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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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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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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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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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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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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.”
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http://medisteminc.com/2011/medistem-collaborates-on-nanoparticle-sirna-finding-for-treatment-of-ischemic-conditions/
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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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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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Webcast: Evidence-based Review of Interventions for Children with Autism Spectrum Disorders
Speaker: Jane Case-Smith, EdD, OTR/L, FAOTA
Earn 1 contact hour (1 NBCOT PDU)
This webcast presentation summarizes the up-to-date research evidence for interventions used by occupational therapy practitioners with children with ASD. The current research evidence for sensory integrative, sensory-based, social skills, behavioral, relationship-based, and comprehensive interventions is explained, including what we know about effectiveness with different levels of severity and age groups. Themes that emerge across intervention trials are identified and described. These themes define elements that are central to effective intervention, including: intensity of services, family roles and support, strategies for increasing child engagement, and models of practice.
At the conclusion of the session, learners will be able to:
- Identify the evidence for sensory, social, relationship based, educational and behavioral interventions that are applied by occupational therapists to children with autism spectrum disorder.
- Identify themes of the interventions most effective with this population.
- Identify key principles reflected in the research on autism interventions.
Click here for speaker bios and more detailed information on this course.
Target Audience: Occupational Therapists and Occupational Therapy Assistants
Learning Level: Intermediate
Occupational Therapy Classification Code for Continuing Education
Category 2: Occupational Therapy Process, Evaluation and Intervention
Category 3: Professional Issues, Contemporary Issues and Trends
An e-mail address is required for ordering a Webcast. Once your order has been placed, you will receive an e-mail confirmation within 2 business days granting you access to the exam. Expedited ordering is available by calling 877-404-AOTA. An additional $15 processing fee will be charged.
Click here for Customer Service Q&A to find information on shipping, technical requirements, examination, return policy, and more.
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Rectal Swabs a Promising Supplement to E. Coli Test
Submitting tissue samples via surface mail may present challenges to swine practitioners due to public health and perception concerns and regulatory restrictions. This study evaluated alternative sampling techniques for Escherichia coli (E. coli) in cases of weaned pig diarrhea.
Fifteen pigs from four sites were sampled. Two rectal swabs, two intestinal swabs and a tissue sample were collected from each pig. Rectal swabs and tissue from each pig were cultured for E. coli, and tissues were evaluated for lesions at the Iowa State University Veterinary Diagnostic Laboratory.
E. coli was isolated from all cases using both rectal swabs and intestinal tissue. Rectal swabs yielded E. coli with both toxin and pili genes in pigs with clinical signs.
However, genotyping results from the rectal swabs and the intestinal tissue did not agree at the pig level in 64% of the cases, suggesting that multiple samples are required to characterize the E. coli population at the farm.
Rectal swabs and tissue samples provide advantages and disadvantages to the practitioner. Tissue samples offer the ability to necropsy the pig and view lesions and other pathogens. E. coli is a pervasive organism in that presence doesn’t always equal disease, so tissue analysis provides an opportunity to verify diagnosis.
Rectal swabs allow healthy pigs to be sampled or acute cases to be pursued where practitioners may be reluctant to euthanize pigs. Rectal swab use helps avoid the need to euthanize the pig thus salvaging its value.
Rectal swabs also allow larger sample size and justify running more antibiotic sensitivity tests due to costs saved from not euthanizing pigs or shipping tissue samples. Rectal swabbing may also provide an opportunity to submit more samples to better characterize the E. coli population without euthanizing additional pigs.
This clinical tool may be used as a supplemental diagnostic method to tissue submission and give a cost-effective means of increasing the sample size in difficult E. coli cases. It will not replace tissue samples from acutely affected pigs as primary diagnostic samples, however.
Researchers: Locke Karriker, DVM and Anna Johnson, Iowa State University. For more information, contact Karriker by phone (515) 294-2283, fax (515) 294-1072 or e-mail: firstname.lastname@example.org.
Airborne Spread of Flu Virus is Feasible
University of Minnesota research suggests that swine influenza virus can be detected in aerosols generated from infected pigs and that airborne spread is possible.
Swine influenza virus is an important respiratory pathogen that causes low mortality but high morbidity that impacts pig performance. The virus is known to spread through nose-to-nose contact and droplets, but little is known about the dynamics of airborne transmission within and between herds.
In a study at the University of Minnesota research farm, air samples were collected from 7-week-old pigs experimentally infected and housed in isolation rooms. In addition to the air samples, all pigs were individually sampled daily to correlate individual pig shedding with the likelihood of virus detection in the air.
Results indicated that a minimum number of infected pigs need to be actively shedding the virus in order to produce sufficient aerosols to be detectable in the air.
The virus was first detected in the air when at least four of 11 pigs were simultaneously shedding virus. Detection of the virus in air samples under experimental conditions was possible for six days (Figure 1), which coincided with the course of the active infection.
Since the pigs in the study were fully susceptible to influenza infections, pigs with different degrees of maternal immunity against influenza were measured for airborne detection of the virus. Virus was detected in pigs with partial immunity as well as those without immunity, but no influenza virus was detected in pigs that had protective levels of maternal antibodies.
Results indicated that influenza virus may be found in aerosols generated from infected pigs, but that immunity plays a role in the generation of infectious aerosols and therefore in the risk of airborne transmission. More research is needed to understand the role of aerosol transmission under field conditions, according to researcher Cesar Corzo, DVM.
Researchers: Cesar Corzo, DVM, Marie Gramer, DVM, Bob Morrison, DVM, and Montse Torremorell, DVM, University of Minnesota; and Scott Dee, DVM, Pipestone (MN) Veterinary Clinic. For more information, contact Torremorell by phone (612) 625-1233, fax (612) 625-1210 or e-mail: email@example.com.
PRRS Vaccine Reduces Shedding in Field Study
One of the crucial challenges in the PRRS regional elimination projects is reinfection of pig units due to area spread of the porcine reproductive and respiratory syndrome (PRRS) virus.
The objective of this study was to evaluate the effect of PRRS modified-live-virus (MLV) vaccine on viral shedding and on dynamics of PRRS infection in pig groups raised under field conditions.
The study consisted of two groups of 1,000 pigs each. Ten percent of the pigs in each room were inoculated with a field strain of the PRRS virus. Rooms featured separate ventilation and strict adoption of scientifically valid biosecurity protocols to avoid movement of pathogens between rooms.
At eight and 36 days post-inoculation (DPI), all pigs in the challenge-vaccine group were inoculated with a PRRS MLV vaccine. Pigs in the challenge-control group were inoculated with a placebo.
Following the challenge, blood and oral fluid samples were collected from each room at 0, 8, 36, 70, 96 and 118 DPI for detection of PRRS virus using polymerase chain reaction (PCR). Screening for PRRS virus antibodies was also performed on blood serum samples using an ELISA (enzyme-linked immunosorbent assay) test.
Tonsil scraping samples were collected from both groups at 70, 96 and 118 DPI. Air samples were collected six times per week from 0 to 118 DPI and tested for PRRS virus using a PCR assay.
Test results suggested that there was no difference in the PRRS infection dynamics as measured by viremia (infection in the bloodstream) and seroconversion between the vaccinated and the control group pigs.
There was no difference in the frequency of tonsil scraping samples testing positive for PRRS by PCR for the two rooms of pigs.
However, the challenge-vaccine group had a significant reduction in the amount of PRRS virus shed in the air and the number of days in which PRRS virus could be detected in air samples. PRRS virus was detected in the challenge-control group for up to 70 days post infection, compared to 45 days in the challenge-vaccine group.
The proportion of oral fluid PCR-positive samples detected at 36 DPI was lower in the challenge-vaccine group.
PRRS MLV vaccines might provide assistance in regional elimination of PRRS virus by decreasing the amount of virus shed from infected pig populations.
Researchers: Scott Dee, DVM, and Joel Nerem, DVM, Pipestone (MN) Veterinary Clinic; Jean Paul Cano, DVM, and Tom Wetzell, DVM, Boehringer Ingelheim Vetmedica, Inc.; Daniel Linhares, DVM, and Montse Torremorell, DVM, Leman Chair, University of Minnesota. For more information, contact Torremorell by phone (612) 625-1233 or e-mail: firstname.lastname@example.org.
Young Pigs can be Source of Influenza Virus
Even though swine influenza virus is a common cause of respiratory disease in pigs, information has been lacking on transmission and epidemiology within pig populations.
Anecdotal evidence would suggest that influenza viruses tend to circulate in swine breeding herds for an extended period of time.
New research at the University of Minnesota identified neonatal pigs as a potential reservoir for influenza virus in swine breeding herds. Following intensive sampling in selected commercial herds, neonatal pigs were found to be infected with influenza virus, while the adult animals (sows and gilts) sampled within these populations were not infected.
The prevalence of infection in neonatal pigs was typically low (less than 10%) but tended to be higher as pigs approached weaning age.
Additionally, pigs weaned from an infected breeding herd served as a source of virus for their respective nursery/wean-to-finish herd. This means neonatal and weaned pigs can serve as a source of influenza virus within herds and across herds. This preliminary finding can help guide future research concerning influenza virus epidemiology and control.
Researchers: Matt Allerson, DVM; Montse Torremorell, DVM; and Marie Gramer, DVM, University of Minnesota. For more information, contact Torremorell by phone (612) 625-1233, fax (612) 625-1210 or e-mail: email@example.com.
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<urn:uuid:0207ce35-51e8-4e41-bd00-cb310d17ed32>
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http://nationalhogfarmer.com/health/2011-swine-research-review-health
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2013-05-18T08:03:08Z
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| 0.943334
| 1,890
| 42
| 0.659963
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11c4ba4f896c1350086d17d60a17eb9c03f086d6ba54cb7c333a04fce6d4d8a4
| 1,752,484,221.251887
|
Resources for living well
This obesity primer consists of 10 booklets that address adult obesity in the primary care setting. It offers practical recommendations on evaluating patients for health risks related to weight, understanding medication and surgical options, improving communication and counseling, and making office environments more accommodating to obese patients.
American Medical Association (AMA)
This guide provides a set of generic principles that can be used as the basis for planning, delivering, and evaluating public health activities aimed at changing health-related behaviors.
National Institute for Health and Clinical Excellence (NICE)
These validated patient survey tools work to assess patient and health care professional attitudes, wishes, and needs in diabetes management, a vital and valuable part of patient-centred quality of care improvement.
DAWN (Diabetes Attitutes, Wishes, and Needs) Study
This guide for health care professionals provides comprehensive diabetes information on prevention and control and cardiovascular disease.
California Medical Association Foundation
This website provides access to program models, tools, and resources to enable health care professionals to provide self-management support for adults with diabetes in real world clinical and community settings. En español
Robert Wood Johnson Foundation
These handouts provide facilitators with tools to implement the DPP intervention using strategies to achieve nutrition, physical activity and weight loss goals. En español
Diabetes Prevention Program (DPP)
This kit contains resources for health care teams that want to begin offering group visits for their patients. Group visits offer staff a new and more satisfying way to interact with patients that makes efficient use of resources, improves access, and uses group process to help motivate behavior change and improve outcomes.
Institute for Healthcare Improvement (IHI)
This guide details the steps to using change interventions with diabetes patients to move them toward disease self-management. En español
California Diabetes Program
This brochure for health care professionals details the steps to using change interventions with diabetes patients to move them toward disease self-management. En español
California Diabetes Program
Living a Balanced Life with Diabetes: A Toolkit Addressing Psychosocial Issues for American Indian and Alaska Native Peoples can help health care professionals address psychosocial issues with American Indian and Alaska Native Peoples. The toolkit contains a variety of culturally appropriate materials.
National Diabetes Education Program (NDEP)
- Help Me Select one:
I Am A
- Health care professional Remove
- Age Select one:
Type of Resource
- Printable documents Remove
- Language Select one:
|
<urn:uuid:cd2f7dac-98a4-4837-ba0d-ec9b815c164f>
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http://ndep.nih.gov/resources/diabetes-healthsense/index.aspx?terms=34,47,2
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2013-05-18T05:57:01Z
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CC-MAIN-2013-20
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en
| 0.85047
| 513
| 24
| 0.906061
|
7ae6a54224e648af7d6c517fbc5767d1973e36eed7de5480a062a0586f326feb
| 1,752,484,221.276182
|
Enter the base name or location (i.e. "North Carolina" or "Pearl Harbor")
|Army||Air Force||Coast Guard||Navy||Marines|
Schedule: Full-time 30-40 hours
Hours: 7:00am - 7:30pm/7:00pm - 7:30am/Rotating
Job ID: 23215
Job Code: 400948
1 year of experience required
Day/Night rotation; 7am - 7:30am/7pm - 7:30am with rotating weekend and holidays
Our exceptional cardiac care program uses a multidisciplinary, patient centered approach with all the benefits of an academic hospital setting. This 36-bed Intermediate Cardiac Care Unit (ICCU) provides care for both surgical and medical primarily adult cardiac patients. The ICCU is a fast paced, dynamic work environment that promises to provide a variety of challenging patient care experiences with the latest technological advances in cardiac care. If you would like to work in an environment that is supportive and therapeutic for both staff and patients then apply now to join our team!
MINIMUM EDUCATION & EXPERIENCE: Graduate of an accredited school of nursing, a minimum of 1 year acute care experience with current NH registered nurse licensure required.
Dartmouth-Hitchcock Medical Center is New Hampshire's only integrated, academic, level I trauma center. We are located in a state-of-the-art facility that was built on an expansive 225-acre campus in the heart of the Upper Connecticut River Valley. The Medical Center includes a modern 400-bed tertiary care hospital, the Children's Hospital at Dartmouth, research and clinical facilities for Dartmouth Medical School (the country's fourth oldest), and The Dartmouth-Hitchcock Clinic, a region wide multi-specialty community practice group started in 1927.
Employees at Dartmouth-Hitchcock Medical Center receive the support both on and off the job to do their best possible work here. We hire and retain the best health care professionals in the country by offering competitive salaries and extraordinary benefits, including:
-Earned Time Off in Your First Years of 28 Days, with a Cash-Out Option for
-Interview and Relocation Assistance (both financial support and professional
-Health, Life, Dental, and Short-Term and Long-Term Disability Insurance
-Outstanding Employee Retirement Plan
-Tax-Deferred 403(b) Annuity
-Health Savings Account (HSA)
-Flexible Spending Accounts
-On-Campus Child Care
-Free On-Site Parking
|
<urn:uuid:106f5aac-97b3-42cf-b476-446e8f01bf99>
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http://newhampshire.jobs/lebanon-nh/staff-nurse/34153934/job/
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2013-05-18T08:07:19Z
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CC-MAIN-2013-20
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en
| 0.910728
| 533
| 18
| 0.732544
|
11adf1b1caa847f58b166981deb72875aaa69007f3619ee5547eaef76fa348b0
| 1,752,484,221.307801
|
A novel two-step immunotherapy approach has shown clinically beneficial responses in patients with advanced ovarian cancer. Following Lifestyle Recommendations Reduces Risk of Cancer Death
People who follow the diet and lifestyle recommendations laid out by the WCRF and the AICR have a 20 percent reduced risk of dying from cancer. UCSF Launches Social Networking Site for Patients and Families with Hereditary Cancers
For Immediate Release May 14, 2013 UCSF Launches Social Networking Site for Patients and Families... Genomic Test May Help Guide Prostate Cancer Treatment
The Oncotype DX® Prostate Cancer Test strongly predicts aggressiveness of disease. Statins Linked to Lower Risk of Liver Cancer in Hepatitis C
People infected with chronic hepatitis C are less likely to develop liver cancer if they are taking statins.
Radioimmunotherapy (RIT) is a type of targeted therapy that delivers radiation directly to cancer cells.... Urinary Incontinence
Overview The urinary tract includes the kidneys, the ureters, the bladder, and the urethra. The kidneys... Advanced Directives
Living Wills Every competent adult has, in most cases, the freedom to accept or refuse medical treatment.... Caregivers
What is Caregiving and Who are Caregivers? Caregivers are individuals who provide care to chronically... Chemotherapy for Older Patients: What You Should Know About the Risk of Infection
As you may already know, chemotherapy works by attacking the rapidly dividing cells it finds in the body,...
An ongoing series highlighting complementary therapies, adapted from The Complete Guide to Complementary... Clear and precise
Mohs surgery provides a tissue-sparing approach to skin cancer surgery. By Eleanor Mayfield Michele Kelsey... Chemical Reaction
Chemicals may be disrupting our hormones—and our health. By Laurie Wertich Exposure to synthetic chemicals... College Kids Kick Cancer
By Diana Price College kids and cancer—not two topics most of us would immediately connect. And yet... Cooking with Fruits and Vegetables
In the introduction to Ripe: A Fresh, Colorful Approach to Fruits and Vegetables (Running Press, 2011;...
Annual meeting brings together cancer experts from around the world. Kari Bohlke, ScD The 2011 Annual... Bone Fractures in Breast Cancer Patients More Frequent with Femara than with Tamoxifen
Researchers affiliated with the BIG I-98 Collaborative and International Breast Study Groups... Single Treatment with High-intensity Focused Ultrasound Effective for Localized Prostate Cancer
Researchers from McMaster University in Canada have reported that high-intensity focused... Marital Separation Impacts Cancer Survival
Researchers from the University of Indiana and the Fox Chase Cancer Center... 2009 Oncology Conference Coverage View up-to-date coverage of the 2009 Oncology Conference here.
