The Virtual Visit May Expand Access to Doctors

Last time I posted something about technology that helps (?) nurses so this time I posted something about technology that makes access to physicians easier for the general public.  I think I like this, but I will have to think about it more.  I can see that this could have a practical application for minor illnesses and would save time and money for most people.  I can also see the doctor’s position–that there is no actual relationship with a patient and that they are reluctant to treat without face-to-face interaction.

However, the future is here with us now and we may all have to rethink our biases and our ideas of what health care is and is not.

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By CLAIRE CAIN MILLER Published: December 20, 2009

SAN FRANCISCO — Americans could soon be able to see a doctor without getting out of bed, in a modern-day version of the house call that takes place over the Web.

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Mark Graham for The New York Times

Dr. Christopher Crow conducting a simulated online exam in Plano, Tex.

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Mark Graham for The New York Times

A screen shot of that exam, which is not of an actual patient. Dr. Crow says the NowClinic system allows him to pick up on nonverbal cues, similar to an in-person visit.

OptumHealth, a division of UnitedHealth Group, the nation’s largest health insurer, plans to offer NowClinic, a service that connects patients and doctors using video chat, nationwide next year. It is introducing it state by state, starting with Texas, but not without resistance from state medical associations.

OptumHealth believes NowClinic will improve health care by ameliorating some of the stresses on the system today, like wasted time dealing with appointments and insurance claims, a shortage of primary care physicians and limited access to care for many patients.

But some doctors worry that the quality of care that patients receive will suffer if physicians neglect one of the most basic elements of health care: a physical exam.

“This is a pale imitation of a doctor visit,” said David Himmelstein, a primary care doctor and associate professor at Harvard Medical School. “It’s basically saying, ‘We’re going to give up any pretense of examining the patient and most of the nonverbal clues that doctors use.’ ”

Others, including Rashid Bashshur, director of telemedicine at the University of Michigan Health System, say online medicine is a less expensive way of providing routine care.

“The argument that you need the ‘laying on of hands’ to practice medicine is an old and tired argument that simply has no credibility,” he said. “There are two constants in medicine: change and resistance to change.”

Christopher Crow, a family physician in Plano, Tex., who used the system during its test period, said, “NowClinic gives you the ability to have that gut feel if something is wrong, in tone or facial expression or body language, that you have when you walk in the door with a patient.”

Many patients who do not have primary care physicians nearby use the emergency room for routine problems. Wait times for patients needing immediate attention have increased 40 percent, in part because of overcrowding, according to a study by Harvard Medical School and Cambridge Health Alliance.

In Texas, 180 counties do not have enough physicians, 70 percent of patients cannot obtain a same-day visit with their primary care doctor, and 79 percent of emergency room visits are for routine problems, according to OptumHealth.

“We are, through this technology, replenishing the pool of physicians and making them available to patients,” said Roy Schoenberg, chief executive of American Well, which created the system that OptumHealth is using.

For $45, anyone in Texas can use NowClinic, whether or not they are insured, by visiting NowClinic.com. Doctors hold 10-minute appointments and can file prescriptions, except for controlled substances. Eventually they will be able to view patients’ medical histories if they are available.

The introduction of NowClinic will be the first time that online care has been available nationwide, regardless of insurance coverage.

American Well’s service is also available to patients in Hawaii and Minnesota, through Blue Cross Blue Shield, and to some members of the military seeking mental health care, through TriWest Healthcare Alliance.

Some hospitals and technology companies provide similar services on a smaller scale, including Cisco, the networking equipment maker, which uses its videoconferencing technology to remotely connect employees with doctors. It is working with UnitedHealth Group to offer the service more broadly.

The service has encountered resistance in states where it is already available. Texas law requires that before doctors consult with patients or prescribe medicine online or over the phone, they form a relationship through means like a physical examination.

The Texas Medical Board, which regulates doctors in the state, is evaluating its telemedicine policies in light of new technologies. But Mari Robinson, executive director of the board, said that an online or telephone exam was inadequate if doctors and patients had not met in person and was “not allowed under our rules.”

After American Well’s service began in Hawaii last year, lawmakers passed legislation that allowed doctors and patients to establish a relationship online, though the Hawaii Medical Association opposed the bill.

“From our perspective, we still are a little bit concerned that a relationship can be established online with no prior relationship,” said April Troutman Donahue, the association’s executive director.

American Well and OptumHealth predict that health care professionals will adapt. “This is new technology, so you have a lot of code written that doesn’t take these medical technologies into account,” said Rob Webb, chief executive of OptumHealth Care Solutions.

