Fall safety for kids: How to prevent falls - Mayo Clinic

Fall safety for kids: How to prevent falls

Keeping your child safe from falls takes more than luck. Follow these precautions, and you'll go a long way toward preventing injuries.

Curious about fall safety for kids? Precautions at home and on the go can help reduce your child's risk of falls and injuries.

Every parent knows how hard it is to protect a child from injuries related to falling. When a baby learns to walk, preventing falls requires constant supervision. Later, a toddler might tumble while trying to get to the cookie jar — and an older child might slip while rocketing up hardwood stairs in socks. Still, there's plenty you can do to promote fall safety and minimize injuries when falls happen.

Taking basic precautions in these hot spots can help prevent falls at home:

• Windows. Most children 5 years old and younger can fit through a 6-inch opening. To prevent falls from windows, install a stop that prevents windows from opening any further than 4 inches. Alternatively, install window guards that cover the lower part of the window. Other prevention strategies include opening double-hung windows only from the top, moving furniture away from windows, and supervising children in a room with open windows. Don't rely on a window screen to prevent falls.
• Stairs. Install safety gates at the top and bottom of staircases. Put doorknob covers on doors that lead to staircases, such as basement doors. Install lower stair rails that are easier for younger children to reach. Don't leave clutter on stairs.
• Porches and balconies. Don't let a child play unattended on a balcony, porch or fire escape even if there are railings. Lock doors and windows that provide access to these areas.
• Baby furniture and equipment. Use preinstalled safety straps on a changing table or highchair. Select a highchair with a wide base that makes tipping less likely. Don't leave a child unattended on a changing table or in a highchair.
• Beds. Install safety rails on beds for toddlers. Bunk beds should be used for children who are six or older. Safety rails on bunk beds should be on both sides of the bed, and gaps between rails should be 4 inches or less. Use a nightlight near the bunk bed stairs or ladder for safe use at night.
• Other furniture. Don't leave a baby unattended on furniture. Place bassinets or portables car carriers on the floor, rather than on tables, counters, beds or other furniture. Place bumpers or guards on sharp corners of furniture to protect toddlers when they fall.
• Bathtubs. Use a bathmat in tubs to lower the risk of falls. Don't leave your child unattended in a bath. Use a nonslip bathmat and clean up wet floors promptly.
• Baby walkers. The American Academy of Pediatrics recommends not using baby walkers, which can lead to falls. Consider alternatives, such as a stationary walker center or activity center.
• Nightlights. Use a nightlight in your child's bedroom, the bathroom and hallways to prevent falls at night.

Fall safety for kids on the go

When you're out and about, consider taking these precautions:

• Strollers. When shopping for a stroller, look for one with a wide base that is less likely to tip. Always use the safety harness when your baby or toddler is in the stroller. To avoid tipping the stroller, don't hang bags from the handles. Check the weight limit of strollers that have a place for older children to stand in the back.
• Shopping carts. Shopping carts can tip easily. Only put a child in the designated seat and use the safety belt. Don't let your child sit in the basket, stand in the cart or hang from the sides of the cart. An adult should push a cart when a child is in the seat.
• Playgrounds. Seek out playgrounds with shock-absorbing surfaces, such as wood chips, mulch, rubber or sand. Falls on cement, packed dirt and turf are more likely to result in injuries. Steer your child to age-appropriate activities to help prevent falls from equipment.
• Helmets and other protective gear. Always have your child wear a helmet while biking, inline skating, skateboarding or riding scooters. When using skates, a scooter or a skateboard, your child should wear guards for the wrists, elbows and knees.
• Escalators. Hold your child's hand when using an escalator. Watch for loose clothing, shoestrings or shoes such as flip-flops that can cause tripping. Don't let your child sit or play on an escalator. Don't use a stroller on an escalator.
• Watch for slippery surfaces. Encourage your child to approach wet, dark and paved areas with caution in cold temperatures. Make sure your child wears shoes or boots with traction in bad weather. A heavy or bulky coat can provide cushioning in the event of a fall. Teach your child not to run around a swimming pool.

Keeping your child safe from falls takes more than luck. Follow these precautions, and you'll go a long way toward preventing injuries.

Fall safety for kids: How to prevent falls - Mayo Clinic: Fall safety for kids — Prevent falls by taking these simple precautions.