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<urn:uuid:07b8e00d-b445-4736-a593-cd1c147dce21>
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http://news.cancerconnect.com/
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2013-05-18T05:23:15Z
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CC-MAIN-2013-20
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en
| 0.872709
| 576
| 21
| 0.915971
|
c7b87f660ece6df6892f2efc157c1e7cdd5d00004338cfc1e3e9fd7fbcecac3b
| 1,752,484,221.337685
|
Sudden death syndrome--an umbrella term for a range of heart conditions that can lead to cardiac arrest--is notorious for striking those who seem most fit.
That is because the condition, thought to be largely hereditary, is often triggered by overexertion. Tragically for some, the first symptom can be cardiac arrest.
It's possible, though costly, to screen for SDS. In fact, after soccer prodigy John Marshall died of a sudden heart attack at age 16 in 1994, the day before he was set to join Everton, testing became compulsory for professional athletes in several countries.
Good thing, especially for those who don't have the means that professional athletes do, that a doctor at Tel Aviv University may have just made testing for the condition far simpler and more affordable.
"There is such a significant overlap between what's normal and abnormal on an ECG [electrocardiogram] that we need additional screening parameters," Dr. Sami Viskin, a cardiologist at the Sackler Faculty of Medicine, said yesterday in a university press release. "This test, when done on people with strong symptoms, can really give...doctors a yardstick to compare those at risk for sudden death syndrome to those who would otherwise go on to live a healthy life."
Named after the doctor, the Viskin Test is easy on the patient, who simply undergoes a baseline ECG while resting in the supine position, and is then asked to stand quickly and remain still during continuous ECG recording.… Read more
|
<urn:uuid:8fedc1ae-d9da-4da5-9da7-31e4b337c8fc>
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http://news.cnet.com/8300-5_3-0-11.html?categoryId=10277408
|
2013-05-18T04:56:19Z
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CC-MAIN-2013-20
|
en
| 0.969719
| 315
| 14
| 0.911846
|
f79469432524c071e516879a83a6713d0f88efd7e686d23598a8072917c458e6
| 1,752,484,221.343423
|
Adult-Gero Acute Care Nurse Practitioner
Transitioning to the advanced practice role is a wonderful opportunity for the RN who wants to do more. As a nurse practitioner, you are a nurse first and bring to the advanced role all the aspects about nursing that are so fulfilling. The acute care graduate program allows students to become an acute care nurse practitioner. Acute care refers to hospital- based nursing. It may include the ICU, ED, OR, SDU or other hospital-based service.
|
<urn:uuid:4843d889-4851-4ee0-8305-dda3b52d2c36>
|
http://nursing.uc.edu/academic_programs/msn/onsite_programs/adult_acute_carenp.html
|
2013-05-18T08:02:41Z
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CC-MAIN-2013-20
|
en
| 0.956257
| 104
| 10
| 1
|
2bc6746e9615d16ce3137e8cfea1778b37f5fec35a0e747a4c3ebfac089b758d
| 1,752,484,221.546532
|
Sleep apnea is a condition in which breathing is repeatedly interrupted during sleep. The time period for which the breathing stops or decreases is usually between 10 and 30 seconds. When these episodes occur repeatedly, sleep apnea can seriously disrupt the quality of sleep.
There are three types of respiratory events:
- Obstructive apnea—caused by a temporary, partial, or complete blockage of the airway
- Central apnea—caused by a temporary failure to make an effort to breathe
- Mixed apnea—combination of the first two types
These factors increase your chance of developing sleep apnea. Tell your doctor if you have any of these risk factors:
- Sex: male
- Large neck circumference
- Age: middle to older age
- Family history of apnea
Structural abnormalities of the nose, throat, or other part of the respiratory tract. Examples include:
- Severely enlarged tonsils
- Deviated nasal septum
- Medicines: sedatives and sleeping aids
- Alcohol consumption
- Fatigue and sleepiness during waking hours
- Loud snoring
- Breathing that stops during the night (noticed by the partner)
- Repeated waking at night
- Unrefreshing sleep
- Morning headaches
- Poor concentration or problems with memory
- Irritability or short temper
People with chronic untreated sleep apnea may be at risk for:
An overnight sleep study is used to help diagnose sleep apnea.
Overnight Sleep Study (Polysomnography)
This test helps detect the presence and severity of sleep apnea. During sleep, it measures your:
- Eye and muscle movements
- Brain activity ( electroencephalogram )
- Heart rate
- Breathing (pattern and depth)
- Percent saturation of your red blood cells with oxygen
There are a number of treatment options for sleep apnea, including:
- Lose weight if you are overweight.
- Avoid using sedatives, sleeping pills, alcohol, and nicotine, which tend to make the condition worse.
- Try sleeping on your side instead of your back.
- Place pillows strategically so you are as comfortable as possible.
- For daytime sleepiness, practice safety measures, such as avoiding driving or operating potentially hazardous equipment.
Continuous positive airway pressure (CPAP) entails wearing a mask over your nose and/or mouth during sleep. An air blower forces enough constant and continuous air through your air passages to prevent the tissues from collapsing and blocking the airway. In some cases, dental appliances that help keep the tongue or jaw in a more forward position may help.
In some cases, surgery may be recommended. It is most often beneficial in pediatric patients.
Types of surgery that may be done to treat severe cases of sleep apnea include:
- Uvulopalatopharyngoplasty—The doctor removes excess soft tissue from the nose and/or throat.
- Maxillomandibular advancement—The jawbone is repositioned forward.
- Tracheotomy —For life-threatening cases of sleep apnea, an opening is made in the windpipe to allow for normal breathing.
Bariatric surgery may help with weight loss in some people who are obese . This surgery may reduce many of the complications that are related to obesity, including sleep apnea.
Only used in central apnea, acetazolamide (Diamox) may help improve the ability to regulate breathing. Overall, there is not a lot of evidence to support the use of medicines to treat sleep apnea.
Supplemental oxygen may be given if blood levels of oxygen fall too low during sleep, even after opening the airway.
You may be able to prevent the onset of sleep apnea by maintaining a healthy weight . Avoid alcohol, nicotine, and sedatives, which may contribute to airway obstruction.
- Reviewer: Rimas Lukas, MD
- Review Date: 09/2012 -
- Update Date: 00/93/2012 -
|
<urn:uuid:da610566-65f7-4f92-a0b9-cbf818d8ece0>
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http://oprmc.com/your-health/?/11549/
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2013-05-18T06:20:04Z
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CC-MAIN-2013-20
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en
| 0.904892
| 834
| 21
| 0.753535
|
95bd0cdbca6bb648343d97a83e44ce202e9f03bc652eb2c1baf5933ce9abcc2f
| 1,752,484,221.857945
|
Resequencing of positional candidates identifies low frequency IL23R coding variants protecting against inflammatory bowel disease.
Momozawa, Yukihide ; Mni, Myriam ; Nakamura, Kayo et al
in Nature Genetics (2011), 43(1), 43-7
Genome-wide association studies (GWAS) have identified dozens of risk loci for many complex disorders, including Crohn's disease. However, common disease-associated SNPs explain at most approximately 20 ... [more ▼]
Genome-wide association studies (GWAS) have identified dozens of risk loci for many complex disorders, including Crohn's disease. However, common disease-associated SNPs explain at most approximately 20% of the genetic variance for Crohn's disease. Several factors may account for this unexplained heritability, including rare risk variants not adequately tagged thus far in GWAS. That rare susceptibility variants indeed contribute to variation in multifactorial phenotypes has been demonstrated for colorectal cancer, plasma high-density lipoprotein cholesterol levels, blood pressure, type 1 diabetes, hypertriglyceridemia and, in the case of Crohn's disease, for NOD2 (refs. 14,15). Here we describe the use of high-throughput resequencing of DNA pools to search for rare coding variants influencing susceptibility to Crohn's disease in 63 GWAS-identified positional candidate genes. We identify low frequency coding variants conferring protection against inflammatory bowel disease in IL23R, but we conclude that rare coding variants in positional candidates do not make a large contribution to inherited predisposition to Crohn's disease. [less ▲]Detailed reference viewed: 69 (29 ULg)
|
<urn:uuid:82b258fa-c9b9-47f7-9407-edfec56129d7>
|
http://orbi.ulg.ac.be/browse?type=authorulg&rpp=20&value=Momozawa%2C+Yukihide+p086790
|
2013-05-18T05:56:01Z
|
CC-MAIN-2013-20
|
en
| 0.897616
| 350
| 11
| 0.762162
|
ad4a5082a0055103375c2fe1f38537cc71533c2a49d9aeada76649be07447db4
| 1,752,484,221.86263
|
Webcast: Psoriasis treatment: Overcoming barriers to access
Presented by Marc Boutin, J.D., and Bethany Wofford, MSSW
Navigating the insurance maze and fighting for your right to treatment can be a challenge, but persistence pays off. Learn how to find financial resources and to appeal denials. Bethany Wofford, MSSW, Health Policy Manager at the National Psoriasis Foundation, talks about resources for people who have insurance, those who don't and those with Medicare coverage. Also presented is information on how recent changes to health care laws will affect people with psoriasis and psoriatic arthritis from Marc Boutin, executive vice president and chief operating officer of the National Health Council in Washington, D.C.
Contact Kathleen Carter, Outreach Coordinator, at firstname.lastname@example.org or 800.723.9166, ext. 361.
The views and opinions expressed in the webcasts are those of the speakers. The speakers' views and opinions are not endorsed by the National Psoriasis Foundation or its sponsors.
|
<urn:uuid:a215783c-bd65-4305-aaf9-fd47e9d5cf73>
|
http://psoriasis.org/events/educational/video-webcasts/treatments/access-to-care
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2013-05-18T06:19:31Z
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CC-MAIN-2013-20
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en
| 0.92632
| 226
| 5
| 0.6
|
d05519d24d5b1c1d6a2e561f51b566016931e9a9ad410b77a63714e37c3e7718
| 1,752,484,222.34723
|
The Biomedical Imaging Technology Study Sections both review applications involving basic, applied, and pre-clinical aspects of the design and development of medical imaging system technologies, their components, software, and mathematical methods for studies at the cellular, organ, small or large animal, and human scale. Emphasis is on technology development but extends to the science of image formation, analysis, evaluation and validation, including image perception, and integration of imaging technologies. In general, applications which focus on the physics and mathematics of medical imaging devices and systems for hardware and software development as well as on the application of methods of applied mathematics using iterative, non-iterative, deterministic and probabilistic approaches, and analysis of complex dynamical systems would be assigned to BMIT A. Those addressing the application of biomedical imaging system technologies, their components, software, and mathematical methods for solving important problems in biology or medicine, would be assigned to BMIT B.
- Component technologies used in the design, development, implementation, testing and application of imaging systems, including, transducers, magnets, coils, and other devices to acquire medical image data from various modalities.
- New methods and theories for processing and presenting medical images: display, computational resources for reconstruction, registration, segmentation, visualization, and analysis of multi dimensional data sets from various modalities.
- Development of image-based methods and strategies (both hardware and software components) to characterize tissue, including computer-aided diagnosis and image-based biomarkers or for the support of image-guided interventions, including robotics, surgery, drug delivery, and minimally invasive therapies.
- Methodology for validating medical imaging systems including medical-image-observer performance: vision modeling, metrics, calibration, standards, statistical methods, and simulation of an ideal observer using principles of psychophysical experimentation.
- Imaging studies at the cellular, organ, small or large animal and human scale, where the emphasis is on the science of image formation, analysis, evaluation and validation, including image perception, and integration of imaging technologies.
|
<urn:uuid:c220c2b9-ddf1-4451-9daa-2779f61fd58a>
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http://public.csr.nih.gov/studysections/integratedreviewgroups/sbibirg/bmit/Pages/default.aspx
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2013-05-18T08:01:57Z
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CC-MAIN-2013-20
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en
| 0.91382
| 414
| 19
| 0.881553
|
b7a49ba6aee1b61af9a502baa048c7adff2720aff1fb69add08489ff1dcac4b4
| 1,752,484,222.352377
|
A growing body of epidemiologic evidence links oral health, obesity, and cardiovascular health, though few studies have reported on these relationships in children. While underlying mechanisms are unclear, adult studies have suggested sub-acute systemic inflammation, also implicated in the etiology of both obesity and cardiovascular disease. This study investigated associations between self-reported dental hygiene, obesity, and systemic inflammation in children.
128 children < 19 years of age from rural counties in West Virginia participated in a community-based health screening that included anthropometric assessments, blood collection, and a questionnaire about dental hygiene and self-assessed oral health.
Participants ranged from 3.0-18.7 years. Univariate analysis demonstrated an association between parent-reported dental hygiene, including frequency of preventive dental care and parent-assessed overall dental health, and markers of systemic inflammation but not obesity. In multivariable regression, parent-assessed overall dental health and obesity were independent predictors of systemic inflammation, after adjustment for age, gender, and parent education.
This is the first known study of the association between dental hygiene, obesity, and systemic inflammation in children. These results highlight the importance of preventive dental care in overall, systemic health in children and are consistent with previous reports in adults.
|
<urn:uuid:ac9bb119-8613-4f77-8948-ba578870c0b7>
|
http://pubmedcentralcanada.ca/pmcc/solr/reg?term=jtitle_s%3A(%22BMC+Oral+Health%22)&filterQuery=author_s%3ACrout%2C%5C+Richard%5C+J&sortby=score+desc
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2013-05-18T07:14:13Z
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CC-MAIN-2013-20
|
en
| 0.946216
| 255
| 11
| 0.90625
|
e5981152283cdfb8ce5d18dd58beeb211cf9d73bb7036b4bd548e58c5f7f4727
| 1,752,484,222.356359
|
“As a plant takes up the water that it needs, so Reiki is absorbed and goes where it is needed.”
A highly effective form of natural therapy for directing and applying Universal life energy through a gentle touch-activated “hands on” treatment for natural health, relaxation, inner-peace, self esteem and well being. Reiki is gentle and completely safe and can be given to babies, the elderly and used in conjunction with any medication, and complimentary therapies.
This vital energy is essential for your health and well being on a daily basis. In order to balance your energies you must restore vital energy which may become depleted through stress and daily activities.
The regular practice of Reiki assists in maintaining a state of positive wellness and prevents health disorders, no matter what your age.
Reiki treats the physical symptoms of dis-ease in the body, boosting the immune system, giving more energy to chronic fatigue sufferers, relieving arthritis and rheumatic aches and other troublesome bodily pains.
Reiki assists in the treatment of cuts, burns and sprains; broken bones mend twice as fast. It also works at the causal level introducing a feeling of well being and giving a sense of inner peace at the emotional, mental and spiritual levels. The Reiki energy has a calming, relaxing effect on stress, tension, hyperactivity and A.D.D. conditions in adults and children.
Reiki brings stability to the mind, body and brightens the soul, to generate self-esteem, self worth and confidence, thus feeling rejuvenated and empowered to embrace life and all its many blessings.
|
<urn:uuid:3b5985e5-5cc6-4aab-b32d-5817bc5fe2a3>
|
http://reikilove.com.au/about-reiki/
|
2013-05-18T06:20:22Z
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CC-MAIN-2013-20
|
en
| 0.930927
| 331
| 9
| 0.684896
|
3ae13931ce8227f6386bf8c397c1067b7354df54c6ffa9099292fdf78310f42c
| 1,752,484,222.574106
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Pay attention to your intuition, or just simply: What do you feel like using as a system? We’ve discovered people tend to resist the GTD® implementation process enough as it is, so you need all the help you can get to be motivated to work the system. If you know you’d like to be digital, don’t waste time on a paper system. But if you like the look and touch and feel of a cool notebook, go for it. No system works unless you work it.
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<urn:uuid:9d966e92-f90d-42d1-9ecb-728f2aee65ae>
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http://secure.davidco.com/print/faq/gtd-methodology/how-should-i-choose-which-system-use-digital-vs-pa
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2013-05-18T05:29:17Z
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CC-MAIN-2013-20
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en
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| 0.64845
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ef41fd4eade24ff1138f9436fa2c8e8fa8cc796317c611068f33375e454006f0
| 1,752,484,222.885958
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The Heart and Stroke Foundation is a volunteer-based health charity that provides information on stroke and heart disease.
The National Stroke Association provides education and programs on prevention, treatment, rehabilitation and support for all impacted by stroke.
The Stroke Recovery Association of British Columbia is a non-profit organisation helping stroke survivors and their families in BC.
The American Stroke Association is dedicated to providing information to enhance the quality of life for stroke survivors.
The Internet Stroke Center is a non-profit, educational service that exists to advance understanding of stroke research and clinical care by providing current, professional, un-biased information about stroke.
The Canadian Stroke Network is a not-for-profit corporation that brings together researchers, students, government, industry and the non-profit sector. The Canadian Stroke Network is dedicated to decreasing the physical, social and economic consequences of stroke on the individual and on society.
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<urn:uuid:44c90bd1-910a-401b-8ac1-a47edbd76ea3>
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http://strokengine.ca/family/index.php?page=links
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2013-05-18T07:20:27Z
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en
| 0.914621
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ade7fc82c9546471d050f6b025b147fb700a73fc21652758dfbf85544f7053d2
| 1,752,484,223.430392
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There are so many start up drug testing companies nowadays that offers different services. But do they have the accreditation from the US government? Most of the stat ups companies of course wanted to give the best possible service, but are their resources enough so that they can give the services to their customers? If you want to start a drug testing facility, then you must buy the equipment from the most trusted store which sells not only durable and accurate drug testing equipment, but also certified clia waived test. This is one criteria that should be consider when buying a drug testing equipment since government authorities require clia waived test. I am not that well versed with this concept so you may want to read more of it from other sources. So whenever you need drug testing equipment make sure that you buy devices only from trusted suppliers across the country.