Many patients seem ready to embrace the new technology. In a recent study, a Harvard research team at Beth Israel Deaconess Medical Center found that patients were comfortable with computers playing a central role in their health care and expected that the Web would substitute for face-to-face doctor visits for routine health problems.

You can view the original article here

[Via http://nursingtrends.wordpress.com]

Merry Christmas: the same in any language

In any language, Merry Christmas means the same.  The reason for the season is the birth of a child in a manger. For Christians, this marks the day remembered as the birth of the Savior, Jesus, the Son of God.  For us all, let us seek to have a new year filled with love, tempered with common sense and belief in values.  Merry Christmas to all . . . obi jo and jomaxx

In those days a decree went out from Caesar Augustus that all the world should be enrolled. This was the first enrollment, when Quirinius was governor of Syria. And all went to be enrolled, each to his own city. And Joseph also went up from Galilee, from the city of Nazareth, to Judea, to the city of David, which is called Bethlehem, because he was of the house and lineage of David, to be enrolled with Mary, his betrothed, who was with child. And while they were there, he time came for her to be delivered. And she gave birth to her first-born son and wrapped him in swaddling cloths, and laid him in a manger, because there was no place for them in the inn.

- The Bible, Luke John 1:12

聖誕快樂     Vrolijke Kerstmis     Joyeux Noël     Frohe Weihnachten     Χαρούμενα Χριστούγεννα

Feliz Natal     즐거운 성탄     Buon Natale     メリークリスマス     С Рождеством Христовым     Feliz Navidad

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NHS Prescription / Homeopathy Remedies for Cold and Flu

昨日、バスから追い出され、雪の中を半時間歩いたせいか、ひきかけの風邪が悪化した。鼻がぐずぐずしてひどい鼻声になり、しょっちゅう鼻をかんでいる。風邪薬を買いに行きがてら、薬局で先日もらった処方箋薬も受け取る（上は以前使用しなかった処方箋）。イギリスでは、処方箋薬は無料。だから特に指定がなければ、価格の安いジェネリック医薬品が処方される。薬代は無料でも、処方箋料（NHS prescription charges）を一回につき£7.20払わなければいけない。なので、成分や薬効が変わらなれば、値段の安い、処方箋の要らない市販薬を勧められることもある。

少し前に街角でもらったフリーペーパー、The Epoch Times（大紀元：法輪功関連の新聞だそうだ。知らなかった！読んだのは英語版）に載っていた、新型インフルエンザに効くというホメオパシー・レメディーをBoots（ブーツ）で買っておいたので、風邪にも効くかなと使ってみた。ホメオパシーが盛んなイギリスでは、ブーツ等の普通の薬局で手に入る。最初に少しの喉の痛みを感じてから、風邪やインフルエンザのひきはじめに効くというAconite（Aconitum napellus：アコナイト、トリカブト／£4.99）を使用。その後数日間は、レメディーのせいか安静にしていたからかどうか分からないけれど、症状は悪化しなかった。風邪がひどくなった今日から、新型の初期流行に最も効果的だったというArsen alb（Arsenicum Album：アーセニカム、砒素／£4.99）が、鼻水を伴う風邪にも効くというので試している。

ホメオパシーは、科学的にその効果が証明されておらず、プラセボ効果以上に効き目はないと言われているのだが、イギリスでは£4000億の市場規模を誇るビジネス。レメディーを売っているブーツ自身、効果はさておき、売れるから取り扱っていると認めている。Mは超科学信奉者なので、ホメオパシーや代替療法は一切信用しない。共に薬剤師である両親も然り。私はというと、プラセボ効果でも何でも、効けばラッキーぐらいに思っている。また他に効果的な治療法や薬がなければ、民間療法でも何でも、すがりたくなる気持ちも分かる。さて、今使っているレメディーの効果はいかに？でも、あんまり効果がない場合に備えて、一応市販の風邪薬も買ってある。

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Probably because I was kicked out from the bus and forced to walk in snow for half an hour yesterday, my cold got worse. My nose is runny and my voice has changed, and I have been blowing my nose  all the time. So I went to a pharmacy to buy a cold medicine, and picked up my prescription drug as well (the prescription above is the unused one I got in the past). In UK, a prescription drug is free, but you pay NHS prescription charges for £7.20 (price from April 2009 to now). and usually a cheap generic medicine is given if you don’t choose others. A pharmacist often recommend to buy over-the-counter drug, if it is cheaper than prescription charge and if the ingredients and effectiveness are more or less the same with the prescription medicine.