Controversial ACA ruling: 4 things Patients should know | American Medical Association

Controversial ACA ruling: 

Kevin B. O'Reilly

News Editor

American Medical Association

 @kboreillyFull Bio @BarbaraMcAnenyFull Bio

In the days since a federal judge’s ruling striking down the Affordable Care Act (ACA) in its entirety, there has been a flood of punditry on the merits of the decision and its potential impact. While that makes fun reading for some, for others without law degrees it can be a bit overwhelming. So here are four key things that practicing physicians should understand and share with patients who ask.

Keep it in perspective. While the ruling, from the U.S. District Court for the Northern District of Texas, is unfortunate, it’s important to put it in context.

This Texas v. United States decision was based on the court’s finding that the 2017 Tax Cuts and Jobs Act—which zeroed out the tax penalties associated with the ACA’s individual mandate—renders the mandate unconstitutional. The judge further concluded that since the mandate was an essential part of the ACA, the entirety of the law is unconstitutional.

Barbara L. McAneny, MD

President

American Medical Association

 @BarbaraMcAneny

Full Bio

About AMA’s amicus brief to defend patients’ ACA coverage

This week, the AMA—along with the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry—filed an amicus brief in response to the court case, Texas v. United States. With this action, the AMA opposes a lawsuit that would undermine the policies supported by our House of Delegates, including expanded health insurance coverage and other important patient protections.

Unfortunately the AMA represents only 30% of American physicians, yet it pretends to represent all American Physicians. It also portends to represent the best interest of patients. The reasoning is rather circuitous, bathed in moral and ethical obfuscation.

**********************************************************************************************

Sounds dire. Does that mean the 20 million people who became insured since the ACA’s passage are now out of luck? Definitely not, because the court did not issue an injunction, so that means the law stands for now.

In addition, the Trump administration announced that it will keep administering the law until the U.S. Supreme Court weighs in on the matter. And that won’t happen until 2020 at the earliest, because other legal steps need to take place first.

Just as it was difficult to legislate the Affordable Care Act, so too will it take considerable time and effort to deconstruct it. Our balance of powers makes quick changes almost impossible except for Presidential orders.  (Reassuring, isn't it ? )

Controversial ACA ruling: 4 things physicians should know | American Medical Association:

KEZ - Immediate Emergency Notification Smart Band | Indiegogo

There seems to be a plethora of wrist borne remote monitoring offerings now coming on to the market.

Apple Watch, ver 4.0 offers EKG monitoring with a monitoring and notification feature. This adds a new function to the already ubiquitous Apple Watch.  Unfortunately the older Apple Watch cannot be upgraded, requiring a rather expensive new purchase.

The Apple Smart Watch ver 4.0 has an FDA approval, but is not completely certified as a medical devide.

There are however several devices coming to market.

Polar’s latest Vantage fitness watches are now available for purchase

In September, Polar announced its latest wearables — the Polar Vantage V and the Polar Vantage M, both of which provide a new optical heart rate sensor, additional tracking metrics, and more. The fitness watches are now available for purchase and are shipping out for those who pre-ordered either one at launch.

Both the Vantage M and Vantage V can be bought through Polar’s website. The Vantage M will cost you $280. The Vantage V is a bit more pricey, coming in at $500 in either black, orange, and white, in sizes medium and large — small bands can be bought for about $10.  You can also opt for the heart rate bundle, which comes with the Vantage V and Polar H10 heart rate monitor for $50 more.

For the most part, the Vantage M and Vantage V are packed with the same features. Under the hood, you will find Polar Precision Prime — Polar’s new wrist-based heart rate technology. With three sensor types and new electrode sensors to measure skin contact, both wearables are expected to have higher accuracy and a quicker response time when it comes to measuring heart rate.

Both watches also offer continuous heart rate and activity tracking. That way, even on days you’re not training, the Vantage M and Vantage V provide you with daily calorie burn and insightful data in terms of your everyday activity.

Polar's offering will set you back $250 to $500 depending on the options.

On Indiegogo  A KEZ - Intelligent Emergency Notification Smart Band based on Bio-sensing is in development. 

In an emergency, KEZ offers both 360° real-time video to immediately assess the situation and GPS location tracking so you can rush to your loved one’s side. Triggered by an automated bio-sensor, KEZ requires no action on the part of the person in distress. Capable of measuring bio-rhythms including heart rate, blood pressure and body temperature, KEZ’s patented algorithm will monitor bio-data in real-time to only alert you in times of abnormal readings or urgent emergency. Sometimes there is no time to explain the emergency. Equipped with a 360° fish-eye camera, when an emergency is triggered, KEZ will automatically begin to record the situation. Activated only in emergency situations, the camera will record for 15 sec. in a 360°FOV (field of view) and automatically transmit the video to the guardian.