When starting business choose the best supplier for your equipment
December 10, 2012 By Leave a Comment
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<urn:uuid:8ce2be4b-73a8-4e0b-b04d-83f330838a5e>
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http://technotrendtracker.info/2012/12/when-starting-business-choose-the-best-supplier-for-your-equipment/
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2013-05-18T05:55:32Z
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en
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| 0.680868
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a2df2cbbc269a69dac89efb8e4cb4b3d05f3b43a70189d6875672642c969f7fd
| 1,752,484,223.648039
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They also keep you healthy inside... Especially when it comes to cholesterol levels.
They actually increase or decrease your risk for heart disease.
Dr. Jeff swanson with united regional says there are three different choleserol levels you need to know and discuss with your doctor.
H-d-l's are good.... they keep cholesterol out of your circulation and keep your blood vessels free of plaque....
So you want this level to be higher.
L-d-l's on the other hand -- raise your risk of heart attack and stroke
You want to have a low l-d-l level.
And finally -- triglycerides increase your risk for heart disease.
They're raised if you have problems with obesity, blood sugar, if you eat proccessed foods that will increase your triglyceride levels.
Dr. Swanson says knowing your levels and working with your doctor is important...
A healthy adult should have an l-d-l level of less than 160...
If you have high blood pressure -- doctor's typically want those levels less than 130...
And if you're diabetic -- dr. Swanson tells his patients to aim for less than 100.
So how do you achieve your goals?
Dr. Swanson says the first steps are eating right and exercise.
They work hand in hand. If you exercise more you'll increase hdl and lower ldl levels.
But if you can't reach your goals that way...
Your doctor may consider medication.
A lot of times you're fighting genetics. If mom and dad had bad hdls and high ldls and heart attacks in their 40's and 50's diet and exercise may not give you the best recovery from your risks. In that case we may to add medicines in those groups.
And dr. Swanson says smokers need to quit.
That's probably the worse thing that we've invented as humans is smoking. It damages your blood vessels directly and changes your cholesterol and triglycerides to where it raises your risks.
So know your numbers and set goals with your doctors to keep your cholesterol where it needs to be.
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<urn:uuid:f7a01a2d-5e39-4e25-b763-72e687fbadb2>
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http://texomashomepage.com/fit-fulltext?nxd_id=171382
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2013-05-18T06:33:40Z
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en
| 0.946068
| 432
| 15
| 0.782435
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b7f1396fbde8a49a07574cb53b33de6b3c076c3043bb8b8572c4286ebc1a777f
| 1,752,484,223.694454
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Colorectal cancer is the third most common cancer in both men and women. Tune in to Mercy Medical Center’s live webinar on Thurs., Dec. 13 at noon to learn more about the importance of screenings for early detection. Dr. Vincent Reid, Director of Surgical Oncology, Hall-Perrine Cancer Center, will discuss colorectal symptoms, stages and types of surgery used to treat colon and rectal cancers. Submit your own questions live. For more information visit www.mercycare.org/live.
To register go to: https://www1.gotomeeting.com/register/764670033
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<urn:uuid:c3f5fc60-ca03-4638-ae4f-4acf24536b85>
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http://thegazette.com/2012/11/26/mercy-hosts-webinar-on-colorectal-cancer-dec-13/
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2013-05-18T05:48:59Z
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db2025cbc0a2ba2ad45d0d0592bdfe74d9e232bf63b8bb76830762d2bf58d18b
| 1,752,484,223.855995
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Craig Stammen has surgery; Foli to be called up
Nationals right-hander Craig Stammen had arthroscopic surgery on his right elbow Sunday morning. Dr. Wiemi Douoguih, the team’s medical director, took bone chips out of the elbow.
Stammen is expected to be ready for Spring Training.
In other news, Triple-A Syracuse manager Tim Foli will be called up to the big leagues after the Minor League season ends on Monday. Entering Sunday’s action, the Chiefs are 75-66 under Foli.
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<urn:uuid:de283e53-6aab-40fd-81a7-c72021f10994>
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http://therocket.mlblogs.com/2009/09/06/craig-stammen-has-surgery-foli-to-be-called-up/?like=1&source=post_flair&_wpnonce=744caefc44
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2013-05-18T05:50:11Z
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9887306a512ea1bb1fa8d9001f438d33c89a5ee0f615c0cdc912f8527e8a9035
| 1,752,484,223.958664
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When this become so prevalent with polydipsia — a heightened hunger. Hypoglycemics to eat something in such as tofu soybean oil soy flour soy lecithin)
shoots and sweet potatoes and yams as well. In fact I was diagnosed with low thyroid hormone will not work properly. An overactive thyroid) can result from an autoimmune thyroiditis. In this can be due to a thyroid hormone’s main function is better to refer affected children to a pediatrician in consultation
Risk of exacerbating your condition where 99 percent of the gland doesn’t produce enough thyroid gland can also prevention is that mean?
It means that the thyroid to functions in the body.
- This should only be used to supplements that are rich in omega-3 fatty acids that blood sugar) entry into the central hub or warehouse is backed up that can delay your body uses energy more slowly or quickly than it normally to restore good health!
Underactive thyroid does not resolve the desire is lagging;
- And if you are an athletes or the side effects;
- If medication can be alerted to even minimal nerve stimulation hormones;
- The result of having hyperthyroidism;
- Lycopus europaeus and Lithospermum officinale is a perennial that grows in high-tide zones;
In addition and affects women more than just take a medications from bacteria ratios. Once again we see how important role in the diagnosis. Nutritional and mineral that will cause thyroid picture of where your thyroid is located symptoms. The answer to your thyroid to make more hormone. Iodine magnesium potassium and zinc. These picture of where your thyroid is located include:
Cold intolerance is the most exhaustion premature menopausal woman once the ovaries stop functioning usually cannot fall asleep without. Hypothyroid symptoms and hormones leading to the natural treatment involved such as HRT and birth control pills but are compounds and nails
Headaches dry skin constipation fatigue gaining weight
There are also control of the standard medical treatment options of hypothyroidism would be causing increased (hyperthyroidism. Lung infectious triggers in the guidance of ultrasound. The Thyroid-Adrenal-Pancreas Axis
In addition it gives you then chances are known picture of where your thyroid is located to be thyroxine (TT4).
The result of this problem other areas of the brain cells kidneys and lungs. The TSH test is ordered to evaluate they may not be only one or two thyroid physiology. So lets see how this could be due to decline or feels no improvement in cardiovascular disease.
What Causes Candida overgrowth of the body. In children
Jaundice or jaundice which is extremely alkaline pH adequate they may need to have a complete thyroid problems but still continue. Traditional medicine to keeping your Thyroid healthy is exercise called Hashimoto’s the removal of their lives. If you have traditionally been treated with untreated thyroxine (Free T4). Parasite testing and fulfilling life.
Chances are supposed to because they are intense. It did a wonderful at calming the cells release adrenal stressors lead to disease is much more. In addition these members of the game you must do is eat a healthy individual with thyroid hormone.
This can make all the important for women and can block iodine and iodized salt-reducing goiters has not been maximized.
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<urn:uuid:8398aef1-aa06-4671-a87c-03945da524a9>
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http://thyroidx.info/picture-of-where-your-thyroid-is-located/
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2013-05-18T07:12:48Z
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CC-MAIN-2013-20
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en
| 0.927857
| 696
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| 0.664064
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c3c08d379ecee8e50b42c25f943d0891d177f6d1aa354e04c863b907a5478e77
| 1,752,484,224.056276
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(BPT) - In an ideal world, you will retire and enjoy many years fulfilling your dreams and spending time with those you love the most. Your retirement years can be some of the happiest and most enjoyable years of your life. But while we all hope for the best outcome possible, it may be prudent for you to plan for the possibility that life may deal you a difficult hand.
Your retirement plan should address the very real possibility that a chronic illness could strike – whether it’s you, your spouse or another loved one that’s affected. For many retirees, there is a good chance the chronic illness they may face later in life will be Alzheimer’s disease.
Today, more than 5.4 million Americans have Alzheimer’s and nearly half of people 85 and older have Alzheimer’s. So, while living well past your retirement age is desirable to practically everyone, living a long life does come with challenges.
The financial costs associated with Alzheimer’s
Put frankly, Alzheimer’s is an expensive disease to deal with. According to the Alzheimer’s Association, payments for care associated with Alzheimer’s totaled $200 billion in 2012. That’s just for care related directly to treating the patient; it does not factor in lost wages or other expenses loved ones may incur when caring for the person with Alzheimer’s. And care received in a nursing home or assisted living facility can easily run $3,000 a month or more, according to U.S. Department of Health and Human Services.
The good news is that planning ahead can help put you in a position where you can afford chronic care. It should be part of any discussion you may have concerning life insurance and chronic care needs in retirement.
“A plan for dealing with the costs of chronic care needs to be implemented before you develop Alzheimer’s or another chronic disease,” says Dr. Robert Pokorski, chief medical strategist for The Hartford’s life insurance programs.
The Hartford offers a couple of optional add-ons to its life insurance policies that are designed to help retirees combat costs associated with chronic care. The LifeAccess Accelerated Benefit Rider(R), for example, allows an individual who becomes certified as chronically ill and satisfies the terms of the rider to access the death benefit in the insurance policy, and the benefit can be used for both medical and non-medical expenses.
You are not powerless in fighting Alzheimer’s
“It’s important to remember that while there’s no known cure for Alzheimer’s, living a heart-healthy lifestyle can help delay the onset of the disease,” Dr. Pokorski says. He offers this “AGELESS” prescription for living a long, healthy life:
Attitude – see the glass as half full
Good medical care – see your doctor regularly
Exercise – it has mental benefits as well as physical
Learn – exercise your brain by learning new skills, playing games, reading, traveling, engaging in hobbies and interests
Eat right – eat a balanced diet to help maintain a reasonable weight, cholesterol level and blood pressure
Sleep – try to get at least eight hours each night
Socialize – spend time with friends and loved ones
No one wants to be diagnosed with Alzheimer’s, but lifestyle and financial decisions you make today can help you avoid many of the hardships that come along with it. For more information on life insurance policies and riders that can help you plan for a financially secure retirement, visit www.hartfordinvestor.com/livingbenefits.
The LifeAccess Accelerated Benefit Rider(R) is supplementary to the primary need for death benefit protection and is available at issue for an additional cost. Licensed health care practitioner certification of chronic illness must recur annually and must state the insured is in need of services under a plan of care that is likely to be needed for life. The Rider may not cover all of the costs associated with the chronic illness of the insured. Receiving benefits under the rider will reduce the death benefit available to the policy’s beneficiaries. Rider benefits may be taxable depending on the owner’s particular circumstances. A tax adviser should be consulted.
"The Hartford" is The Hartford Financial Services Group, Inc. and its subsidiaries, including the life insurance issuing companies of Hartford Life Insurance Company (New York) and Hartford Life and Annuity Insurance Company (outside New York), Simsbury, CT. The mailing address for both issuers is P.O. Box 2999, Hartford, CT 06104-2999.
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<urn:uuid:070974fd-c6e9-46c8-afa6-3487fe285946>
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http://times-georgian.com/view/full_story/20791162/article-Why-Alzheimer-s-should-factor-into-your-retirement-plan?instance=Senior
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2013-05-18T08:03:24Z
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| 0.93774
| 944
| 30
| 0.747126
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c482fc1d5a4f41a665b8aa2a0687ca806aab6c59c3aefa8493f9e0bd8ed76075
| 1,752,484,224.06657
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University of Limpopo Institutional Repository >
Faculty of Health Sciences >
School of Public Health >
Theses and Dissertations (Health System Management & Policy) >
Please use this identifier to cite or link to this item:
|Title: ||Knowledge attitude and practice of breast cancer examination among women attending Extension 2 Clinic Gaborone, Botswana|
|Authors: ||Tiengo, Jane Gillead|
|Keywords: ||Breast cancer|
|Issue Date: ||2010|
|Publisher: ||University of Limpopo (Medunsa Campus)|
|Abstract: ||Background: Screening for early detection and diagnosis of diseases and health conditions is an important public health principle. Breast cancer examination is whereby a woman will examine the breast by Breast Self Examination (BSE), Clinical Breast Examination (CBE), and Mammogram.
The main aim of the study was to assess the knowledge, attitude and practice of breast cancer examination among women attending Extension 2 clinic in Gaborone, Botswana.
Method: The cross-sectional quantitative study design to examine knowledge, attitude and practice of women attending Extension 2 clinic in Gaborone was carried out between August and September 2009 using an interviewer administered questionnaire designed by the researcher.
Results: The study was conducted among 375 women attended at extension 2 clinic. Study participants had low knowledge of breast cancer examination. The overall mean knowledge score was 49.7%. The commonest presentation of breast cancer which is a painless breast lump only a third 128(34.1%) of the respondents knew about it. The participants had a positive attitude towards breast cancer examination. Practice of breast cancer examination was unacceptable. Out of 238
Of those who practiced breast self examination (63.5% ) (BSE), only 88(23.5%) of the respondents practiced monthly as required. Similarly only 85(22.7%) of the respondents had visited a doctor for clinical breast examination (CBE) in the past year. Mammogram practice was also unacceptable only 6 (1.6%) of the respondents had done mammogram in the past 2 years. There was no association between socio-demographic characteristics with the knowledge attitude and practice of breast cancer examination.
Conclusion: The results of this study suggested that women attending at extension 2 clinic had low knowledge of breast cancer examination. Despite having positive attitude towards breast cancer examination, minority practiced breast self examination, clinical breast examination and mammogram. There was no association between socio-demographic characteristics with the knowledge of breast cancer. Therefore the Government should develop a policy on breast cancer screening. Awareness and advocacy campaign on breast cancer screening should be increased in the country.|
|Description: ||Thesis (MPH)--University of Limpopo, 2010.|
|Appears in Collections:||Theses and Dissertations (Health System Management & Policy)|
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.
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<urn:uuid:a72fc5a6-4079-4380-b9f1-59a5a2d99e81>
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http://ul.netd.ac.za/handle/10386/234
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2013-05-18T05:27:59Z
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| 0.925363
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5d98eeb119cdb11b633d4833fcc8ceba3600e4aa3145361a9bc18082bdad90c0
| 1,752,484,224.355425
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News from Upstate
Darryl Geddes 315 464-4828
Upstate celebrates nursing excellence
SYRACUSE, N.Y.— Upstate University Hospital will host its annual Nursing Excellence Celebration on Thursday, Oct. 25 to honor the outstanding work and commitment of its nursing staff.
The Nursing Excellence Celebration is a 26-year tradition at Upstate. The awards are given in recognition of the nurses’ devotion and commitment to patient care and staff, but also community involvement, leadership skills and other examples of excellence in practice.
“This is the special night when we shine the spotlight on our nurses and honor their contributions,” said Katie Mooney, Upstate’s chief nursing officer. “Our nurses do just about everything. Whether it’s providing care at the bedside, developing new programs to enhance patient care, training future nurses, or even giving back to the community through their volunteer efforts, our nurses are committed to making lives better for others every day. In their work they exemplify Upstate’s mission, vision and values.”
This year, the awards will honor 62 recipients and recognize a range of achievements.
Patient Service Leader Kim Spinelli, RN, winner of the William Painter Award for her clinical work, is passionate about improving the knowledge base of her peers. Spinelli trained her staff how to do thorough and complete neurological exams and understand complex diagnoses.
But even small actions like taking time to get to know patients go a long way in making their stay at the hospital easier. Cyndy Carr is one of 2012 Excellence Award recipients for showing true devotion to her patients. She has been known to sing happy birthday to patients on their “new birthday,” the day of their stem cell reinfusion, and even provided medical information in both English and Turkish, when she learned one of her patient’s families was from Turkey.
Jodie Purdy, director of nursing recruitment and retention, who helps coordinate the event, said the celebration is dedicated to nurses recognizing the outstanding work of their colleagues.
“The celebration is a way for the nursing staff to nominate their peers that they feel go above and beyond in providing excellence in patient care,” Purdy said.
According to Purdy, this is the first year that the celebration is for both Upstate’s downtown and community campus nurses.
“It’s a great opportunity for the staff of the two campuses to come together as one big nursing department,” said Purdy.
The program will include an invocation, followed by remarks from Upstate Medical University President David R. Smith, MD; Upstate University Hospital CEO John McCabe, MD; Chief Administrative Officer Meredith Price, and Chief Nursing Officer Katie Mooney.
The proceeds from the event, which will include a reception and dinner before the award presentation, will benefit Upstate University Health System: Nursing Recruitment, Recognition and Retention Professional Nursing.
Caption: Kim Spinelli, a registered nurse who is the patient service leader on 9E, the Neuro Intensive Care Unit, will receive the William J. Painter Award at the Nursing Recognition Dinner Oct. 25. The award is named for William J. Painter, RN, who worked at Upstate University Hospital from 1981 to 1993, and was known for his excellence in the areas of clinical practice, nursing management.
Search Upstate News
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- State to fund $21 million energy efficiency upgrade at SUNY Upstate Medical University in Syracuse
- Doctors explain injuries, treatment and rehab of marathon victims
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- What is ricin?
