sac which will appear clear to the light.
A doctor will also perform a comprehensive medical history and check any medications the patient is currently taking. Patients are advised not to eat or drink anything up to 12 hours before the procedure because it is performed under general anesthesia.
After the Operation- At Home
Once the operation is complete the patient will recover usually for a few hours in a day bed. The procedure is usually performed on an outpatient basis meaning the patient can usually go home on the same day. Most of the time it is best to wear looser fitting close that will prevent irritation and discomfort on leaving.
There are some risks associated with this procedure as there are with any procedure including a small risk of infection. Other risks including the risk of bleeding during or after the procedure, and a risk of a blood clot forming in the area of the procedure. The doctor may accidentally damage the scrotum or the tissues surrounding this area too.
Anytime a patient undergoes general anesthesia there are risks associated with this too including a risk of pneumonia following surgery. The nurse or doctor will encourage the patient to take deep breaths to clear the lungs following surgery. Many people especially younger children undergoing this operation may report feeling nauseous or dizzy following the procedure, a side effect largely associated with the general anesthesia. These complications are usually temporary however and resolve within a couple of days of treatment.
A hydrocele procedure is generally performed to relieve fluid build up around the testicle or within the scrotum. This procedure is relatively simple with few complications. The primary risks include a risk of infection and risk of rupture or nicks to nearby tissues or structures. If you work with a competent health professional you reduce your odds of complications.
Because these surgeries are often performed on younger individuals it pays to ask someone if they have experience working on youths or pediatric patients. You may need to pay a small amount extra to work with someone that specializes in pediatrics or even geriatrics if you are over 50 or 60 and have a fluid-filled sac in the scrotum that you require surgery for. Regardless of where you go or who you see make sure they practice safe hygiene practices to ensure your safety and wellness.
Estimated Costs for Hydrocele Operation
The cost of surgery varies widely and may depend partly on the patient’s age and overall health and wellness. Patients that do not require extensive health accommodations or hospital stays are likely to have to pay the least in adjunctive healthcare therapy. That said you should always be prepared to foot the bill for extra expenses including any complications that may rise from treatment. Health insurance may offset some of these costs.
Keep in mind there may be separate fees associated with anesthesia. The hospital and anesthesia fees are usually separate from the fees charged for the procedure itself, although some medical tourism companies tend to provide all-inclusive packages for their patients. This may be the best option for individuals that plan to travel abroad already and want to fit in a little health care while traveling for pleasure.
|Country||Costs Hydrocele Operation|
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<urn:uuid:57d92190-6ad1-4d8c-aca4-713307cec119>
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http://medicaltourismguide.com/procedures/medical/hydrocele-operation/
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Adult Stem Cell Company Publishes With Canadian Scientists on Finding That Could Lead to Improved Transplantation Results
SAN DIEGO CA–(Marketwire – Oct 20, 2011) – Medistem Inc. (PINKSHEETS: MEDS), a clinical stage adult stem cell company, reported today on a publication of a novel method of preventing transplant-associated ischemic liver injury using a nanotechnology delivery system that selectively targets hepatocytes.
In collaboration with Dr. Wei-Ping Min from the University of Western Ontario, the group demonstrated that nanoparticle administration of targeted short interfering RNA (siRNA) was effective at protecting livers from damage caused by oxygen and nutrient deprivation.
“During transplantation, since organs are transported across great distances, the cells undergo what is called ‘ischemic injury’ as a result of being outside of the body,” said Thomas Ichim, CEO of Medistem. “The company is currently using its Endometrial Regenerative Cell (ERC) universal donor stem cell product to treat ischemia in legs and hearts. Through the collaboration with Dr. Wei-Ping Min’s lab, Medistem is trying to elucidate molecular mechanisms of ischemic injury as well as develop additional pipeline candidates.”
The peer-reviewed paper describing the discovery, titled, “Targeted gene silencing of TLR4 using liposomal nanoparticles for preventing liver ischemia reperfusion injury,” was published in the American Journal of Transplantation (link http://www.ncbi.nlm.nih.gov/pubmed/21794086). The technology described in the publication can theoretically be applied to ischemic conditions including stroke, heart attack, and bypass-associated kidney failure.
“Medistem is one of the few companies that not only has clinically developed stem cell products, but also has a strong academic interest in understanding the biological mechanisms by which conditions like ischemic injury are manifested,” said Dr. Wei-Ping Min, Senior Author of the publication. “The fact that Medistem received FDA approval to begin clinical trials using their stem cells attests to the fact that the company possesses substantial scientific depth while still pursuing an aggressive commercialization program.”
|
<urn:uuid:dfeca8f4-0a01-4f6f-9301-e013497b4510>
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http://medisteminc.com/2011/medistem-collaborates-on-nanoparticle-sirna-finding-for-treatment-of-ischemic-conditions/
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2013-05-18T08:02:17Z
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| 0.925741
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| 12
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c44c869f8527fbaa47faf8e70f6c0e776394339000ae4d14513890b4daf89630
| 1,752,484,220.760852
|
Raymond K. Cross, Jr., M.D.,M.S. is a board certified Gastroenterologist and Associate Professor of Medicine, Division of Gastroenterology and Hepatology, at the University of Maryland School of Medicine in Baltimore, Maryland. He also serves as Director of the Inflammatory Bowel Disease Program at the University of Maryland School of Medicine in Baltimore and is the Chief of the GI section at the Veterans Affairs, Maryland Health Care System Baltimore.