Beyond alerts and a video record, KEZ will also determine the exact location of the wearer in crises. Real-time GPS tracking provides the exact address and map location. Even if they are unable to tell you, never feel hopeless and always know where to go respond to. 

When an emergency is triggered, KEZ will record and transmit an emergency alert in 40 seconds or less. SOS alert will include video of the surroundings and recording of the immediate danger. Appraise the situation & take action immediately.

Others:

There are a plethora of fitness trackers offered by such firms as Nike and other sport related companies.






KEZ - Immediate Emergency Notification Smart Band | Indiegogo: KEZ - Intelligent Emergency Notification Smart Band based on Bio-sensing | Check out 'KEZ - Immediate Emergency Notification Smart Band' on Indiegogo.

Direct primary care can rein in America’s out-of-control healthcare costs

While Democrats and Republicans debate the merits and drawbacks of reforming America’s broken health insurance system, few policymakers are paying attention to perhaps the biggest reason health insurance is so expensive: The actual cost of healthcare, which insurers have to pay, is out of control.

There are many reasons the cost of providing healthcare has been steadily rising in most sectors of the healthcare industry. One of the most important is that the traditional health insurance model wastes piles of cash. It pays health insurers to act as middlemen between patients and their doctors. Patients continue to use their health insurance to pay for virtually every healthcare service, including those that they could easily pay for on their own, like primary care visits, flu shots, and routine exams.

Insurers’ involvement in nearly every primary care visit is causing healthcare expenses to skyrocket. Patients are being forced to pay extra so insurance companies can facilitate transactions they really don’t need to be involved in. Not only does this cause the cost of primary care services to rise, it also forces doctors to squander time filling out paperwork instead of treating patients. Some doctors choose to hire more staff to handle much of the administrative work, also contributing to the rising cost of providing primary care.

I remember the day (not so long ago) circa 1950 my mom would take me to see the 'family doctor: or GP as was common knowledge. She would pay about $7.00-$15.00 for an office visit. The doctor (Dr. Brown) would often come to our house to see me if I had a fever. ( I lived in Connecticut, where in the winter it would get pretty cold, icy and generally inhospitable.)

No matter, today an initial visit to a 'primary care doctor' runs about $125.00 and a followup is around $75.00.

I am often told medical care is so expensive today because we can treat almost anything, and have drugs we had not back in 1950 (except for maybe, penicillin) and that is why health care is so expensive.  It's a 'simple' explanation of how we arrived at this point in time.

But is it ?

Prior to 1965 there was no Medicare, some seniors had retirement benefits from their employers along with their pensions. Once Medicare became established the Federal government infused billions into the health system, creating inflation.  In 1981 the Health Maintenance Organization billl was passed, allowing doctors to sign contracts with insurance companies.  At that time most medical practices were private and independent. Over the next 25 years Health Insurance Plans were indemnity plans, which evolved into Health plans.  Invasive regulations created oversight and bureaucracy increasing the costs to medical practices. Prior authorization for services increased the workload and delayed treatments.  Billing and reimbursement issues became very cumbersome, increasing overhead substantially. The days of one doctor and one 'nurse' in the office dissolved into major business.

The increasing overhead led to acquisitions, mergers, and a transition from solo practice to group practices.

In 2006 the use of electronic health records was mandated by CMS and HHS, in order to be  fully reimbursed.  Further inflationary funds were given to doctors to purchase EHRs.   There was no funding for ongoing maintenance or replacement of IT systems.  The benefits of the federal largesse were vendors of IT system. The money  given to medical practice, and hospitals flowed through to vendors and software companies.

The 'incentive' was a perverse combination of penalties for non compliance and an increase in fees for those who 'complied'.

Other issues arose, the conversion from the ICD-9 to ICD-10 coding increased work loads for medical providers.

As things progressed in the early 2000s insurance companies began to feel the competition and had diminishing profit figures, which stockholders and investors .  Major insurers began to merge,  pharmacy companies merged with each other, or health plan to maximize their own profits. Many of these occurences did not decrease costs to the system.  The beneficiaries were the major insurrers, pharmacy benefit programs. Gone were the days of the independent pharmacies, much like medical practices. They are replaced by PBMs (Pharmacy Benefit Managers) with large scale contracts with advantage plans.