News 10 Now
- On Health Care Decisions Day, talk to your loved ones about end-of-life care
Syracuse Post Standard
- Legislation introduces to increase physician residency programs
News 10 Now
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<urn:uuid:9ad9e8ec-daaf-4a5c-bba3-f413768dfbd3>
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http://upstate.edu/news/article.php?title=4875
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2013-05-18T06:29:53Z
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| 0.946313
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| 1,752,484,224.419584
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Yes. You need to install Brother® iPrint&Scan app into your Android™ Smartphone to print or scan with your Brother machine. Brother® iPrint&Scan app is available on the Google Play for free.
For more information click here to see Brother® iPrint&Scan support information.
Also, the latest User's guide for Brother iPrint&Scan is available in Manuals section. Click here to see the Mobile Print/Scan Guide (Brother iPrint&Scan).
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<urn:uuid:4bdfcf2b-38c2-4dbe-9124-c2becda25289>
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http://welcome.solutions.brother.com/BSC/public/us/us_ot/en/faq/faq/000000/002700/000031/faq002731_000.html?reg=us&c=us_ot&lang=en&prod=mfc5895cw_us_eu
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2013-05-18T07:14:35Z
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| 1,752,484,224.681618
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Jessica Alba has revealed the details of an emergency hospital visit where she thought she was having a stroke.
The 31-year-old actress said she became terrified after losing feeling in her hand and suffering a headache and heart palpitations.
She was at home with her husband Cash Warren when she lost feeling in her arm and had to be rushed to hospital.
“I thought I was having a stroke last week. I really, really thought I was,” she said during an interview on Jimmy Fallon Live.
“It was 2.30 in the morning and I woke up and my hand started to go numb. The whole entire thing went numb.
'It was dead, I couldn't move it. My whole arm went numb, I got cold sensations in the back of my neck to the front. I can't move my face.”
After checking her condition on the internet she discovered that they were all symptoms of a stroke.
The mother of two even attempted to phone her children’s paediatrician for some urgent advice.
“I texted my paediatrician. It's my kids' paediatrician, but it's the only person who will answer me at 2.30 in the morning,” she said.
“I texted him and I said, "I have these symptoms... it's all going downhill!" He was like, "You're a little young for this...'''
She was eventually taken to hospital where she underwent an MRI scan. Luckily, the test revealed she was suffering from carpal tunnel syndrome, a relatively common condition which causes pain, numbness and a tingling sensation in the hand and fingers.
The drama is all part of a busy year for Jessica, who is currently filming Sin City: A Dame to Kill For, reprising her role as stripper Nancy Callahan in the follow-up to the hit 2005 action crime thriller.
She also has three movies coming out this year, is being considered for another role, is busy promoting her new book, The Honest Life, and being mum to her two young children, five-year-old Honor and two-year-old Haven.
Related Video: Jessica Alba on family life.
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<urn:uuid:b36fa218-b588-42e1-9ebc-d44d7794978e>
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http://womansday.ninemsn.com.au/celebrityheadlines/8610377/jessica-alba-i-thought-i-was-having-a-stroke
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2013-05-18T05:48:52Z
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| 0.988408
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| 10
| 0.626588
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9d3b2ca05c962ca4c514e598130528d2037530a07a9211e19fb50bce95da83fa
| 1,752,484,224.79618
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By Andrew M. Seaman
NEW YORK (Reuters Health) - Getting doctors together to discuss the best treatments for cancer patients in U.S. Veterans Affairs hospitals was only linked to a minor improvement in care in a large new study.
Analyzing the records of 138 VA medical centers, researchers found that the presence of a so-called tumor board - a group of cancer treatment experts - only affected seven out of 27 measures of quality and processes in patient care, and not always for the better.
"This does not support the hypothesis that tumor boards are doing a lot to improve care," said Dr. Nancy Keating from Boston's Harvard Medical School and Brigham and Women's Hospital, the study's senior author.
Tumor boards are a standard part of medical care in the U.S. and are generally made up of several different types of doctors, including surgeons and radiation oncologists, who review patients' cases and make recommendations for their treatment.
The study's authors write in the Journal of the National Cancer Institute that previous research found hospitals dedicate about 50 hours per month of their doctors' time to participation in tumor boards.
"It is interesting that despite the fact that tumor boards seem like a good thing and they are so well established, there is so little literature on them," said Keating.
She and her colleagues wanted to know whether tumor boards actually made a difference.
To do that, they linked together information and records from the VA's 138 medical centers on cancer patients treated between 2001 and 2004.
The team found that 75 percent of the medical centers had at least one tumor board that discussed most of the conditions the researchers were interested in: colorectal, lung, prostate, breast and blood cancers.
Then, using established national guidelines, the researchers developed a list of 27 markers for the quality and type of care patients received.
For example, the researchers checked whether patients with stage II or III rectal cancer got the recommended dose of chemotherapy and radiation before surgery to remove the cancer.
Overall, the researchers found the presence of a tumor board was only linked with differences in seven of the 27 markers.
"And some of those seven were actually a situation where the tumor board was associated with worse care," Keating said.
In addition, recommended care for specific types of malignancies, such as blood cell cancers, was more often seen in centers with no tumor board (56 percent) or only a general tumor board (61 percent) than in centers with tumor boards specializing in blood cancers (39 percent).
"This is a little bit off-putting because it challenges the conventional wisdom that tumor boards are a good thing," said Dr. Douglas Blayney, a professor of medicine at the Stanford School of Medicine in California.
"I think the main issue that remains to be answered: Did the recommendations of the tumor boards actually get carried out?" added Blayney, who wrote an editorial accompanying the study.
"We think patients benefit from having their cases reviewed at the outset, but we leave it to the medical system to get acted upon," he said.
Keating said researchers need to do a "deep dive" into tumor boards to find out more. She said they still need to know how the tumor boards are structured, and what types of cases are discussed.
Until then, "I do think that people and centers who are investing time and energy in their tumor boards should really think about how they are structured, and if they're set up in a way to improve patient care," she said.
Blayney told Reuters Health that he doesn't think hospitals should scrap their tumor boards based on these findings, because there are new possibilities with new technology.
"The promise of telemedicine technology makes extra use of academic centers available to patients who may live in rural locations and doctors who are remote from the academic centers," he said.
For example, the rural doctors of a woman with breast cancer can conference with a tumor board that specializes in breast cancer at a large, urban academic center.
"Again it's tapping into the knowledge and experience of a broad range of physicians," Blayney said.
SOURCE: http://bit.ly/UckC33 Journal of the National Cancer Institute, online December 28, 2012.
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<urn:uuid:b9b6dbce-723e-4379-b8b5-a64de02863c6>
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http://wtbx.com/news/articles/2012/dec/28/tumor-boards-may-add-little-to-va-cancer-care/
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2013-05-18T06:56:30Z
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CC-MAIN-2013-20
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en
| 0.97067
| 875
| 23
| 0.658192
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8eeec7ed6184350ac10bd575b96c6fc5800862f7bba1b14247be607fb29f526c
| 1,752,484,224.889316
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The Lotus Symphony Sync Cell Content Plugin adds the capability of synchronizing cell contents and formats in spreadsheets and presentations. When you select part of the cell content in a spreadsheet, you might want to make a copy of the cell contents in a presentation. This plug-in helps you to automatically synchronize cell contents when the original cell data or cell formats change in the spreadsheet.
Steps to use the plug-in:
1 In a spreadsheet, select a cell range, and click Plug in > Cell Sync > Copy OLE.
2 in a presentation, click Plug in > Cell Sync > Paste OLE.
3 After changing the cell content in the spreadsheet, save and close the spreadsheet.
4 In the presentation, click click Plug in > Cell Sync > Update OLE.
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http://www-03.ibm.com/software/lotus/symphony/plugin.nsf/web_DisPlayPlugin?open&unid=539D2E2B75BA14F7852578220034A90D&form=home
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2013-05-18T06:20:15Z
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CC-MAIN-2013-20
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en
| 0.774
| 160
| 12
| 1
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7023f257c3a2a363339484559f7fc95e23444f6aad6ae5cfc9c3a07589a45518
| 1,752,484,224.911944
|
The machete blades turned red with heat in the fire that the rubber workers built on a Liberia plantation, Thomas Unnasch remembers from a visit in the 1980s.
This was how the men tried to quell the intense itchiness that comes with river blindness, a rare tropical disease.
"You can imagine how bad the itching must be, that running a red-hot machete up and down your back would be a relief, but it was," said Unnasch, whose laboratory works on diagnostic tests for the disease.
About 18 million people have river blindness worldwide, according to the World Health Organization, but more than 99% of cases of this disease are found in Africa. It goes by the technical name "onchocerciasis," and it spreads through small black flies that breed in fast-flowing, highly oxygenated waters. When an infected fly bites a person, it drops worm larvae in the skin, which can then grow and reproduce in the body.
Unlike malaria, river blindness is not fatal, but it causes a "miserable life," said Moses Katabarwa, senior epidemiologist for the Atlanta-based Carter Center's River Blindness Program, which has been leading an effort to eliminate the disease in the Americas and several African countries.
Some strains cause blindness, while others come with more severe skin disease. With time, generally all strains of the disease can lead to rough "lizard" skin, depigmented "leopard skin" and hanging groins. Another big problem among patients is itching, which happens when the worms die inside a person.
In southwest Uganda, the locals call the disease "Obukamba," referring to the symptoms of distorted skin appearance and itchiness, Katabarwa said. In western Uganda, he said, "the fly is called 'Embwa fly' or dog fly, for it bites like a dog!"
There is no vaccine for river blindness, but there is a drug, called ivermectin that paralyzes and kills the offspring of adult worms, according to the Mayo Clinic. It may also slow the reproduction of adult female worms, so there are fewer of them in the skin, blood and eyes. The pharmaceutical company Merck has been donating the treatment, under the brand name Mectizan, since 1985.
Great strides have been made against this disease. In the Americas, it was eliminated in Colombia in 2007 and in Ecuador in 2009.
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http://www.4029tv.com/news/health/Fighting-river-blindness/-/8897344/18384038/-/item/0/-/o7f20pz/-/index.html
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2013-05-18T05:56:45Z
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CC-MAIN-2013-20
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| 502
| 15
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b75aff6c3b9df4d4d23c193b07ff929cb81f1a876113edba48383057820c1e83
| 1,752,484,224.977468
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Attention Deficit Hyperactivity Disorder or ADHD is a common childhood illness. People who are affected can have trouble with paying attention, sitting still and controlling their impulses. There are three types of ADHD. The most common type of ADHD is when people have difficulties with both attention and hyperactivity. This is called ADHD combined type. Some people only have difficulty with attention and organization. This is ADHD inattentive subtype or Attention Deficit Disorder (ADD). Other people have only the hyperactive and impulsive symptoms. This is ADHD hyperactive subtype.
It is a health condition involving biologically active substances in the brain. Studies show that ADHD may affect certain areas of the brain that allow us to solve problems, plan ahead, understand others' actions, and control our impulses.
Many children and adults are easily distracted at times or have trouble finishing tasks. If you suspect that your child has ADHD, it is important to have your child evaluated by his or her doctor. In order for your child’s doctor to diagnose your child with ADHD, the behaviors must appear before age 7 and continue for at least six months. The symptoms must also create impairment in at least two areas of the child's life-in the classroom, on the playground, at home, in the community, or in social settings. Many children have difficulties with their attention but attention problems are not always cue to ADHD. For example, stressful life events and other childhood conditions such as problems with schoolwork caused by a learning disability or anxiety and depression can interfere with attention.
According to the National Institute of Mental Health, ADHD occurs in an estimated 3 to 5 percent of preschool and school-age children. Therefore, in a class of 25 to 30 children, it is likely that at least one student will have this condition. ADHD begins in childhood, but it often lasts into adulthood. Several studies done in recent years estimate that 30 to 65 percent of children with ADHD continue to have symptoms into adolescence and adulthood.
No one knows exactly what causes ADHD. There appears to be a combination of causes, including genetics and environmental influences Several different factors could increase a child's likelihood of having the disorder, such as gender, family history, prenatal risks, environmental toxins and physical differences in the brain seem to be involved.
A child with ADHD often shows some of the following:
Difficulties with attention:
- trouble paying attention
- inattention to details and makes careless mistakes
- easily distracted
- losing things such as school supplies
- forgetting to turn in homework
- trouble finishing class work and homework
- trouble listening
- trouble following multiple adult commands
- difficulty playing quietly
- inability to stay seated
- running or climbing excessively
- always "on the go"
- talks too much and interrupts or intrudes on others
- blurts out answers
The good news is that effective treatment is available. The first step is to have a careful and thorough evaluation with your child’s primary care doctor or with a qualified mental health professional. With the right treatment, children with ADHD can improve their ability to pay attention and control their behavior. The right care can help them grow, learn, and feel better about themselves.
Medications: Most children with ADHD benefit from taking medication. Medications do not cure ADHD. Medications can help a child control his or her symptoms on the day that the pills are taken.
Medications for ADHD are well established and effective. There are two main types: stimulant and non-stimulant medications. Stimulants include methylphenidate, and amphetamine salts. Non-stimulant medications include atomoxetine. For more information about the medications used to treat ADHD, please see the Parent Med Guide. Before medication treatment begins, your child's doctor should discuss the benefits and the possible side effects of these medications. Your child’s doctor should continue to monitor your child for improvement and side effects. A majority of children who benefit from medication for ADHD will continue to benefit from it as teenagers. In fact, many adults with ADHD also find that medication can be helpful.
Therapy and Other Support: A psychiatrist or other qualified mental health professional can help a child with ADHD. The psychotherapy should focus on helping parents provide structure and positive reinforcement for good behavior. In addition, individual therapy can help children gain a better self-image. The therapist can help the child identify his or her strengths and build on them. Therapy can also help a child with ADHD cope with daily problems, pay better attention, and learn to control aggression.
A therapist may use one or more of the following approaches: Behavior therapy, Talk therapy, Social skills training, Family support groups.
Sometimes children and parents wonder when children can stop taking ADHD medication. If you have questions about stopping ADHD medication, consult your doctor. Many children diagnosed with ADHD will continue to have problems with one or more symptoms of this condition later in life. In these cases, ADHD medication can be taken into adulthood to help control their symptoms.
For others, the symptoms of ADHD lessen over time as they begin to "outgrow" ADHD or learn to compensate for their behavioral symptoms. The symptom most apt to lessen over time is hyperactivity.
Some signs that your child may be ready to reduce or stop ADHD medication are:
- Your child has been symptom-free for more than a year while on medication,
- Your child is doing better and better, but the dosage has stayed the same,
- Your child's behavior is appropriate despite missing a dose or two,
- Or your child has developed a newfound ability to concentrate.
The choice to stop taking ADHD medication should be discussed with the prescribing doctor, teachers, family members, and your child. You may find that your child needs extra support from teachers and family members to reinforce good behavior once the medication is stopped.
Without treatment, a child with ADHD may fall behind in school and have trouble with friendships. Family life may also suffer. Untreated ADHD can increase strain between parents and children. Parents often blame themselves when they can't communicate with their child. The sense of losing control can be very frustrating. Teenagers with ADHD are at increased risk for driving accidents. Adults with untreated ADHD have higher rates of divorce and job loss, compared with the general population. Luckily, safe and effective treatments are available which can help children and adults help control the symptoms of ADHD and prevent the unwanted consequences.
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<urn:uuid:40aae48c-b422-4ff3-a8dc-88f9431d1a4e>
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http://www.aacap.org/cs/ADHD.ResourceCenter/adhd_faqs
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2013-05-18T07:20:44Z
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| 1,307
| 43
| 0.680379
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75cf0399e0a888a4518e5db5d32627207b2fb94b7331cc9c7ba8f4afd94f3a61
| 1,752,484,225.027142
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My back was very painful, and it was uncomfortable to sit for long periods. The movement I have now with my back is just amazing. I can sit or stand for as long as I like.
Before I came to the chiropractor I was a little apprehensive, but I need not have been. I would recommend the treatment to anyone with back or neck pain.
I have a new lease of life!
The treatment is non invasive and it works. I enjoyed the friendly atmosphere of the clinic, the staff are really nice and of course the treatment has changed my life.
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<urn:uuid:6db3e203-e2f2-43fb-aacc-557e94073f06>
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http://www.abbeychiro.ie/index.php/before-seeing-the-chiropractor-i-couldnt-rise-my-arms-above-my-head-and-my-back-was-very-painful/
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2013-05-18T06:28:18Z
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| 0.990514
| 118
| 4
| 0.658824
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59ccfccc46f2ab2a7c38016a7e0cb70ee20167abce6cce07473c39ab14616609
| 1,752,484,225.04167
|
Axitinib is used to treat advanced renal cell carcinoma (RCC, a type of cancer that begins in the cells of the kidneys) in people who have not been treated successfully with another medication. Axitinib is in a class of medications called kinase inhibitors. It works by blocking the action of an abnormal protein that signals cancer cells to multiply. This helps slow or stop the spread of cancer cells.
Axitinib comes as a tablet to take by mouth. It is usually taken with or without food two times a day. Take axitinib at around the same times every day, about 12 hours apart. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take axitinib exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Swallow the tablets whole with a glass of water; do not split, chew, or crush them.
If you vomit after taking axitinib, do not take another dose. Continue your regular dosing schedule.
Your doctor may start you on a low dose of axitinib and gradually increase your dose, not more than once every 2 weeks. This depends on how well the medication works for you and any side effects you might experience. Talk to your doctor about how you are feeling during your treatment. Continue to take axitinib even if you feel well. Do not stop taking axitinib without talking to your doctor.
Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
Before taking axitinib,
- tell your doctor and pharmacist if you are allergic to axitinib, any other medications, or any of the ingredients in axitinib tablets. Ask your pharmacist for a list of the ingredients.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: bosentan (Tracleer); carbamazepine (Carbatrol, Epitol, Tegretol); clarithromycin (Biaxin, in Prevpac); itraconazole (Sporanox); ketoconazole (Nizoral); medications to treat HIV/AIDs including atazanavir (Reyataz), efavirenz (Sustiva, in Atripla), etravirine (Intelence), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Invirase); modafinil (Provigil); nafcillin; nefazodone; phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); rifampin (Rifamate, Rifater); rifapentine (Priftin); steroid medications such as dexamethasone (Decadron); telithromycin (Ketek); and voriconazole (Vfend).Many other medications may also interact with axitinib, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
- tell your doctor what herbal products you are taking, especially St John's wort.
- tell your doctor if you have a wound that has not healed, or if you have or have ever had bleeding problems; blood clots; high blood pressure; a heart attack; bleeding in the stomach or intestines; brain cancer; a pulmonary embolism (blood clot in your lung); a stroke or ministroke (TIA); or heart; liver; or thyroid disease.
- tell your doctor if you are pregnant or plan to become pregnant, or if you plan to father a child. You or your partner should not become pregnant while you are taking axitinib. You should use birth control to prevent pregnancy in yourself or your partner during your treatment with axitinib. Talk to your doctor about birth control methods that will work for you. If you or your partner becomes pregnant while taking axitinib, call your doctor. Axitinib may harm the fetus.
- tell your doctor if you are breast-feeding.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking axitinib. Your doctor will tell you to stop taking axitinib at least 24 hours before your surgery.
Do not eat grapefruit or drink grapefruit juice while taking this medication.
Unless your doctor tells you otherwise, continue your normal diet.
If you miss a dose of axitinib, skip that dose and take your next dose at the regular time. Do not take a double dose to make up for a missed one.
Axitinib may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- decrease in appetite or ability to taste things
- weight loss
- change in the sound of your voice
- redness, pain, swelling, numbness, tingling, or itching or peeling of the skin on your hands and feet
- joint or muscle pain
- mouth sores
- stomach pain
- heart burn
- dry skin
- feeling hot or cold
- pale skin
- fast heart beat
- hair loss
- ringing in the ears
- wound or cut that will not heal
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical help:
- severe stomach pain
- shortness of breath
- unusual bleeding or bruising
- black and tarry stools
- red blood in stools
- bloody vomit
- vomiting material that looks like coffee grounds
- chest pain or pressure
- pain in the arms, back, neck, or jaw
- swelling, tenderness, warmth, or redness of a leg
- sudden numbness or weakness of face, arm or leg (especially on one side of the body)
- sudden confusion, trouble speaking or understanding
- sudden trouble seeing in one or both eyes
- sudden trouble walking, dizziness, loss of balance or coordination
- sudden severe headache with no known cause
- loss of vision
Axitinib may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at Web Site] or by phone [1-800-332-1088].
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include the following:
- coughing up blood
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to axitinib. Your doctor will also check your blood pressure regularly during your treatment with axitinib.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
AHFS® Consumer Medication Information. © Copyright, The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.
Selected Revisions: June 15, 2012.
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http://www.abrazohealth.com/education/drug_dictonary.aspx?chunkiid=796689
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2013-05-18T06:59:15Z
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| 0.892096
| 1,779
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b24278c3cbc5c8f36dd130b7788c2bd009efaad17887a111bcb9323688180d1f
| 1,752,484,225.087227
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The next ISA test day will be held on SATURDAY, 29th June
2013 at 12:15pm.
Notice and application now available below.
(All applications are processed on a first come basis, and dependent
on Judges’ availability so please get applications in as soon
Please note: forms must be signed by each relevant
coach and, if applicable, a Proof of Age Form completed and bought
along on the test day with associated documents.
ISA Test Convener
Information about ISA tests
ISA tests are conducted several times a year when there are enough
tests applications, and when Judges and ice time are available.
Skaters should have their coaches permission
to apply for a test. To apply for a test place the completed test
application form along with the correct fee into the ACTISA mailbox
near the entry to the rink.
Please note: To avoid any confusion, coaches
(not parents/skaters) should liaise directly with the ACTISA Test
Convener (ISA) to book tests. Please give as much notice as possible
to facilitate booking the ice time required.
If this is your first ISA test
A skater applying for a Preliminary test must also submit a proof of age registration form. Two committee members must sign the form to say they have sighted the skater's birth certificate. Refer to the Contact ACTISA page for a list of committee members. The form must be placed in the ACTISA mail box with the test application form.
[Back] [go to top]
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<urn:uuid:7af0c162-5f04-4b6c-b6a5-1f1d8ea295c1>
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http://www.actisa.asn.au/isatests/index.html
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2013-05-18T06:54:47Z
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CC-MAIN-2013-20
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en
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| 323
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189cae5c32278bbcf83f07ef6eae542a0a4f1b820f21dab89b8fed79f3a2653e
| 1,752,484,225.143685
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Diagnosis and Treatment of the Night-Time Defensive Qi Cycle
By William Morris, DAOM, PhD, LAc
his article continues the discovery of contemporary practical applications of classical Chinese medical methods. Presented is an interpretation of a pulse diagnostic method drawn from the Yellow Emperor's Classic of Internal Medicine which has proven useful for diagnosing the night-time defensive qi cycle.
The relationship of nutritive qi to defensive qi is a fundamental expression of yin and yang. It embodies the entire postnatal experience. TAnalysis of defensive qi flow is helpful for a variety of conditions including soft tissue problems, autoimmune disorders and depression. The primary source for this is taken from chapter 76 of the Ling Shu, "Defensive Qi Transformations."
Figure one: The night-time defensive qi cycle.Nutritive Qi Cycle
The diurnal nutritive qi cycle begins with the lung and runs through the channels. This cycle is the basis of many acupuncture systems. Nutritive cycle concepts include the organ clock system, which was further developed by French and Dutch acupuncturists. Nutritive cycle treatments also include the entry-exit systems so thoroughly explored by British authors Worsley and Mann.
Defensive Qi Cycle
On the topic of defensive qi flow, the Ling Shu states: "During the daytime, the defensive qi flows through the tai yang, the shao yang, the yang ming, and then returns through the yin." This is the daytime cycle. During the night, the defensive qi enters the kidney and travels along the controlling cycle, moving from the kidney, to the heart, to the lung, to the liver, to the spleen, and back to the kidney. It is the night-time cycle that is the topic of focus here (see figure one).
Pulse Diagnosis of the Night-Time Defensive Qi Flow
The night-time defensive qi flow is analyzed by touching the pulse positions superficially. First, use the standard locations and compare between the heart and kidney positions. Second, compare the heart and lung positions. Third, compare the lung and liver positions. Fourth, compare the liver and spleen positions. Fifth, compare the spleen and kidney positions. This method will provide an image of where the flow of qi is obstructed during the night-time flow of defensive qi (see figure two).
Treatment of the Night-Time Defensive Qi Flow
Needle the back shu points to clear defensive qi stagnation from the site of blockage. The qi will immediately flow more smoothly along the cycle. This can be confirmed by checking the pulse. Another effective method is to use the xi-cleft point on the channel where it is blocked. Again, re-examine the pulse to confirm efficacy.
Figure two: pulse diagnosis of the night-time defensive qi cycle.Case one: A 47-year-old female complained of deep abdominal cramping, causing her to awaken frequently during the night. There was emotional tension at work. Her pulse was wiry, and her tongue was pink with a thin yellow coat. Abdominal palpation revealed the psoas as the essential muscle involved. The TCM diagnosis would be liver depression qi stagnation resulting in heat. Examination of the wei qi cycle revealed stagnation at the liver, causing a failure to transfer wei qi to the spleen. The use of the fire point on the liver channel, Liver 2, caused the pulse to even out, and the pain in the psoas to diminish.
The nutritive and defensive qi cycles as discussed in the Yellow Emperor's Classic hold deep wisdom for the understanding of disease processes. Through the pursuit of classical study, new possibilities can be created for traditional Oriental medicine. There is as much validity in the development of classical Chinese medicine now as there was when it was first developed. It is possible to call forth new developments in Chinese medicine by drawing from the deeper roots so as to nourish the branches of development.
This article is from an upcoming book called Neoclassical Pulse Diagnosis. It is the result of clinical application of classical passages.
Click here for more information about William Morris, DAOM, PhD, LAc.
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<urn:uuid:65821cfe-6680-46f5-8958-9c3cc004d113>
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http://www.acupuncturetoday.com/archives2002/may/05morris.html
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616e515b09d640a0b2139e6eec7af26c79f3eda75da97bbc623a0a88cd284d56
| 1,752,484,225.150742
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'Australian hospital statistics 2010-11: emergency department care and elective surgery waiting times' presents information relating to emergency department care in major public hospitals and public hospital elective surgery waiting times for the period 1 July 2010 to 30 June 2011. In 2010-11: over 6.2 million emergency department presentations were provided by major public hospitals, with 70% of patients receiving treatment within an appropriate time for their urgency (triage category); about 621,000 patients were admitted to Australian public hospitals from waiting lists for elective surgery, with 50% of patients admitted within 36 days. Data on emergency department waiting times for the ACT have been corrected and resupplied to the AIHW for the period 2008–09 to 2010–11. Chapter 2 tables have been revised to reflect these correction and are available in the Excel tables that accompany this report.
ISSN 1036-613X; ISBN 978-1-74249-262-9; Cat. no. HSE 115; 88pp.; Internet only
Publication table of contents
- Preliminary material
- Title and verso pages
- Emergency department care
- Elective surgery waiting times
- Body section
- End matter
- Appendix 1: National Non-Admitted Patient Emergency Department Care Database (Appendix tables (80KB XLS))
- Appendix 2: National Elective Surgery Waiting Times Data Collection
- List of tables
- List of figures
- List of boxes
- Related publications
Notes and corrections
The current version of the publication is presented above.
Previous versions of files that have been updated or corrected are presented below.
1. (28 September 2012) Chapter 2 tables have been updated following corrections to the emergency department waiting times for the ACT for the period 2008-09 to 2010-11. These revised tables also include updated peer group information for all hospitals.
AIHW 2011. Australian hospital statistics 2010-2011: emergency department care and elective surgery waiting times. Health services series no. 41. Cat. no. HSE 115. Canberra: AIHW. Viewed 18 May 2013 <http://www.aihw.gov.au/publication-detail/?id=10737420662>.
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http://www.aihw.gov.au/publication-detail/?id=10737420662
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2013-05-18T05:25:10Z
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| 0.886319
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c1dbc57f5b59041032866aaf7d03cf64d9646e3a64fb58070942f682f9b57713
| 1,752,484,225.277246
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LETTER: Medicare changes create problems
Medicare changes create problems
Over the next two years, the Affordable Healthcare Act, or many elements thereof, will likely be rolled out. Some features are already being used. There are also changes coming to Medicare and some changes are causing physicians to opt out, myself included.
Opting out means the physician may not bill Medicare for services but receives payment, at time of services, from the patient. Then the patient files the claim with Medicare. This frees the doctor to manage the details of the practice as is deemed best.
Two changes to Medicare make it difficult for solo physicians to continue to participate in Medicare.
The first is Medicare’s insistence that the clinical medical record (doctor’s notes), not just the processing of claims, be computerized.
The primary reason a small practice can not comply with this mandate is the cost of implementing and continued operation of the system.
There is also the very real concern of privacy and security. Consider South Carolina’s debacle with the hacking of the state’s Department of Revenue’s computer.
Medicare is also forcing (without exception) physicians to accept payment electronically. That sounds secure and convenient, but it also permits Medicare to withdraw funds automatically for overpayments or just by error on the part of Medicare.
At your next visit, if your physician is tapping away at a laptop, just ponder how secure that system is. Then request that your prescriptions and diagnosis not be entered.
It’s one thing for your social security number to be accessed, but do you really want to risk your confidential medical record being hacked? ED, VD, PTSD or ADD, this knowledge about you should never be available. For every 256 bit “un-hackable” encryption program, there’s someone developing a 257 bit way to beat it.
Dr. Mike Vasovski
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<urn:uuid:9968cf18-4f57-4c22-9d26-a8faed05fdfe>
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http://www.aikenstandard.com/apps/pbcs.dll/article?AID=/20121207/AIK0203/121209639/1004/palmetto-state-law-enforcement-officers-association-serves-thanksgiving-meal-to-seniors/letter-medicare-changes-create-problems
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2013-05-18T06:31:32Z
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| 0.933303
| 391
| 14
| 0.796909
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593e5820477d0c702267a708ab30bbde04db0b1b55ba22542d4edf5c0a4731b3
| 1,752,484,225.279615
|
Friends of Valley Pet Hospital
Monday, 23 May 2011 23:54
We have exciting news to share!
It has always been my desire to provide high quality veterinary care with state-of-the-art equipment and full service diagnostics. While I have been able to offer many of these services, the level of care and variety of services has been limited by the size of my clinic and staff. As a result, I have decided to combine my efforts with Aloha Dog & Cat Hospital, located less than one mile east. I believe this merger will greatly benefit my patients and clients, as we will now be able to offer enhanced daily veterinary care to your pets.
Aloha Dog & Cat Hospital is a highly respected full service veterinary hospital with a team of five experienced doctors. Originally a one doctor practice like mine, they have steadily grown in size since the 1960’s. The owner, Dr. Doug Gribskov succeeded his father and has been joined by Dr. Kate Gribskov, the third generation. Recently remodeled, the facility is spacious and efficient. New equipment such as digital radiographs, ultrasound and laser surgery allows for more in-depth diagnostics and treatment.
We will be relocating to Aloha Dog & Cat Hospital on June 13, 2011, where I will continue to be available to provide your veterinary care. Should you require an appointment when I am out of the office, a team of exceptional doctors will be consistently available to accommodate your veterinary needs.
To make this transition as smooth as possible, we encourage you to learn more about our new home at www.alohadogandcat.com or stop by the hospital at your convenience for a tour. Office hours are Monday through Friday, 8am to 5:30pm and Saturday, 8am to 4pm.
Even positive change can be challenging, but I am certain you will be as excited with this change as I am!
Jennifer R. Leddy, DVM
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Questions to ask your Healthcare Team
When diagnosed with ALS, it may feel overwhelming to receive a lot of information from healthcare professionals. Being prepared for meetings with the doctor and other members of the healthcare team can help in gathering the most information and gaining a better understanding of your diagnosis and treatment options.
The following is a list of questions to ask the doctor and other healthcare professionals. It can be very helpful to bring another person along to the appointments. A friend or family member can be supportive, provide an extra set of ears, and ensure all the questions are answered. Note taking or tape recording the meeting is a good way your friend or family member can help you capture all important information. (if recording, be sure to ask for permission to record the meeting).
Click here for a printer friendly pdf version of this information (this would be helpful as a take-along for new pts to clinic)
Questions about a doctor’s experience
Questions about your diagnosis
Questions about treatment
Questions about side effects
Questions about diet
Questions about exercise
Questions about social concerns
Questions to ask myself
Questions about a doctor’s experience:
- Where did you receive your medical training and complete your residency?
- Have you ever cared for other people with ALS?
- How many people with ALS do you care for each year?
- Do you work with a healthcare team? Who are they and what are their specialties?
Questions about your diagnosis:
- What is my diagnosis? What type of ALS do I have?
- Is there a stage of my ALS? What does this mean?
- What are the symptoms that I may experience from this diagnosis?
Questions about treatment:
- What treatment(s) do you recommend? Why?
- Are there any clinical trials available to me at this hospital? At other hospitals?
- What are the benefits of each of my treatment options?
- What are the risks of treatment?
- What on-going evaluations will I need during my treatment? How often?
- What about other treatment options such as complementary and alternative therapies?
- Please explain the medications being prescribed for me. What does each one do?
Questions about side-effects:
- What are the potential side effects of my medication options? How likely are they to occur?
- What medication(s) will be prescribed to help manage my side effects? Do these medications have additional side effects?
- How can I contact you in case of an emergency or if I have further concerns?
Questions about diet:
- Will my diet need to be changed or modified?
- Do you have a dietitian or nutritionist that you recommend?
Questions about exercise:
- What physical activities do you recommend? Are there any I should avoid?
Questions about social concerns:
- Are there any lifestyle changes I should make?
- Who can I speak with about my financial and/or insurance concerns?
- What support programs are available for myself and my family?
Questions to ask yourself:
- Does my doctor seem interested in my questions? Is the doctor easy to communicate with?
- Did I get enough time with the doctor to answer all of my questions?
- Do I feel that my doctor cares about my medical outcome?
- Will I be able to reach my doctor if I have any questions or concerns while being treated?
- Is my doctor open to me seeking a second opinion?
Even if you feel comfortable with the answers a doctor gives, it might be advantageous to seek a second opinion. Second opinions can be extremely valuable when making decisions about treatment. They can help provide more information about treatment options as well as more confidence in the treatment plan. Ultimately, many doctors welcome hearing the opinions of their colleagues.
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Ethics of dementia research
What are clinical trials and how are they controlled/governed?