Dr. Cross received his undergraduate degree from Washington and Jefferson College in Washington, Pennsylvania, and his medical degree from the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania. He completed his postgraduate training in Internal Medicine at the University of Maryland and Baltimore VA Medical Centers in Baltimore, Maryland, where he was chosen as Chief Resident. He performed his Gastroenterology fellowship also at the University of Maryland and Baltimore VA Medical Centers in Baltimore. In addition, Dr. Cross has obtained a Master of Science degree in Clinical Research at the University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, in Baltimore.
Dr. Cross has several research interests within the field of inflammatory bowel disease. First, he is testing a home telemanagement system for patients with ulcerative colitis (UC). Telemanagement is a home telemedicine system that assists providers in implementing practice guidelines and in monitoring their patients. Additionally, telemanagement systems assist patients in following action plans and in delivering patients focused education. Dr. Cross has previously tested the system in patients with inflammatory bowel disease, and was able to demonstrate that telemanagement was feasible in this population and that patients accepted the technology. The 12-month study will compare the telemanagement system to best available care in patients with ulcerative colitis. He is planning a separate trial to examine telemanagement in patients with Crohn's disease (CD).
Dr. Cross has evaluated the differences in disparities in outcomes both UC and CD by race at the University of Maryland and VA. He has published his findings in CD in Inflammatory Bowel Diseases, treatment disparities in CD and UC in Inflammatory Bowel Diseases and in Digestive Diseases and Sciences. A follow up study is being conducted to evaluated disparities in disease activity and quality of life in patients with inflammatory bowel disease.
Dr. Cross completed a health survey of physician practicing patterns and knowledge of infliximab side effects among gastroenterologists in Maryland and Washington D.C. The results have been published in Digestive Diseases and Sciences. He has completed a follow up national e-mail survey of American Gastroenterological Association members; the findings have been published in Inflammatory Bowel Diseases.
In addition, Dr. Cross recently completed a study of the impact of medication side effects on the quality of life and disease activity in patients with IBD. To evaluate medication side effects, he used a new questionnaire that had been used in patients with asthma and depression. The findings have been published in the Journal of Clinical Gastroenterology.
Inflammatory bowel disease (ulcerative colitis, Crohn's disease, microscopic colitis) Infectious colitis Chronic diarrhea Short bowel syndrome
Cross, RK, Longhitano, JP, Rapoport, AP, Cadogan, MA, Brown, LA and Mackowiak, PA. A 78-year-old man with pancytopenia and abnormal lymphocytes. The American Journal of Medical Sciences. 2001;322:151-155.
Cross, RK, Longhitano, JP, Oursler, KA, Saladino, AJ, and Mackowiak, PA. A 75-year-old man with right upper quadrant pain and gallstones. The American Journal of Medical Sciences. 2002;323:146-150.
Cross RK, Jr., Howell C. Two cases of spontaneous epidural abscess in patients with cirrhosis. South Med J. 2003;96:291-293.
Gobert, AP, Cheng, Y., Akhtar, M., Mersey, BD, Blumberg, DR, Cross, RK, Chaturvedi, R., Drachenberg, CB, Boucher, JL, Hacker, A., Casero, RA, Jr., Wilson, KT. Protective role of arginase in a mouse model of colitis. J Immunol. 2004;173:2109-17.
Cross RK, Wilson KT, Binion DG. Polypharmacy and Crohn's disease. Aliment Pharmacol Ther. 2005;21:1211-6
Cross RK, Wilson KT, Binion DG. Narcotic use in patients with Crohn's disease. Am J Gastroenterol 2005;100(10):2225-9.
Cross RK, Binion DG. Narcotic use in patients with Crohn's disease: reply form Drs. Cross and Binion. Am J Gastroenterol 2006;101(6): 1397-8.
Cross RK, Arora M, Finkelstein J. Acceptance of telemanagement is high in patients with inflammatory bowel disease. J Clin Gastroenterol 2006;40(3):200-8.
Cross RK, Jung C, Wasan S, Joshi G, Sawyer R, Roghmann MC. Racial Differences in Disease Phenotypes in Patients With Crohn's Disease. Inflamm Bowel Dis 2006;12(3):192-198.
Castro, HK, Cross, RK, and Finkelstein, J. Using a Home Automated Telemanagement System (HAT): Experiences and Perceptions in Patients with Inflammatory Bowel Disease. AMIA Annu Symp Proc 2006; 872.
Cross, RK, and Finkelstein, J. Feasibility and Acceptance of a Home Telemanagement System in Patients with Inflammatory Bowel Disease: A 6-Month Pilot Study. Dig Dis Sci 2007;52(2):357-364.
Donovan, M, Lunney, K, Carter-Pokras, O, and Cross, RK. Prescribing Patterns and Awareness of Adverse Effects of Infliximab: A Health Survey of Gastroenterologists. Dig Dis Sci. Aug 2007;52(8):1798-1805.