The development of specific focused drug applications added increasing expenses to drug companies coupled with the expense of the FDA drug approval process







http://tinyurl.com/y7c7xzot

Proposed ‘Public Charge’ Policy Would Have Chilling Effect On Children Getting Health Care, California Medical Association Says | California Healthline

Proposed ‘Public Charge’ Policy Would Have Chilling Effect On Children Getting Health Care, California Medical Association Says | California Healthline: Proposed ‘Public Charge’ Policy Would Have Chilling Effect On Children Getting Health Care, California Medical Association Says
California Medical Association, which has 43,000 members, weighed in on the proposed policy from President Donald Trump that would penalize legal immigrants who are seeking green cards for receiving government aid such as Medicaid. “Discouraging participation in Medi-Cal (Medicaid) could result in coverage losses throughout California, decreased access to care, and worse health outcomes for entire families, including children, many of whom are U.S. citizens," wrote Dr. David H. Aizuss, CMA president.

Sacramento Bee: 43,000 California Medical Association Doctors Oppose Trump Immigration Proposal
As public comment came to a close Monday on a controversial Trump administration immigration proposal, the California Medical Association wielded the clout of its 43,000 members to oppose a measure that has drawn criticism from food banks, community colleges, domestic abuse advocates and immigrant rights groups. “This proposed rule is a step in the wrong direction, one that could lead thousands of Californians to avoid needed health care,” wrote Dr. David H. Aizuss

What to know about the telehealth upsides of Medicare Advantage plans | Healthcare Finance News

Forthcoming policies from CMS will open up the home as a covered 

site of care in which hospitals can earn payment.

This past October, the Centers for Medicare and Medicaid Services came out with an eagerly-anticipated new rule expanding the ways providers can use telehealth and get paid by Medicare Advantage plans.

The biggest way the rule changes the status quo, once it goes into effect in 2020, is that providers will be able to keep track of a patient's health through remote monitoring and consumers will be able to connect to their physicians through telehealth from their homes.

Let's take a deeper look at what that will mean for healthcare executives considering implementing tele-health or remote patient monitoring tools.

What to know about the telehealth upsides of Medicare Advantage plans | Healthcare Finance News:

Forthcoming policies from the Centers for Medicare and Medicaid Services will open up the home as a covered site of care in which hospitals can earn payment for delivered services.

Without Obamacare Penalty, Think It’ll Be Nice To Drop Your Plan? Better Think Twice

DanaFarrell’s car insurance is due. So is her homeowner’s insurance — plus her property taxes.

It’s also time to re-up her health coverage. But that’s where Farrell, a 54-year-old former social worker, is drawing the line.

“I’ve been retired two years and my savings is gone. I’m at my wit’s end,” says the Murrieta, Calif., resident.

So Farrell plans — reluctantly — to drop her health coverage next year because the Affordable Care Act tax penalty for not having insurance is going away.

That penalty — which can reach thousands of dollars annually — was a key reason that Farrell, who considers herself healthy, kept her coverage.

Now, “why do it?” she wonders. “I don’t have any major health issues and I’ve got a lot of bills that just popped up. I can’t afford to pay it anymore.”

Farrell is among millions of people likely to dump their health insurance because of a provision in last year’s Republican tax bill that repeals the Obamacare tax penalty, starting in 2019, by zeroing out the fines.

The Congressional Budget Office estimated that the repeal of the penalty would move 4 million people to drop their health insurance next year — or not buy it in the first place — and 13 million in 2027.

Some people who hated Obamacare from the start will drop their coverage as a political statement. For people like Farrell, it’s simply an issue of affordability.

Since Farrell started buying her own insurance through the open market in 2016, her monthly premium has swelled by about $200, she says, and she bears the entire cost of her premium because she doesn’t qualify for federal ACA tax credits. Next year, she says, her premium would have jumped to about $600 a month.

Instead, she plans to pay cash for her doctor visits at about $80 a pop, and for any medications she might use — all the while praying that she doesn’t get into a car accident or have a medical emergency.

“It’s a situation that a lot of people find themselves in,” says Miranda Dietz, lead author of a new study that projects how ending the penalty will affect California.

Another option is to join a prepaid, or direct pay primary practice. These clinics offer a monthly subscription fee which covers over 90% of clinic visits.  In some cases they may also cover some specialty care. The fees are much lower since they do not bill insurance and have fewer employees engaged in bureaucratic paper work. You should find out if your doctor uses a direct payment plan.
These plans are so new that the Affordable Care has not yet recognized these plans.  However this is changing rapidly as copays are increasing as well as deductibles.