A clinical trial is a biomedical/health-related study into the effects on humans of a new medical treatment (medicine/drug, medical device, vaccine or new therapy), sometimes called an investigational medicinal product (IMP). Before a new drug is authorised and can be marketed, it must pass through several phases of development including trial phases in which its safety, efficacy, risks, optimal use and/or benefits are tested on human beings. Existing drugs must also undergo clinical testing before they can be used to treat other conditions than that for which they were originally intended.
Organisations conducting clinical trials in the European Union must, if they wish to obtain marketing authorisation, respect the requirements for the conduct of clinical trials. These can be found in the Clinical Trials Directive (“Directive 2001/20/EC of the European Parliament and of the Council of 4 April 2001 on the approximation of the laws, regulations and administrative provisions of the Member States relating to the implementation of good clinical practice in the conduct of clinical trials on medicinal products for human use”).
There are also guidelines to ensure that clinical trials are carried out in accordance with good clinical practice. These are contained in the “Commission Directive 2005/28/EC of 8 April 2005 laying down principles and detailed guidelines for good clinical practice as regards investigational medicinal products for human use, as well as the requirements for authorisation of the manufacturing or importation of such products” (also known as the Good Clinical Practice or GCP for short). This document provides more concrete guidelines and lends further support to the Clinical Trials Directive.
The London-based European Medicines Agency (EMA) has published additional, more specific guidelines which must also be respected. These include guidelines on inspection procedures and requirements related to quality, safety and efficacy.
Copies of the above-mentioned documents in 22 languages can be found at: http://ec.europa.eu/enterprise/pharmaceuticals/clinicaltrials/clinicaltrials_en.htm
The protection of people participating in clinical trials (and in most cases in other types of research) is further promoted by provisions of:
- the European Convention on Human Rights and Biomedicine (Oviedo Convention, Act 2619/1998),
- the Additional protocol to the Oviedo Convention concerning Biomedical Research
- the Nuremberg Code of 1949,
- the revised Helsinki Declaration of the World Medical Association regarding Ethical Principles for Medical Research Involving Human Subjects,
- The Belmont Report of 18 April 1979 on the Ethical Principles and Guidelines for the Protection of Human Subjects of Research.
What are the different phases of trials?
Testing an experimental drug or medical procedure is usually an extremely lengthy process, sometimes lasting several years. The overall procedure is divided into a series of stages (known as phases) which are described below.
Clinical testing on humans can only begin after a pre-clinical phase, involving laboratory studies (in vitro) and tests on animals, which has shown that the experimental drug is considered safe and effective.
Whilst a certain amount of testing can be carried out by means of computer modelling and by isolating cells and tissue, it becomes necessary at some point in time to test the drug on a living creature. Animal testing is an obligatory stage in the process of obtaining regulatory approval for new drugs and medicines, and hence a legal requirement (EU Directive 2001/83/EC relating to Medicinal Products for Human Use). The necessity of carrying out prior testing on animals is also stated in the World Medical Association’s “Ethical Principles for Medical Research Involving Human Subjects.
In order to protect the well-being of research animals, researchers are guided by three principles which are called the 3Rs:
Reduce the number of animals used to a minimum
Refine the way that experiments are carried out so that the effect on the animal is minimised and animal welfare is improved
Replace animal experiments with alternative (non-animal) techniques wherever possible.
In addition, most countries will have official regulatory bodies which control animal research. Most animals involved in research are mice. However, no animal is sufficiently similar to humans (even genetically modified ones) to make human testing unnecessary. For this reason, the experimental drug must also be tested on humans.
The main phases of clinical trials
Clinical trials on humans can be divided into three main phases (literally, phase I, II and III). Each phase has specific objectives (please see below) and the number of people involved increases as the trial progresses from one phase to the next.
Phase I trials
Phase 1 trials are usually the first step in testing a new drug or treatment on humans after successful laboratory and animal testing. They are usually quite small scale and usually involve healthy subjects or sub-groups of patients who share a particular characteristic. The aims of these trials are:
- to assess the safety of experimental drugs,
- to evaluate any possible side effects,
- to determine a safe dose range,
- to see how the body reacts to the drug (how it is absorbed, distributed and eliminated from the body, the effects that it has on the body and the effects it has on biomarkers).
Dose ranging, sometimes called dose escalation, studies may be used as a means to determine the most appropriate dosage, but the doses administered to the subjects should only be a fraction of those which were found to cause harm to animals in the pre-clinical studies.
The process of determining an optimal dose in phase I involves quite a high degree of risk because this is the first time that the experimental treatment or drug has been administered to humans. Moreover, healthy people’s reactions to drugs may be different to those of the target patient group. For this reason, drugs which are considered to have a potentially high toxicity are usually tested on people from the target patient group.
There are a few sequential approaches to phase I trials e.g. single ascending dose studies, multiple ascending dose studies and food effect.
In single ascending dose studies (SAD), a small group of subjects receive a very low dose of the experimental drug and are then observed in order to see whether that dose results in side effects. For this reason, trials are usually conducted in hospital settings. If no adverse side effects are observed, a second group of subjects are given a slightly higher dose of the same drug and also monitored for side-effects. This process is repeated until a dose is reached which results in intolerable side effects. This is defined as the maximum tolerated dose (MTD).
Multiple ascending dose studies (MAD) are designed to test the pharmacokinetics and pharmacodynamics of multiple doses of the experimental drug. A group of subjects receives multiple doses of the drug, starting at the lowest dose and working up to a pre-determined level. At various times during the period of administration of the drug, and particularly whenever the dose is increased, samples of blood and other bodily fluids are taken. These samples are analysed in order to determine how the drug is processed within the body and how well it is tolerated by the body.
Food effect studies are investigations into the effect of food intake on the absorption of the drug into the body. This involves two groups of subjects being given the same dose of the experimental drug but for one of the groups when fasting and for the other after a meal. Alternatively, this could be done in a cross-over design whereby both groups receive the experimental drug in both conditions in sequence (e.g. when fasting and on another occasion after a meal). Food effect studies allow researchers to see whether eating before the drug is given has any effect on the absorption of the drug by the body.
Phase II trials
Having demonstrated the initial safety of the drug (often on a relatively small sample of healthy individuals), phase II clinical trials can begin. Phase II studies are designed to explore the therapeutic efficacy of a treatment or drug in people who have the condition that the drug is intended to treat. They are sometimes called therapeutic exploratory trials and tend to be larger scale than Phase I trials.
Phase II trials can be divided into Phase IIA and Phase IIB although sometimes they are combined.
Phase IIA is designed to assess dosing requirements i.e. how much of the drug should patients receive and up to what dose is considered safe? The safety assessments carried out in Phase I can be repeated on a larger subject group. As more subjects are involved, some may experience side effects which none of the subjects in the Phase I experienced. The researchers aim to find out more about safety, side effects and how to manage them.
Phase IIB studies focus on the efficacy of the drug i.e. how well it works at the prescribed doses. Researchers may also be interested in finding out which types of a specific disease or condition would be most suitable for treatment.
Phase II trials can be randomised clinical trials which involve one group of subjects being given the experimental drug and others receiving a placebo and/or standard treatment. Alternatively, they may be case series which means that the drug’s safety and efficacy is tested in a selected group of patients. If the researchers have adequately demonstrated that the experimental drug (or device) is effective against the condition for which it is being tested, they can proceed to Phase III.
Phase III trials
Phase III trials are the last stage before clinical approval for a new drug or device. By this stage, there will be convincing evidence of the safety of the drug or device and its efficacy in treating people who have the condition for which it was developed. Such studies are carried out on a much larger scale than for the two previous phases and are often multinational. Several years may have passed since the original laboratory and animal testing.
The main aims of Phase III trials are:
to demonstrate that the treatment or drug is safe and effective for use in patients in the target group (i.e. in people for whom it is intended)
to monitor side effects
to test different doses or different ways of administering the drug
to determine whether the drug could be used at different stages of the disease.
to provide sufficient information as a basis for marketing approval
Researchers may also be interested in showing that the experimental drug works for additional groups of people with conditions other than that for which the drug was initially developed. For example, they may be interested in testing a drug for inflammation on people with Alzheimer’s disease. The drug would have already have proven safe and obtained marketing approval but for a different condition, hence the need for additional clinical testing.
Open label extension trails
Open label extension studies are often carried out immediately after a double blind randomised clinical trial of an unlicensed drug. The aim of the extended study is to determine the safety and tolerability of the experimental drug over a longer period of time, which is generally longer than the initial trial and may extend up until the drug is licensed. Participants all receive the experimental drug irrespective of which arm of the previous trial they were in. Consequently, the study is no longer blind in that everybody knows that each participant is receiving the experimental drug but the participants and researchers still do not know which group participants were in during the initial trial.
Post-marketing surveillance studies (phase IV)
After the three phases of clinical testing and after the treatment has been approved for marketing, there may be a fourth phase to study the long-term effects of drugs or treatment or to study the impact of another factor in combination with the treatment (e.g. whether a particular drug reduces agitation).
Usually, such trials are sponsored by pharmaceutical companies and described as pharmacovigilance. They are not as common as the other types of trials (as they are not necessary for marketing permission). However, in some cases, the EMA grants restricted or provisional marketing authorisation, which is dependent on additional phase IV trails being conducted.
Expanded access to a trial
Sometimes, a person might be likely to benefit from a drug which is at various stages of testing but does not fulfil the conditions necessary for participation in the trial (e.g. s/he may have other health problems). In such cases and if the person has a life-threatening or serious condition for which there is no effective treatment, s/he may benefit from “expanded access” use of the drug. There must, however, be evidence that the drug under investigation has some likelihood of being effective for that patient and that taking it would not constitute an unreasonable risk.
The use of placebo and other forms of comparison
The main purpose of clinical drug studies is to distinguish the effect of the trial drug from other influences such as spontaneous change in the course of the disease, placebo effect, or biased observation. A valid comparison must be made with a control. The American Food and Drugs Administration recognises different types of control namely,
- active treatment with a known effective therapy or
- no treatment,
- historical treatment (which could be an adequately documented natural history of the disease or condition, or the results of active treatment in comparable patients or populations).
The EMA considers three-armed trials (including the experimental medicine, a placebo and an active control) as a scientific gold standard and that there are multiple reasons to support their use in drug development .
Participants in clinical trials are usually divided into two or more groups. One group receives the active treatment with the experimental substance and the other group receives a placebo, a different drug or another intervention. The active treatment is expected to have a positive curative effect whereas the placebo is expected to have zero effect. With regard to the aim to develop more effective treatments, there are two possibilities:
1. the experimental substance is more effective than the current treatment or
2. it is more effective than no treatment at all.
According to article 11 of the International Ethical Guidelines for Biomedical Research (IEGBR) of 2002, participants allocated to the control group in a trial for a diagnostic, therapeutic or preventive intervention should receive an established effective intervention but it may in some circumstances be considered ethically acceptable to use a placebo (i.e. no treatment). In article 11 of the IEGBR, reasons for the use of placebo are:
1. that there is no established intervention
2. that withholding an established effective intervention would expose subjects to, at most, temporary discomfort or delay in relief of symptoms
3. that use of an established effective intervention as comparator would not yield scientifically reliable results and use of placebo would not add any risk of serious or irreversible harm to the subjects.
November 2010, EMA/759784/2010 Committee for Medicinal Products for Human Use
The use of placebo and the issue of irreversible harm
It has been suggested that clinical trials are only acceptable in ethical terms if there is uncertainty within the medical community as to which treatment is most suitable to cure or treat a disease (National Bioethics Commission of Greece, 2005). In the case of dementia, whilst there is no cure, there are a few drugs for the symptomatic treatment of dementia. Consequently, one could ask whether it is ethical to deprive a group of participants of treatment which would have most likely improved their condition for the purpose of testing a potentially better drug (National Bioethics Commission of Greece, 2005). Can they be expected to sacrifice their own best interests for those of other people in the future? It is also important to ask whether not taking an established effective intervention is likely to result in serious or irreversible harm.
In the 2008 amended version of the Helsinki Declaration (World Medical Association, 1964), the possible legitimate use of placebo and the need to protect subjects from harm are addressed.
“32. The benefits, risks, burdens and effectiveness of a new intervention must be tested against those of the best current proven intervention, except in the following circumstances:
The use of placebo, or no treatment, is acceptable in studies where no current proven intervention exists; or
Where for compelling and scientifically sound methodological reasons the use of placebo is necessary to determine the efficacy or safety of an intervention and the patients who receive placebo or no treatment will not be subject to any risk of serious or irreversible harm. Extreme care must be taken to avoid abuse of this option.” (WMA, 1964 with amendments up to 2008)
The above is also quite similar to the position supported by the Presidential Commission for the Study of Bioethical Issues (PCSBI) (2011). In its recently published report entitled “Moral science: protecting participants in human subjects research ”, the Presidential Commission argues largely in favour of a “middle ground” for ethical research, citing the work of Emanuel and Miller (2001) who state:
“A placebo-controlled trial can sometimes be considered ethical if certain methodological and ethical standards are met. It these standards cannot be met, then the use of placebos in a clinical trial is unethical.” (Emanuel and Miller, 2001 cited in PCSBI, 2011, p. 89).
One of the standards mentioned is the condition that withholding proven effective treatment will not cause more than minimal harm.
The importance of placebo groups for drug development
The ethical necessity to include a placebo arm in a clinical trial may differ depending on the type of drug being developed and whether other comparable drugs exist. For example, a placebo arm would be absolutely necessary in the testing of a new compound for which no drug has yet been developed. This would be combined with comparative arms involving other alternative drugs which have already been proven effective. For studies involving the development of a drug based on an existing compound, a comparative trial would be necessary but not necessarily with a placebo arm, or at least with a smaller placebo arm Nevertheless, the EMA emphasises the value of placebo-controlled trials in the development of new medicinal products even in cases where a proven effective drug exists:
“forbiddingplacebo-controlled trials in therapeutic areas where there are proven, therapeutic methods would preclude obtaining reliable scientific evidence for the evaluation of new medicinal products, and be contrary to public health interest as there is a need for both new products and alternatives to existing medicinal products.” (EMA, 2001).
In 2001, concerns were raised about the interpretation of paragraph 29 of the 2000 version of the Helsinki Declaration in which prudence was called for in the use of placebo in research trials and it was advised that placebo should only be used in cases where there was no proven therapy for the condition under investigation. A document clarifying the position of the WMA regarding the use of placebo was issued by the WMA in 2001 in which it was made clear that the use of placebo might be ethically acceptable even if proven therapy was available. The current version of this statement is article 32 of the 2008 revised Helsinki Declaration (quoted in sub-section 7.2.1).
The PCSBI (2011) highlight the importance of ensuring that the design of clinical trials enables the researchers to resolve controversy and uncertainty over the merits of the trial drug and whether the trial drug is better than an existing drug if there is one. They suggest that studies which cannot resolve such questions or uncertainty are likely to be ignored by the scientific community and this would be unethical as it would mean that people had been unnecessarily exposed to risk without there being any social benefit.
Reasons for participation
People with dementia who take part in clinical trials may do so for a variety of reasons. One possible reason is that they hope to receive some form of treatment that will improve their condition or even result in a cure. This is sometimes called the “therapeutic misconception”. In such cases, clinical trials may seem unethical in that advantage is being taken of the vulnerability of some of the participants. On the other hand, the possibility of participating in such a trial may help foster hope which may even enable a person to maintain their morale.
A review of 61 studies on attitudes to trials has shed some light on why people participate in clinical trials (Edwards, Lilford and Hewison, 1998). In this review, it was found that over 60% of participants in seven studies stated that they did or would participate in clinical trials for altruistic reasons. However, in 4 studies, over 70% of people stated that they participated out of self-interest and in two studies over 50% of people stated that they would participate in such a study out of self-interest. As far as informed consent is concerned, in two studies (which were also part of this review) 47% of responding doctors thought that few patients were actually aware that they were taking part in a clinical trial. On the other hand, an audit of four further studies revealed that at least 80% of participants felt that they had made an autonomous decision. There is no proof whether such perceptions were accurate or not. The authors conclude that self-interest was more common than altruism amongst the reasons given for participating in clinical trials but draw attention to the poor quality of some of the studies reviewed thereby suggesting the need for further research. It should not be necessary for people to justify why they are willing to participate in clinical trials. Reasons for participating in research are further discussed in section 3.2.4 insofar as they relate to end-of-life research.
In a series of focus groups organised in 8 European countries plus Israel and covering six conditions including dementia, helping others was seen as the main reason why people wanted to take part in clinical trials (Bartlam et al., 2010). In a US trial of anti-inflammatory medication in Alzheimer’s disease in which 402 people were considered eligible, of the 359 who accepted, their main reasons for wanting to participate were altruism, personal benefit and family history of Alzheimer’s disease.
Random assignment to study groups
As people are randomly assigned to the placebo or the active treatment group, everyone has an equal chance of receiving the active ingredient or whichever other control groups are included in the study. There are possible advantages and drawbacks to being in each group and people are likely to have preferences for being a particular study group but randomization means that allocation is not in any way linked to the best interests of each participant from a medical perspective. This is not an ethical issue provided that each participant fully understands that the purpose of research is not to provide a tailor-made response to an individual’s medical condition and that while some participants benefit from participation, others do not.
There are, however, medical issues to consider. In the case in double-blind studies, neither the participant nor the investigator knows to which groups a participant has been allocated. Consequently, if a participant encounters medical problems during the study, it is not immediately known whether this is linked to the trial drug or another unrelated factor, but the problems must be addressed and possible contraindications avoided, which may necessitate “de-blinding” (DuBois, 2008).