Dunnigan, M, Yfantis, H, Rapoport, AP, Hosseinzadeh, K, Gocke, CD, and Cross, RK. Large cell lymphoma presenting as a flare of colitis in a patient with common variable immune deficiency. Dig Dis Sci. 2007;52(3):830-4.
Cross, RK, Lapshin, O, and Finkelstein, J. Patient Subjective Assessment of Drug Side Effects in Inflammatory Bowel Disease. J Clin Gastroenterol. 2008;42(3):244-51
Flasar MH, Johnson T, Roghmann MC, Cross RK. Disparities in the use of immunomodulators and biologics for the treatment of inflammatory bowel disease: A retrospective cohort study. Inflamm Bowel Dis. 2008;14(1):13-9
Flasar, M, Quezada, S, Bijpuria, P, Wu, Roger, and Cross, RK. Racial Differences in Extent, Severity, and Extraintestinal Manifestations in Patients with Ulcerative Colitis: A Retrospective Cohort Study. Dig Dis Sci. Feb 20 2008.
Greenberg, R, Greenwald, B, Ioffe, O, Roth, S, and Cross, RK. Squamous Dysplasia of the Rectum in a Patient with Ulcerative Colitis Treated with 6-Mercaptopurine. Dig Dis Sci. 2008;53(3):760-4.
Flasar, M, Roghmann, MC, and Cross, RK. Disparities in IBD Care: Time to Correct a Problem: reply from Drs. Flasar, Roghmann, and Cross. Gastroenterology. 2008;134(5):1618-1619.
Warren, JW, Howard, FM, Cross, RK, Good, J, Weissman, M, Wesselmann, U, Langenberg, P, Greenberg, P, and Clauw, D. Antecedent non-bladder syndromes in a case control study of interstitial cystitis/painful bladder syndrome. Urology. 2009;73(1):52-7.
Quezada, S, Turner, P, Alexiev, B, Daly, B, and Cross, RK. Severe Refractory Orofacial Crohn's Disease: Report of a Case. Dig Dis Sci. 2008.
Cross RK, Cheevers N, Finkelstein J. Home Telemanagement for Patients with Ulcerative Colitis (UC HAT). Dig Dis Sci 2008.
St. Charles, M, Weiss Smith, SR, Beardsley, R, Fedder, DO, Carter-Pokras, O, and Cross, RK. Gastroenterologists Prescribing of Infliximab: A National Survey. Inflamm Bowel Dis. 2009.
Links of InterestThe Foundation for Clinical Research in IBD
UMMC Inflammatory Bowel Disease Program
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<urn:uuid:04db5da4-a92f-47fb-acb5-e5af668687dd>
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http://medschool.umaryland.edu/facultyresearchprofile/viewprofile.aspx?id=5389
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2013-05-18T05:57:44Z
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When I saw the below *graphic photos last week from UK news sites, I was not surprised -- and considered sharing them to the blog -- but I did not. However they have made them here to the good old US of A and it appears that this is what Mr. Paul Mason of England would desire - is publicity.
Mr. Mason was A Man Of Very Large Size. :)
He nearly reached 1000 pounds at his highest weight, and with the assistance of bariatric surgery he is now down an amazing 644 pounds and left with a massive amount of excess skin. This is obviously quite a feat -- and as a WLS patient yourself -- I am sure you can imagine the skin issues are inexplicably awful.
If you recall, (as maybe one or two of you out there in the interweb do...or not?) I started blogging (... in 2005) hoping to save any pennies I earned doing so for "plastic surgery fund!" (No, I never had any plastics.)
Reconstructive surgery after massive weight loss is not inexpensive, nor easy. I completely understand Mr. Mason's reasoning for throwing his photos out there.
And, I'm throwing them here. Maybe someone will take him on.
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<urn:uuid:eddbae9c-a561-4a45-8c2f-9e331782fb95>
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http://meltingmama.typepad.com/
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2013-05-18T05:55:25Z
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en
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End of preview. Expand
in Data Studio
YAML Metadata
Warning:
empty or missing yaml metadata in repo card
(https://huggingface.co/docs/hub/datasets-cards)
Medical FineWeb Dataset Card
Overview
Medical FineWeb is a curated subset of medical content from the HuggingFace FineWeb dataset. It is designed for medical NLP applications, featuring high-quality, filtered, and annotated web texts.
Key Features
- High-quality scoring (TF-IDF, semantic analysis)
- Medical keyword categorization
- Deduplication
- Scalable, multi-threaded processing
- Automatic metadata and annotation
Use Cases
- Language Modeling
- Text Classification
- Medical Information Extraction
- Question Answering
- Text Generation
Languages
- Primarily English
- Others as available in FineWeb
Data Format
Each record is a JSON object:
{
"text": "...",
"record_id": "...",
"url": "...",
"date": "...",
"language": "en",
"language_score": 0.95,
"token_count": 1547,
"medical_keyword_count": 42,
"quality_score": 0.87,
"content_hash": "...",
"processing_timestamp": 1705123456.789
}
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