For those of you who have HSAs (Health Savings Accounts), IRS regulations are also changing to allow payment of direct payment plans to be paid from those pre-tax dollars. Check with your  CPA.

For those who are wondering what to do, there are other options:

Up to 450,000 more Californians may be uninsured in 2020 as a result of the penalty ending, and up to 790,000 more by 2023, boosting the state’s uninsurance rate for residents under 65 to 12.9 percent, according to the study. The individual market would suffer the biggest losses.

Health insurance can be difficult to afford, but going without it is a “bad gamble,” Scullary says. Keep in mind: More than 22,000 Covered California enrollees broke, dislocated or sprained arms or shoulders in 2017, and 50,000 enrollees were either diagnosed with — or treated for — cancer, he explains.

“We know that none of those people began the year thinking, ‘This is when I’m going to break my arm,’ or ‘This is the year I get cancer,’” he says.

If you’re considering dropping your plan and risking the devastating financial consequences of an unexpected medical expense, check first to see if you can lower your premium.

“A big mistake for people is to look at the notice they get for their current health insurance and see it’s going up a lot and then throw up their hands and decide they’re going to go without,” says Donna Rosato, a New York-based editor at Consumer Reports who covers health care cost issues.

“Before you do that, look at other options.”

The most important thing to do is seek free help from a certified insurance agent or enrollment “navigator.” You can find local options by clicking on the “Find Help” tab on Covered California’s website, http://www.CoveredCA.com.

Next, see if you can qualify for more financial aid. For instance, if your income is close to the threshold to qualify for tax credits through Covered California or another Obamacare insurance exchange — about $48,500 for an individual or $100,000 for a family of four this year — check with a financial professional about adjusting it, Rosato suggests. You might be able to contribute to an IRA, 401(k) or health savings account to lower the total, she says.

Beyond that, be flexible and willing to switch plans, she advises. Consider different coverage levels, both on and off health insurance exchanges. If you’re in a silver-level plan (the second-lowest tier), you might save money by purchasing a less expensive bronze-level plan that has higher out-of-pocket costs but would protect you in case of a medical emergency.

http://tinyurl.com/y77eronl

In The VR Voice Hot Seat - Dr. Walter Greenleaf, Stanford University

In The VR Voice Hot Seat - Dr. Walter Greenleaf, Stanford University – Crowdcast:

Welcome to Cool Blue Media's Crowdcast profile...

The past 24 months have brought Virtual Reality and Augmented Reality to the public's attention.  Virtual Reality has already been in use in Surgical Robotics and has been implemented by several medical device companies and is in  use in many operating rooms.

Clinicians in behavioral health have developed treatment protocols for depression,  and others.  Some are using it for diagnostics as well as treatment.  The field is ripe for study. PubMed.com  is a valuable resource for my readers.

Our source for information in today's post is Dr. Walter Greenleaf (Stanford University). sponsored by Crowdcast a live streaming application.

Virtual Reality shares the limelight now with another superstar, Artificial Intelligence. Undoubtedly the two will join forces, merge and become Virtual Intelligence or some other eponym as an eye catcher for engagement.  At the least our lexicon is changing rapidly.

Walter Greenleaf is a behavioral neuroscientist and a medical technology developer working at Stanford University. With over three decades of research and development experience in the field of digital medicine and medical virtual reality technology, Walter is considered a leading authority in the field.  Dr. Greenleaf has designed and developed numerous clinical systems over the last thirty-three years, including products in the fields of: surgical simulation, 3D medical visualization, telerehabilitation, clinical informatics, clinical decision support, point-of-care clinical data collection, ergonomic evaluation technology, automatic sleep-staging systems, psychophysiological assessment, and simulation-assisted rehabilitation technologies, as well as products for behavioral medicine.

As a research scientist, Dr. Greenleaf’s focus has been on age-related changes in cognition, mood, and behavior.  His early research was on age-related changes in the neuroendocrine system and the effects on human behavior.  He served as the Director of the Mind Division, Stanford Center on Longevity, where his focus was on age-related changes in cognition. He is currently a Distinguished Visiting Scholar at Stanford University’s MediaX Program, a Visiting Scholar at Stanford University’s Virtual Human Interaction Lab, the Director of Technology Strategyat the University of Colorado National Mental Health Innovation Center, and a member of the Board of Directors for Brainstorm: The Stanford Laboratory for Brain Health Innovation and Entrepreneurship.