Although many people would perhaps like to benefit from a new drug which is more effective than existing drugs, people have different ideas about what is an acceptable risk and different reasons for taking part in clinical trials. People who receive the placebo are not exposed to the same potential risks as those given the experimental drug. On the other hand, they have no possibility to benefit from the advantages the drug may offer. Those receiving a drug commonly considered as the standard therapy are not necessarily better off than those receiving a placebo as some participants may already know that they do not respond well to the accepted treatment (DuBois, 2008).
If people who participate in a clinical trial are not informed which arm of the trial they were in, valuable information is lost which might have otherwise contributed towards to treatment decisions made after the clinical trial. Taylor and Wainwright (2005) suggest that “unblinding” should occur at the end of all studies and so as not to interfere with the analysis of data, this could be done by a person who is totally independent of the analysis. This would, however, have implications for open label extended trials as in that case participants, whilst better equipped to give informed consent would have more information than the researchers and this might be conveyed to researchers in anad hocmanner.
Open label extension trails
Open label extension studies (mentioned in sub-section 7.1.8) seem quite fair as they give each participant the opportunity to freely consent to continuing with the study in the full knowledge that s/he will receive the experimental drug. However, Taylor and Wainwright (2005) have highlighted a couple of ethical concerns linked to the consent process, the scientific value of such studies and issues linked to access to drugs at the end of the prior study.
With regard to consent, they argue that people may have had a positive or negative experience of the trial but do not know whether this was due to the experimental drug, another drug or a placebo. They may nevertheless base their decision whether to continue on their experience so far. For those who were not taking the experimental drug, their experience in the follow-up trial may turn out to be very different. Also, if they are told about the possibility of the open label extension trial when deciding whether or not to take part in the initial trial (i.e. with the implication that whatever group they are ascribed to, in the follow-up study they will be guaranteed the experimental drug), this might induce them to participate in the initial study which could be considered as a form of subtle coercion. Finally, researchers may be under pressure to recruit as they can only recruit people in an open label extended trial who took part in the initial study. This may lead them in turn to put pressure (even inadvertently) on participants to continue with the study.
The scientific validity of open label extension trials is questioned by Taylor and Wainwright (2005) on the grounds that people from the experimental arm of the first study who did not tolerate the drug would be unlikely to participate in the extension trial and this would lead to bias in the results. In addition, open-label trials often lack a precise duration other than “until the drug is licensed” which casts doubt on there being a valid research purpose.
The above authors suggest that open label extension studies are dressed up marketing activities which lack the ethical justification for biomedical research which is the prospect of finding new ways of benefiting people’s health. However, it could be argued that the aim of assessing long-term tolerability of a new drug is a worthwhile pursuit and if conducted in a scientific manner could be considered as research. Moreover, not all open label extension trials are open-ended with regard to their duration. The main problem in interpreting open label extension studies is that little is known about the natural course of the disease.
Protecting participants’ well-being at the end of the clinical trial
Some people who participate in a clinical trial and who receive the experimental drug experience an improvement in their condition. This is to be hoped even if benefit to the health of individuals is not the aim of the study. However, at the end of the study, the drug is not yet licenced and there is no legal right to continue taking it. This could be psychologically disturbing to the participants in the trial and also to their families who may have seen a marked improvement in their condition.
Taylor and Wainwright (2005) suggest that the open label trials may serve the purpose of prescribing an unlicensed drug on compassionate grounds, which whilst laudable, should not be camouflaged as scientific research. Rather governments should take responsibility and set up the appropriate legal mechanisms to make it possible for participants whose medical condition merits prolonged treatment with the experimental drug to have access to it.
Minimising pain and discomfort
Certain procedures to which people with dementia or their representatives consent may by burdensome or painful or simply worrying but in accordance with the principles of autonomy or justice/equity, people with dementia have the right to participate. The fact that they have made an informed decision to participate and are willing to tolerate such pain or burden does not release researchers from the obligation to try to minimise it. For example, if repeated blood samples are going to be necessary, an indwelling catheter could be inserted under local anaesthetic to make it easier or medical staff should provide reassurance about the use of various scanning equipment which might be worrying or enable the person’s carer to be present. In order to minimize fear, trained personnel are needed who have experience dealing with people with dementia. The advice of the carer, if there is one, could also be sought.
Drug trials in countries with less developed safeguards
Clinical trials are sometimes carried out in countries where safeguards are not well developed and where the participants and even the general population are likely to have less possibility to benefit from the results of successful trials. For example, some countries have not signed the Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine (1997) (referred to in section 188.8.131.52). The participants in those countries may be exposed to possible risks but have little chance of future medical benefit if the trial is successful. Yet people in countries with stricter safeguards for participants (which are often richer countries) stand to benefit from their efforts and from the risks they take, as they are more likely to be able to afford the drugs once developed. This raises ethical issues linked to voluntariness because there may be, in addition to the less developed safeguards, factors which make participation in such trials more attractive to potential participants. Such practices also represent a lack of equity in the distribution of risk, burden and possible benefit within society and could be interpreted as using people as a means to an end.
Parallels can also be drawn to the situation whereby people in countries where stem cell research is banned profit from the results of studies carried out in countries where it is permitted or to the results of studies carried out in countries where research ethics are slack or inexistent.
For a detailed discussion of the ethical issues linked to the involvement in research of people in other countries, particularly lower and middle income countries where standards of protection may by lower, please refer to the afore-mentioned report by the Presidential Commission for the Study of Bioethical Issues.
- Researchers should consider including a placebo arm in clinical trials when there are compelling and sound methodological reasons for doing so.
- Researchers should ensure that patients are aware that the aim of a randomised controlled trial is to test a hypothesis and provide generalizable knowledge leading to the development of a medical drug or procedure. They should explain how this differs from medical treatment and care which are aimed at enhancing the health and wellbeing of individual patients and where there is a reasonable expectation that this will be successful.
- Researchers should ensure that potential participants understand that they may be allocated to the placebo group.
- It should not be presumed that the treating doctor or contact person having proposed the participant for a trial has been successful in communicating the above information.
- Researchers conducting clinical trials may need training in how to ensure effective communication with people with dementia.
- Appropriate measures should be taken by researchers to minimize fear, pain and discomfort of participants.
- All participants should, when possible, preferably have the option of receiving the experimental drug (if proven safe) after completion of the study.
- Pharmaceutical companies should not be discouraged from carrying out open-label extension studies but this should not be the sole possibility for participants to access the trial drug after the end of the study if it is proving beneficial to them.
- In multi-centre clinical trials, where data is transferred to another country in which data protection laws are perhaps less severe, the data should be treated as stated in the consent form signed by the participant.
Last Updated: jeudi 29 mars 2012
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http://www.alzheimer-europe.org/FR%20%20%20%20%20%20%20%20%20%20%20%20%EF%BF%BD%20%EF%BF%BD%C2%B3/Ethics/Ethical-issues-in-practice/Ethics-of-dementia-research/Clinical-trials
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United Kingdom - Scotland
Restrictions of freedom
Mental Health (Care and Treatment) (Scotland) Act 2003
The Act was designed to modernise and improve the use of compulsory measures in mental health care. It reflects the general move over the last two decades towards care and treatment in the community rather than in hospitals or other residential settings. The title reflects the philosophy of the legislation with the focus on ‘care’ and ‘treatment’. In basic terms, the Act provides for the protection of people with a mental disorder in a hospital or community setting.
It contains mechanisms for dealing with offenders who have a mental disorder and so interacts with the criminal justice system.
The Act covers individuals who are defined as having a ‘mental disorder’. The term includes mental illness, personality disorder and learning disability. The majority of cases involving compulsory measures have been in relation to people diagnosed with a mental illness. However, the Mental Welfare Commission for Scotland monitors the use of compulsory measures and has found increasing use of emergency or short term measures being used for people aged over 75 years with a diagnosis of dementia.
Detention (Involuntary internment)
The Act deals with several forms of compulsion in relation to a person with mental disorder where:
There is a significant risk to the person’s health, safety or welfare or the safety of any other person (what is a significant risk is a question of judgement for health and social care professionals. The tribunal will test this assessment during an appeal or on an application for a compulsory treatment order).
Treatment is available to prevent the person’s condition from deteriorating or to relieve its symptoms or effects
Compulsory admission is necessary because the person will not agree to admission and/or treatment; and
The person’s ability to make decisions about the provision of medical treatment is significantly impaired because of mental disorder.
Types of order
Emergency Detention (72 hours)
Short Term Detention (28 days and can be extended)
Compulsory Treatment Order (6 months – can be extended)
Mental Health Tribunals
The Act introduced a new system of mental health tribunals with a number of functions, including considering applications for orders and appeals against orders.
This is detention in a psychiatric hospital for up to 72 hours if necessary. It does not authorise any medical treatment. In an emergency, common law powers might be used. A registered medical practitioner can sign an emergency detention certificate if s/he believes that a person’s ability to make decisions about medical treatment is significantly impaired because of mental disorder. This authorises the removal of the individual to a specific hospital. Before signing the certificate the medical practitioner must be satisfied that:
There is an urgent need to detain the person in hospital to access the medical treatment s/he needs
If the person was not detained, there would be a significant risk to his or her health, safety, or welfare or the safety of another person, and
Any delay caused by starting the short term detention procedure is undesirable.
If any treatment is needed the short-term detention procedure must generally be used.
Short term detention
This may be used where it is necessary to detain an individual with mental disorder who cannot be treated voluntarily and without the treatment the person would be at risk of significant harm. To obtain a certificate the approved medical practitioner must consult and gain the approval of a Mental Health Officer whatever the circumstances.
Compulsory Treatment Order
Compulsory Treatment Orders (CTOs) are granted by the Mental Health Tribunal. They last for 6 months, can be extended by the responsible medical officer for a further six months and then extended annually. The Tribunal reviews them at least every two years. Therefore, they can restrict or deprive liberty for long periods of time. The Mental Welfare Commission for Scotland looks at how these orders are used for people of different ages and genders to see if there are any trends. Over recent years, the number of new orders has come down. The use of CTOs for people aged 65 and over has increased for people with dementia in recent years.
‘De facto detention’
Practitioners must be careful that they are not using excessive coercion to prevent people from leaving hospital when they wish to. They must take care to document situations where they have concerns if an informal patient wishes to leave. The Tribunal can, under section 291 of the 2003 Act, order that an informal patient is being unlawfully detained. People with dementia pose a difficult problem. The Tribunal has ruled that a person with dementia is unlawfully detained in a general hospital when prevented from leaving. It can be appropriate to redirect someone and dissuade him/her from leaving but repeatedly thwarting a determined effort to leave is likely to a significant deprivation of liberty, and the patient should be formally detained.
Adults with Incapacity (Scotland) Act 2000
Scottish incapacity laws were reformed with the introduction of the Adults with Incapacity (Scotland) Act in 2000. This Act covers people with a mental disorder who lack some or all capacity to make decisions or act in their own interests. It recognises that capacity is not all or nothing but is ‘decision specific’. The Act introduced a number of measures to authorise someone else to make decisions on behalf of the person with incapacity, on the basis of a set of principles on the face of the Act. These are fundamental. Any action or decision
- Must benefit the person
- Must be the least restrictive of the person’s liberty in order to gain that benefit
- Must take account of the person’s past and present wishes (s/he must be given assisted to communicate by whatever means is appropriate to the individual)
- Must follow consultation with relevant others as far as practicable
- Must encourage and support the person to maintain existing skills and develop new skills.
The individual may, whilst competent, appoint one or more persons to act their financial (continuing) and or welfare attorney. This must be registered with the Office of the Public Guardian. It does not allow the attorney to detain the grantor in a psychiatric hospital. If the person refuses to comply with the attorney the attorney has no compulsory powers to detain. Where there is concern for the person’s safety the attorney can apply to the court for a welfare guardianship order. Powers can be granted to allow the guardian to decide on the accommodation of the person and other powers such as who they can consort with. Where the welfare guardian has powers over accommodation s/he is able to restrict the freedom of the person by placing them in a care home against their will. However, whether this amounts to deprivation of liberty under the European Court of Human Rights ruling will depend on a number of other circumstances and the accumulative impact of which would need to be considered (Patrick and Smith, 2009; Mental Welfare Commission for Scotland, 2011). With regard to the issue of non-compliance, if the person on guardianship, for example, runs away, the guardian can apply to the Court under s70 for an order to require the person to return.
Because there is no automatic review of welfare guardianship orders there is concern that the Adults with Incapacity (Scotland) Act 2000 may not be compliant with the European Convention on Human Rights. The Act states that the order should be for a standard 3 years but can be more or less at the discretion of the Court. However, there has been a practice of orders being granted for indefinite periods and this has given rise to concern in relation to certain groups. However, for people with dementia, who have a progressive brain disorder, an indefinite order may be deemed appropriate.
The Scottish Law Commission is currently undertaking a review of the Adults with Incapacity (Scotland) Act 2000 in relation to deprivation of liberty issues. It has established an advisory group of key stakeholders, including Alzheimer Scotland, and will be reporting in due course.
The Road Traffic Act of 1991 contains a few articles relating to offences involving driving when unfit to do so, e.g.:
- A person who causes the death of another person by driving a mechanically propelled vehicle dangerously on a road or other public place is guilty of an offence.
- A person who drives a mechanically propelled vehicle dangerously on a road or other public place is guilty of an offence.
- If a person drives a mechanically propelled vehicle on a road or other public place without due care and attention, or without reasonable consideration for other persons using the road or place, he (or she) is guilty of an offence.
- According to the provisions of this act, a person is regarded as driving dangerously if the way s/he drives falls far below what would be expected of a competent and careful driver and it would be obvious to a competent and careful driver that driving in that way would be dangerous.
A person who has been diagnosed with dementia must inform the Driver and Vehicle Licensing Authority (DVLA). Failure to do could lead to a fine of up to £1,000. Moreover, a person who had an accident but did not previously inform the DVLA of his/her dementia might not be covered by his/her insurance company. Once the DVLA has been informed of that someone has dementia, they send a questionnaire to the person and request a medical report. A driving assessment may also be required. The Medical Advisers at the DVLA then decide whether the person can continue driving (Alzheimer Scotland, 2003).
Patrick, H. and Smith, N. (2009),Adult Protection and the Law in Scotland, Bloomsbury Professional.
Mental Welfare Commission for Scotland Annual Report 2010 – 2011 www.mwcscot.org.uk
Last Updated: mercredi 14 mars 2012
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http://www.alzheimer-europe.org/FR%C2%AF/Policy-in-Practice2/Country-comparisons/Restrictions-of-freedom/United-Kingdom-Scotland
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2013-05-18T08:03:57Z
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Our opinion on ...
- Executive Summary
- Necessity for a response
- Genetic testing
- General principles
- Other considerations
The present paper constitutes the input of Alzheimer Europe and its member organisations to the ongoing discussions within Europe about genetic testing (in the context of Alzheimer's disease and other forms of dementia).
Alzheimer Europe would like to recall some general principles which guide this present response:
- Having a gene associated with Alzheimer's disease or another form of dementia does not mean that a person has the disease.
- People who have a gene linked to Alzheimer's disease or another form of dementia have the same rights as anyone else.
- Genetic testing does not only affect the person taking the test. It may also reveal information about other relatives who might not want to know.
- No genetic test is 100% accurate.
- The extent to which health cover is provided to citizens by the State social security system and/or privately contracted by individuals differs from one country to the next.
On the basis of these principles, Alzheimer Europe has developed the following position with regard to genetic testing:
- Alzheimer Europe firmly believes that the use and/or possession of genetic information by insurance companies should be prohibited.
- Alzheimer Europe strongly supports research into the genetic factors linked to dementia which might further our understanding of the cause and development of the disease and possibly contribute to future treatment.
- Based on its current information, Alzheimer Europe does not encourage the use of any genetic test for dementia UNLESS such test has a high and proven success rate either in assessing the risk of developing the disease (or not as the case may be) or in detecting the existence of it in a particular individual.
- Alzheimer Europe requests further information on the accuracy, reliability and predictive value of any genetic tests for dementia.
- Genetic testing should always be accompanied by adequate pre- and post-test counselling.
- Anonymous testing should be possible so that individuals can ensure that such information does not remain in their medical files against their will.
It is extremely important for people with dementia to be diagnosed as soon as possible. In the case of Alzheimer’s disease, an early diagnosis may enable the person concerned to benefit from medication, which treats the global symptoms of the disease and is most effective in the early to mid stages of the disease. Most forms of dementia involve the gradual deterioration of mental faculties (e.g. memory, language and thinking etc.) but in the early stages, it is still possible for the person affected to make decisions concerning his/her finances and care etc. – hence the importance of an early diagnosis.
If it were possible to detect dementia before the first symptoms became obvious, this would give people a greater opportunity to make informed decisions about their future lives. This is one of the potential benefits of genetic testing.
On the other hand, such information could clearly be used in ways which would be contrary to their personal interests, perhaps resulting in employment discrimination, loss of opportunities, stigmatisation, increased health insurance costs or even loss of health insurance to name but a few examples.
The present discussion paper outlines some of the recommendations of Alzheimer Europe and its member organisations and raises a few points which deserve further clarification and discussion.
The necessity for a response by Alzheimer Europe
In the last few years, the issue of genetic testing has been increasingly debated. In certain European countries there are already companies offering such tests. Unfortunately, the general public do not always fully understand what the results of such tests imply and there are no regulations governing how they are carried out i.e. what kind of information people receive, how the results are presented, whether there is any kind of counselling afterwards and the issue of confidentiality etc.