As a medical technology developer, Dr. Greenleaf’s focus has been on computer supported clinical products, with a specific focus on virtual reality and digital health technology to treat Post-traumatic Stress Disorder (PTSD), Anxiety Disorders, Traumatic Brain Injury and Stroke, Addictions, Autism, and other difficult problems in behavioral and physical medicine.

Dr. Greenleaf founded and served as CEO for Greenleaf Medical Systems, a business incubator; InWorld Solutions, a company specializing in the therapeutic use of virtual worlds for behavioral health care; and Virtually Better, a company that develops virtual environments for the treatment of phobias, anxiety disorders, and PTSD.  In addition to his research at Stanford University, Walter is SVP of Strategic & Corp. Affairs to MindMaze and Chief Science Advisor to Pear Therapeutics. He is a VR technology and neuroscience advisor to several early-stage medical product companies, and is a co-founder of Cognitive Leap.

CVS to complete Aetna merger after clearing final hurdle | TheHill

CVS to complete Aetna merger after clearing final hurdle

The $69 billion merger between CVS and Aetna will close imminently after New York signed off on the deal Monday.

The deal is now expected to close Wednesday. Aetna and CVS say that the merger will improve health-care outcomes and reduce costs immediately.

They have plans to turn CVS’s 10,000 pharmacies and clinics into community-based sites of care with nurses and other health professionals available to give diagnoses or do lab work.

The merger also means that there will no longer be any independent pharmacy benefit managers in the U.S.

The deal was cleared by the Department of Justice in October, and New York was the last state regulatory approval that the companies needed.

As part of New York’s approval, CVS and Aetna agreed to some concessions, including enhanced consumer and health insurance rate protections, privacy controls, cybersecurity compliance, and a $40 million commitment to support health insurance education and enrollment.

CVS to complete Aetna merger after clearing final hurdle | TheHill: The $69 billion merger between CVS and Aetna will close imminently after New York signed off on the deal Monday.

Health Care Providers And Researchers Have An Obligation To Expose The Horrors of Gun Violence

On the heals of a shooting in an emergency room at a Chicago  Hospital 
the NRA has criticized doctors for making guns a public health issue. 

An emergency room physician was mortally wounded along with two other persons. 

NRA told 'anti-gun doctors' to 'stay in their lane' hours before mass shooting

The tweet was published hours before a hooded gunman killed 12 people at the Borderline Bar and Grill in Thousand Oaks, California.

"Someone should tell self-important anti-gun doctors to stay in their lane," the tweet read, specifically calling out the Annals of Internal Medicine. The controversial tweet linked to an article critical of medical papers that advocate for gun control.

Those on the frontlines of health care in communities across the U.S. are well aware of the horrors of gun violence: prehospital care providers, emergency room (ER) doctors, trauma surgeons, nurses, and so many others who have the grave misfortune to see how bullets ravage the human body and soul.  The kind of tragedy that once witnessed can’t be unseen.

Perhaps this explains the outrage over a National Rifle Association (NRA) Tweet posted on November 8th that read “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

Reducing Firearm Injuries and Deaths in the United States: A Position Paper From the American College of Physicians 

The article is based upon a peer reviewed article from the American College of Physicians. along with a number of suitable references from other professional sources.

Health Care Providers And Researchers Have An Obligation To Expose The Horrors of Gun Violence: Health Care Providers And Researchers Have An Obligation To Expose The Horrors of Gun Violence

Google to bring on Geisinger’s CEO to direct its healthcare efforts

The merger of leadership between Google and Geisinger Medical Clinic portends the development of artificial intelligence in the electronic health record.

Geisinger President and CEO David Feinberg plans to step down from the health system to take charge of the healthcare efforts at Google, according to reports.

The health system, which services more than 1.5 million patients in Pennsylvania and New Jersey across 13 hospital campuses, confirmed that Feinberg would leave the company Jan. 3, 2019. Geisinger’s executive VP and chief medical officer, Jaewon Ryu, M.D., will take over as interim president and CEO starting Dec. 1, before a month long transition period.

According to CNBC, Feinberg would report to Google’s artificial intelligence head, Jeff Dean, while working closely with CEO Sundar Pichai to develop a cohesive strategy for Google’s various health and health-adjacent enterprises, including through home automation and wearables.

During Feinberg’s tenure at Geisinger over the past four years, the health system pursued several programs to integrate big data, electronic health records and genomics into its care, including through collaborations with pharmaceutical companies.

Geisinger has also been working with Merck & Co. on two EHR programs designed to boost medication adherence, reduce drug errors and help connect patients and providers, and it has been in talks with health IT companies to roll them out to a larger marketplace.

Teams from Geisinger and Merck will work together to improve patient adherence, increase the role of patients in making decisions to help manage their conditions, share information among extended care teams, and improve clinical care processes. The first tool being developed is an interactive web application designed to help primary care clinicians assess and engage patients at risk for cardiometabolic syndrome. Cardiometabolic syndrome is a clustering of various risk factors that put an individual at risk of developing type 2 diabetes and cardiovascular disease.

Google to bring on Geisinger’s CEO to direct its healthcare efforts

The lowly appendix may play a surprising role in the development of Parkinson’s disease - Los Angeles Times

 The appendix has long been dismissed as an organ that has outlived its usefulness in human evolution. But new research suggests it may play an active — and detrimental — role in the development of Parkinson’s disease.

Healthy appendixes contain alpha-synuclein (shown in red), a protein that is a constituent of the Lewy bodies observed in Parkinson's disease. (B.A. Killinger et al. / Science Translational Medicine)

The appendix has long been dismissed as an organ that has outlived its usefulness in human evolution. But new research suggests it may play an active — and detrimental — role in the development of Parkinson’s disease.

In a finding that extends the link between gut and brain health in a surprising new direction, scientists found that people who had their appendix removed were 20% less likely to develop the neurodegenerative disorder than people who did not have appendectomies.

What’s more, surgical removal of the appendix seemed to forestall the appearance of Parkinson’s symptoms, which include tremors, movement difficulties and signs of dementia. Among older patients in whom Parkinson’s disease was eventually diagnosed, those who’d had their appendix removed experienced their first symptoms 3.6 years later, on average.

Dr. Viviane Labrie - Appendix identified as a potential starting point for Parkinson’s disease

Aggregated alpha-Synuclein is visible in the neurons of the appendix. (Van Andel Research Institute)

The lowly appendix may play a surprising role in the development of Parkinson’s disease - Los Angeles Times:

How Good a Doctor Are You?

Are you in a quandry how to select your doctors?  Should you rely on your insurance company's list of providers?  Do internet websites such as healthgrades provide useful or credible information?  What about those "Best Doctors in America" or your local version of the same.  How about those fancy shiny magazines in your own . doctors reception area?  Did you know that those listing are purchased, and should only be considered as self-serving advertisements. What about celebrity endorsements ?

This opens a 'can of worms'.

Besides political news and gossip healthcare also is a prime topic for print and news media. It affects all of us.  At least in politics one gets to vote.  This is not true of health care.  The old fashioned way of choosing you doctor was by a personal referral.  Today that method is used far less.  The majority of new patients select a doctor from the provider list of their insurance plan.

"Every physician strives to do their best for patients, but are we doing enough? Currently, there is no way to truly know how our outcomes compare with others, which also makes it impossible to know if we are “up to standard.” Implementation has begun on systems that measure individual physician outcomes and then base reimbursement upon them; such systems are a desirable replacement for fee-for-service because they could reduce unneeded care and improve the care that is delivered – but the devil is in the details…

Current methods do not truly assess our success as doctors. Detailed case-by-case oversight only occurs when there is an accusation of malpractice or negligence, and although devastating complications are sometimes reviewed at morbidity and mortality conferences, these do not measure routine care. Infrequent board exams might test a minimum standard of knowledge, but they cannot measure its application in daily practice. And although self-described Centers of Excellence may publish case series with success and complication rates, reports of general results in the wider community are rare.

The overall upshot? When selecting a surgeon for ourselves or a family member, it’s very difficult to objectively determine who is best – or even who is adequate. Online voting polls and magazines listing “Top” doctors receive much attention (mostly in advertisements for those voted highest), but are based on subjective responses from unknown respondents. One popular assumption is that a doctor who frequently performs a certain procedure or frequently treats a specific condition must be better than one who seldom does – and there is considerable evidence that this is correct. (1). However, the fact that surgery rates for a procedure vary dramatically by region of the country suggests that more surgery may not be better for patients (2). More research would be helpful to study the need for surgery and its quality, including its effect on patient quality of life (QoL).