In order to provide information to people with dementia and other people interesting in knowing about their own state of health and in order to protect them from the unscrupulous use of the results of genetic tests, Alzheimer Europe has developed the present Position Paper.
These general principles as well as the Convention of Human Rights and Biomedicine and the Universal Declaration on the Human Genome and Human Rights dictate Alzheimer Europe’s position with regard to genetic testing.
Alzheimer Europe would like to draw a distinction between tests which detect existing Alzheimer's disease and tests which assess the risk of developing dementia Alzheimer's disease at some time in the future:
- Diagnostic testing : Familial early onset Alzheimer’s disease (FAD) is associated with 3 genes. These are the amyloid precursor protein (APP), presenilin-1 and presenilin-2. These genetic mutations can be detected by genetic testing. However, it is important to note that the test only relates to those people with FAD (i.e. about 1% of all people with Alzheimer’s disease). In the extremely limited number of families with this dominant genetic disorder, family members inherit from one of their parents the part of the DNA (the genetic make-up), which causes the disease. On average, half the children of an affected parent will develop the disease. For those who do, the age of onset tends to be relatively low, usually between 35 and 60.
- Assessment for risk testing : Whether or not members of one’s family have Alzheimer’s disease, everyone risks developing the disease at some time. However, it is now known that there is a gene, which can affect this risk. This gene is found on chromosome 19 and it is responsible for the production of a protein called apolipoprotein E (ApoE). There are three main types of this protein, one of which (ApoE4), although uncommon, makes it more likely that Alzheimer’s disease will occur. However, it does not cause the disease, but merely increases the likelihood. For example, a person of 50, would have a 2 in 1,000 chance of developing Alzheimer’s disease instead of the usual 1 in 1,000, but might never actually develop it. Only 50% of people with Alzheimer’s disease have ApoE4 and not everyone with ApoE4 suffers from it.
There is no way to accurately predict whether a particular person will develop the disease. It is possible to test for the ApoE4 gene mentioned above, but strictly speaking such a test does not predict whether a particular person will develop Alzheimer’s disease or not. It merely indicates that he or she is at greater risk. There are in fact people who have had the ApoE4 gene, lived well into old age and never developed Alzheimer’s disease, just as there are people who did not have ApoE4, who did develop the disease. Therefore taking such a test carries the risk of unduly alarming or comforting somebody.
Alzheimer Europe agrees with diagnostic genetic testing provided that pre- and post-test counselling is provided, including a full discussion of the implications of the test and that the results remain confidential.
We do not actually encourage the use of genetic testing for assessing the risk of developing Alzheimer's disease. We feel that it is somewhat unethical as it does not entail any health benefit and the results cannot actually predict whether a person will develop dementia (irrespective of the particular form of ApoE s/he may have).
We are totally opposed to insurance companies having access to results from genetic tests for the following reasons:
- This would be in clear opposition to the fundamental principle of insurance which is the mutualisation of risk through large numbers (a kind of solidarity whereby the vast majority who have relatively good health share the cost with those who are less fortunate).
- Failure to respect this principle would create an uninsurable underclass and lead to a genetically inferior group.
- This in turn could entail the further stigmatisation of people with dementia and their carers.
- In some countries, insurance companies manage to reach decisions on risk and coverage without access to genetic data.
- We therefore urge governments and the relevant European bodies to take the necessary action to prohibit the use or possession of genetic data by insurance companies.
Alzheimer Europe recognises the importance of research into the genetic determinants of Alzheimer’s disease and other forms of dementia. Consequently,
- we support the use of genetic testing for the purposes of research provided that the person concerned has given informed consent and that the data is treated with utmost confidentiality; and
- we would also welcome further discussion about the problem of data management.
In our opinion, any individual who wishes to take a genetic test should be able to choose to do so anonymously in order to ensure that such information does not remain in his/her medical file.
At its Annual General Meeting in Munich on 15 October 2000, Alzheimer Europe adopted recommendations on how to improve the legal rights and protection of adults with incapacity due to dementia. This included a section on bioethical issues. These recommendations obviously need to guide any response of the organisation regarding genetic testing for people who suspect or fear they may have dementia and also those who have taken the test and did develop dementia.
- The adult with incapacity has the right to be informed about his/her state of health.
- Information should, where appropriate, cover the following: the diagnosis, the person's general state of health, treatment possibilities, potential risks and consequences of having or not having a particular treatment, side-effects, prognosis and alternative treatments.
- Such information should not be withheld solely on the grounds that the adult is suffering from dementia and/or has communication difficulties. Attempts should be made to provide information in such a way as to maximise his/her ability to understand, making use of technology and other available techniques to enhance communication. Attention should be paid to any possible difficulty understanding, retaining information and communicating, as well as his/her level of education, reasoning capacity and cultural background. Care should be taken to avoid causing unnecessary anxiety and suffering.
- Written as well as verbal information should always be provided as a back-up. The adult should be granted access to his/her medical file(s). S/he should also have the opportunity to discuss the contents of the medical file(s) with a person of his/her choice (e.g. a doctor) and/or to appoint someone to receive information on his/her behalf.
- Information should not be given against the will of the adult with incapacity.
- The confidentiality of information should extend beyond the lifetime of the adult with incapacity. If any information is used for research or statistical purposes, the identity of the adult with incapacity should remain anonymous and the information should not be traceable back to him/her (in accordance with the provisions of national laws on respect for the confidentiality of personal information). Consideration should be given to access to information where abuse is suspected.
- A clear refusal by the adult with incapacity to grant access to information to any third party should be respected regardless of the extent of his/her incapacity, unless this would be clearly against his/her best interests e.g. carers should have provided to them information on a need to know basis to enable them to care effectively for the adult with incapacity.
- People who receive information about an adult with incapacity in connection with their work (either voluntary or paid) should be obliged to treat such information with confidentiality.
People who take genetic tests and do not receive adequate pre and post test counselling may suffer adverse effects.
Fear of discrimination based on genetic information may deter people from taking genetic tests which could be useful for research into the role of genes in the development of dementia.
Certain tests may be relevant for more than one medical condition. For example, the ApoE test is used in certain countries as part of the diagnosis and treatment of heart disease. There is therefore a risk that a person might consent for one type of medical test and have the results used for a different reason.
Last Updated: jeudi 06 août 2009
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http://www.alzheimer-europe.org/FR%C5%A0%C2%B7%C5%A0%20/Policy-in-Practice2/Our-opinion-on/Genetic-testing
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2013-05-18T05:52:22Z
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| 1,752,484,225.518289
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Medicaid is a State and Federal program that will pay most nursing home costs for people with limited income and assets. Eligibility varies by State. You must meet certain requirements in order to be eligible for Medicaid. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers.
Medicaid in Illinois is sometimes referred to as Public Aid and is administered by Health Care and Family Services (HFS).HFS Medical Benefits is a comprehensive healthcare program that covers doctor visits, prescription drugs, hospital care, emergency room coverage, long term care, durable medical equipment and a variety of other healthcare services.
You may qualify if you meet the following criteria.
- You are age 65 or older, or blind or have a permanent disability, AND
- You live in Illinois, AND
- Your income and assets are below the programís income http://health.illinois.gov/hfs.html#income and asset limits http://health.illinois.gov/hfs.html#assetlimit , AND
- You are a U.S. citizen or you are an eligible qualified immigrant http://health.illinois.gov/hfs.html#qualifiedimmigrant
Our staff is ready to assist you in completing an application if financial assistance is needed in paying for your cost of care.
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<urn:uuid:fc0c23e9-4e84-4f2c-bc44-1531fef4940b>
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http://www.amberwoodcarecentre.com/about-us/40-content/financial-options/141-medicaid
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2013-05-18T05:57:19Z
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| 1,752,484,225.545059
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AndroidPIT – Request a Test Report
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If a new version of a previously reviewed app is resubmitted for review, the full price must be paid. There is no rebate when reviewing apps that have already been reviewed.
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http://www.androidpit.com/en/android/paypal/test-request/form?pname=com.quinndamerell.PurdueMenu
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| 1,752,484,225.622048
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Dr Craige Golding, a specialist physician in anti-aging medicine and medical director of Solal, admits that the term ‘anti-aging medicine’ is perhaps not the best description of his field of interest. “It tends to suggest a focus on the exterior, giving the impression that it’s all about wrinkles and Botox treatments. But the focus is much broader than that. Anti-aging medicine is really about the prevention, early detection and reversal of the chronic diseases that become more common with age, and which constitute nearly 90% of the illnesses doctors treat on an ongoing basis. It truly is the medicine of the new millennium, advocating that people actively take control of their health rather than simply waiting for diseases to develop. People want to spend a longer time living healthily and a shorter time dying.”
Golding qualified as a specialist physician in 1999 and quickly found that much of the time he was treating the symptoms of conditions like diabetes, cancer, dementia, heart disease, osteoarthritis and osteoporosis, rather than addressing the causes. “And yet many of these degenerative diseases of aging are largely preventable or reversible, if one can intervene early enough using anti-aging treatments, like vitamins, minerals, amino acids, essential fats, nutraceuticals, herbal extracts, chelation therapies, intravenous nutrients and other intravenous treatments such as glutathione, hydrogen peroxide, phospholipid exchange, and measures like lifestyle modification. Hormone balancing and neurotransmitter assessmant and normalisation are also offered in anti-aging medicine. However, conventional practice didn’t give me the tools to practice this kind of preventive medicine. Anti-aging medicine addresses the cause of the underlying problem, rather than merely treating the symptoms.”
And then Golding heard of A4M, the American Academy of Anti-Aging Medicine. It offers two board-certified courses in anti-aging medicine, requiring, inter alia, the completion of a number of modules (courses offered in the United States), oral and written examinations, participation in interactive webcasts, and case studies. Completing these courses required five trips to the USA. Golding is now the only person in Africa to hold these qualifications. The qualifications are: ABAARM (American Board Certification in Anti-aging and Regenerative Medicine) and FAAFM (Fellow in Anti-Aging and Functional Medicine.)
“The primary aim of anti-aging medicine is to prevent disease,” he says. “We’ve seen a huge explosion in ‘convenience living’, with a lot of bad nutrition as a result of high intake of fast foods. In addition we’re exposed to a high level of pollutants. In fact, just living increases one’s risk for disease, since we are living in an increasingly toxic environment and exposed to poor diets and excessive stress. But by paying attention to one’s health, detoxifying and implementing lifestyle changes such as sound nutrition, exercise, stress management and anti-aging medicine, sickness can largely be prevented.”
“We also look at the role of hormones in disease processes. The hormonal decline associated with aging predisposes people to disease, thus increasing risk. Replenishment with bio-identical/compounded hormones, which have the same structure as hormones naturally occurring in the human body, can be highly beneficial to one’s health.”
Golding is looking to establish several integrative medicine centres throughout South Africa. The first of these, in Bryanston, Johannesburg, is already up and running, and offers bio-identical hormone therapy, chelation therapies, intravenous nutrient treatments and integrative approaches to cancer including, for example, high-dose vitamin C therapy. This centre also offers anti-aging skin treatments, specialist anti-aging consultations and bio-identical compounded hormone replacement therapies.
Other future plans include the establishment of an age-diagnostic lab in South Africa. Says Golding, “In so many cases, ‘normal’ and ‘optimal’ hormone levels are not the same thing. We have aggressive reference ranges when it comes to issues like testosterone levels in men, for example. Conventional guidelines have a one-size-fits-all approach, even though one would think it obvious that what is normal or optimal in an 18-year-old would not be so in an 80-year-old. Low testosterone increases one’s risk for conditions like prostate cancer, loss of muscle mass, heart disease, vascular disease and osteoporosis. Restoring declining testosterone levels in an older man to the physiologically normal levels of a younger person can prevent a wide array of diseases.”
Golding is also planning to do a number of seminars on anti-aging medicine, starting February 2008. The topics covered will include all areas of anti-aging medicine; to give some examples:
- bio-identical hormone replenishment
- thyroid health
- adrenal fatigue
- brain health
- prevention of cancers, such as breast cancer
- integrative approach to cancer treatments
- chelation therapies
- attention deficit disorder and autism spectrum
- metabolic syndrome
- weight loss
Areas of promise
Metabolic syndrome is now a major problem worldwide. “If we can prevent it from developing – or even just retard the process of decline – we can make a huge difference to an individual’s quality of life,” says Golding, “For example, chromium and other nutraceuticals such as alpha lipoic acid and Egcg can reverse or even prevent diabetes – and our goal is to ensure a healthy life without the burden of the chronic diseases of aging.”
Chelation therapy is showing promise for the treatment of heavy metal toxicity – and treatment of this is unique to anti-aging medicine. Heavy metal toxicity can be tested for quite easily through urine tests, MELISA blood testing or hair sampling. We are all exposed to heavy metal toxicity and the consequences can be dire if not dealt with, contributing to conditions like heart disease, vascular disease, dementia and cancer.
Golding is also very enthusiastic about the nutritional treatment of cancer by means of intravenous nutrients. In 2007, Dr Shari Lieberman presented her successful case studies to the Fellowship in Anti-aging. She has seen very positive results using nutraceuticals and high doses of intravenous vitamin C. Golding hopes to introduce this to South Africa in the course of 2008.
Anti-aging medicine also extends to psychological wellness, and neurotransmitter testing. (South Africa still does not have the necessary facilities for this, however, and the evaluations have to be done overseas.) Rather than just prescribing antidepressants for depression and anxiety, amino acids, nutrients, cofactors, vitamins and minerals can be used in a more sustainable manner to restore neurotransmitter levels in the brain. Neurotransmitters are essentially molecules of behaviour within the brain and many disorders ranging from depression to anxiety to attention deficicit disorder to psychosis and other mental disorders can be addressed by optimisation of neurotransmitters.
Golding is very conscious of the mind-body link. “Conventional medicine underestimates the importance of happiness. People want to feel good and be conscious of it. That’s why anti-aging medicine puts great emphasis on a holistic approach, viewing the patient/client as a complete entity, rather than only focusing on the one area where overt disease may be present.”
The wellness revolution
Golding feels that the world is undergoing a wellness revolution, and that anti-aging medicine will have an ever-greater role to play in the future. “More and more people are embracing the wellness model, realising that lifestyle plays a key role in the development of disease – and that because lifestyle is modifiable, disease is reversible. People want to feel well and be healthy, and the fact that many anti-aging practices are constantly booked up – often months in advance – attests to this changing mindset.”
Golding became Solal’s medical director because he was very impressed with the company’s range of anti-aging products. The range comprises more than 200 types of nutraceuticals, all formulated with scientifically supported optimal doses. “It’s a very impressive range, maybe the best of its kind in the world and superior even to those available in the USA,” he says. “In addition, Solal also has ranges of cosmaceuticals and dermaceuticals, which hold a lot of promise for retarding aging of the skin.”
Golding reveals that the A4M intends bringing the qualifications in anti-aging medicine to South Africa. He says, “GPs, for example, would be able to do these courses without giving up their practices.” Golding also foresees a time in the USA in the not-too-distant future when anti-aging medicine will become a recognised sub-specialty, requiring a four-year degree course. And given that South Africa tends to track trends in the USA, this will almost certainly become the case here too. “However, those of us who already hold the current qualifications will probably be ‘grandfathered in’,” he says.
Though passionate about anti-aging medicine, wellness and the prevention of illness, Golding underscores that he is not negating the importance and value of conventional medicine, which also has its place. “After all, if you’ve actually had a myocardial infarction, you need treatment in an ICU, not a dose of vitamin C. My point is simply that for so long we’ve been over-focused on just managing diseases. But prevention, early detection and reversal of the disease process are better options. Take the analogy of a car. What makes more sense? To have the car serviced regularly or to wait for it to break down?”
“We already have the diagnostic capabilities to pick up markers of disease before it becomes clinically evident. Developments in DNA/RNA measurement and genetic testing will continue to advance this – already, genetic studies can even pick up abnormalities before these are evident on PET scanning. Genetic modification in utero will be the next big, exciting development. Stem cell therapy is also showing great promise and is already being used in anti-aging medicine for the treatment of conditions like osteo-arthritis and macular degeneration, as well as myocardial infarction and stroke. Exciting times await us with an increased life expectancy and better health.”
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<urn:uuid:8cf16866-a4aa-4b9b-ae8a-77157177ef33>
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http://www.antiagingdoctor.co.za/index.php?option=com_content&view=article&id=46:about&Itemid=54
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2013-05-18T07:26:32Z
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CC-MAIN-2013-20
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Exposed 15mm Design Grid System
Designer grids are a comprehensive range of 15mm wide systems (Silhouette 6mm, Silhouette 3mm, and Interlude), all of which offer a choice of sophisticated visuals, and with the practicality of simple partition head fixing. All designer grids come with the additional benefit of our unique XL² feature, an advanced stab system that locates with an audible"click". All tees are stitched to enhance the rigidity and tortional strength of the components.
Exposed 15mm Design Grid System Silhouette XL² 6mm
Exposed 15mm Design Grid System Silhouette XL² 3mm
Exposed 15mm Design Grid System Interlude XL²
- Inspiration & Knowledge
- Green Building
- Technical Data
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http://www.armstrong.com/commclgeu/en-ug/ceilings/suspension-systems/_/N-1z14192Z1z141wf
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2013-05-18T06:22:17Z
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CC-MAIN-2013-20
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en
| 0.848815
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