There are many reasons why doctors and patients should favor standardized, publically available data on medical outcomes. For physicians, such data can improve the overall quality of care because it could help identify the methods that are most successful. For patients, it could provide reassurance that their medical team is competent.

The challenge is to develop outcome criteria that represent objective, quantifiable, and valid measures of the results of care. With the advent of electronic medical records (EMR) and national databases generated for billing purposes, some initial attempts have been made to do this. Unfortunately, the big databases that are available are not designed to assess outcomes, but rather to mimic paper charts and to record details for billing purposes. From them, one can determine how often tests, exams, or procedures were performed – but not whether they were appropriate, interpreted correctly, or had a reasonable outcome. The outcomes reported so far have been “process measures” – how many have you done?  These data have been compared with Preferred Practice Patterns of national organizations, which are generated by consensus, but rarely validated by prospective studies. As big database studies can derive provocative findings – for example, the recent report that fewer elderly hospitalized patients die under the care of female internists than male internists (3) – prospective validation is vital for such work.  If one does a google search for PPP (preferred practice patterns you will not find much except for Ophthalmology and Physical Therapy. In any case these patterns are set by the National organization for each specialty.  The reasons are that medicine evolves and patterns change sometimes very quickly.  Most specialty organizations are loath to list them since they  could be comprehended as 'facts, set in stone'

Inexperience attorney often refer to patterns as legal documents, for which they are not.

To use a specific example, consider how to assess the quality of care provided to a glaucoma patient. It is fashionable to propose that the best measure of outcome is the patient’s perspective, because patient-oriented outcomes are not routinely captured in clinical measures (acuity, visual field tests etc.). However, although QoL questionnaires theoretically measure the patient’s viewpoint, individual expectations and mental state can affect the correlation between clinical measures and reported QoL: the more depressed a person is, the worse they rate their visual function – even when it is normal. Furthermore, because diseases such as glaucoma have minimal disease-related symptomatology until late in their course, the inevitable side effects of standard eye drop treatment – even when performed perfectly in accord with recommended practice – might lead patients to conclude (legitimately) that their quality of vision or life is either no better or even worse after treatment. How many of us can think forward 10 years to what would have occurred had such treatment not been given?

Currently, well-validated QoL questionnaires are not included in commercial EMRs. Medicare may have implemented post-visit questions for patients, but these deal in the “experience” during a visit (“how quickly were you seen?” or “did the staff treat you well?”). And though these may maximize service quality, they do not assess medical outcome. For instance, a 2012 Archives of Internal Medicine report demonstrated that respondents in the highest patient satisfaction quartile had a higher likelihood of hospital admission, greater expenditures, and higher mortality (4). And there may be other negative consequences – one possible contributing factor (among many) for the current opioid epidemic could be Joint Accreditation reviews that emphasized patient reports of inadequate pain relief (5).

“The healthcare system has never really stressed the things that are important to patients.”

Instead of QoL questionnaires, what standard clinical measures would be good benchmarks? Visual acuity after cataract surgery? Visual field progression rate for glaucoma? These exist in EMRs, but they may conflict with the patient’s view of their desired outcome. Patients who want uncorrected distance vision and need glasses after IOL implants are unhappy with uncorrected 20/20, just as few glaucoma patients appreciate that the dramatic slowing of field worsening with successful therapy is “better” than their natural course. To select a field criterion for glaucoma patients we need to know the rate of slowing that is compatible with best present outcome. It may not be “no” worsening, but an “acceptable” rate, adjusted by the distribution of case severity and patient demographics. If knowledge of physicians’ ranking is effective, it could produce a shift toward better overall outcomes, as in the cardiac surgery example mentioned above.

There has been a rush to produce outcome measures that are “practical” – data easily gleaned from the EMR. One such “quality measure” recently suggested was a particular IOP lowering after laser angle treatment for glaucoma… Compared with recently published data, the particular success criterion selected (from one 20-year-old clinical trial) is far too strict. Rather than picking immediate standards that later must be amended, studies are needed to estimate reasonable outcomes based on data from a variety of practice settings.

In my view, the healthcare system has never really stressed the things that are important to patients, and we need to develop methods to accurately benchmark if we are doing a good job for our patients. It is past the time when we can act as if someone else will make this transition meaningful – we all need to be productively involved."

By Harry Quigley, A. Edward Maumenee Professor of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University .  The author reports no conflicts of interest relevant to the content of this article.

How Good a Doctor Are You?: Your income may depend on it… but we have no real way to measure what actually matters to patients.