I bought two homeopathy remedies from Boots, which supposedly effective for Swine flu, after I read the Epoch Times‘ (free paper founded by practitioners of the Falun Gong – I didn’t now it) article about it. First I had used Aconite (Aconitum napellus) , which can be helpful at the first sign of flu and cold symptoms. My condition had been the status quo for few days – I don’t know because of the effect of Aconite, or because I had been at home kept myself warm. Now my symptoms got worse and I started to take Arsen alb, which is “the most commonly indicated remedy for the H1N1 virus outbreak of early 2009,” as I read that it works for a blocked nose as well.

Homeopathy is not supported by modern scientific research, and it is said that there is little evidence the remedies work other than as a placebo. But homeopathy is £40 million industry in the UK, and Boots admits that they sell homeopathic remedies because “they sell, not because they work“. M believes only science, not homeopathy or alternative medicines – so do my parents who are both pharmacists. I myself don’t mind to try anything as long as it works and safe. I also understand people who find a hope in alternative medicines if there is no other cure. Let’s see if my homeopathic remedy works for me. I bought usual cold medicine as well, in case it doesn’t work at all.

下のビデオは、これを書いている時に偶然見た、グラクソ・スミスクライン社のBeecham（ビーチャム）風邪薬のTVコマーシャル。ちなみに、去年のHSBC銀行の広告でも相撲力士が起用された。肌色を濃くして、目を切れ長に修正した白人がモデルのこの広告が、日本人に対する侮辱的だと在住日本人の間でひんしゅくを買っているとの記事があったが、私個人としては，そんなに目くじらたてる程のことでもないと思うんだけれど。多かれ少なかれ、外国人の描き方にステレオタイプが入るのは仕方ないことだし、Mも日本のバラエティ等で「ガイジン」が面白おかしく取り上げられているのが不愉快だと言っている。文句を言う人は、人の振り見て我が振り直せ、というところですね。

The video below is the TV commercial of Beechams, the GlaxoSmithKline owned cold and flu remedy, that I happened to see on TV while I waswriting this entry. HSBC bank also used Sumo wrestler for their advertising last year. But HSBC was under fire as the campaign uses the image of a western man whose skin tone has been darkened and that make-up has been applied that appears to narrow his eyes, and it has upset Japanese living in UK, according to the Guardian article. Personally I don’t think it is a big deal – a portrayal of a foreigner is more or less based on a stereotype, not only Japanese. M complains that some Japanese TV programs make fun of ‘Gaijin’, foreigners in Japanese. At the end of the day, I think any country does the same, or otherwise it would be very boring if everything is goody-goody.

[Via http://everydaylifestyle.wordpress.com]

The Ear Infections Epidemic - The Truth Every Parent Needs to Know!

Dr. Maj adjusting young Samantha

Dr. Stephanie Maj answers the most pressing question in her pediatric practice: What is the cause of ear infections and what can we do to heal them without drugs or surgery?

Chicago-Ask any parent about ear infections, and you will likely hear one horror story after another. Ear infection or Otitis Media, is the most common reason for visits to the pediatrician’s office. In fact, visits to the pediatrician’s office for ear infections have increased over 150% from 1975 to 1990. It is estimated that over 30 million visits are made every year in an attempt to deal with this problem.

In my practice, we have an effective, safe solution to the problems plaguing parents. What we find is most parents fail to understand what is happening with these infections.

Otitis Media is the general name for several conditions affecting the middle ear. The most common symptoms are earache, a feeling of pressure, and perhaps difficulty hearing due to increased amounts of fluid. Teething often produces similar symptoms, therefore, the child should be carefully observed before jumping to any conclusions.

Historically, the treatment for ear infections has been antibiotics. This method of treatment has come under severe attack over the past several years for many reasons. One of the reasons, the overuse and over prescription of these antibiotics, has led to what is termed “antibiotic resistant bacteria”. These bacteria have “evolved” and changed so that the antibiotics no longer affect them. Because of this phenomenon, stronger and stronger antibiotics are being used, which is leading to more and more resistance. (http://tinyurl.com/yep3y33)

Another reason use of antibiotics has come under fire is because study after study has demonstrated that they are not effective. In other words, they do not work! This is why so many children are on one antibiotic after another, stronger and stronger each time. Sure, many times the infection will go away, but it quickly returns with a vengeance, and so begins the antibiotic roller coaster.

The reasons they continually reoccur is two-fold: First, antibiotics kill off most bacteria in the body including the helpful “good” bacteria our bodies need. This depletes our children’s natural immune system, making them vulnerable to many more infections of varying types.

Secondly, antibiotics merely attempt to treat the symptoms of ear infections, they do not address the actual cause and therefore the infections return.

The real question then is what is the cause of ear infections? The reality is that ear infections themselves are merely a symptom of a greater problem. The vast majority of them are secondary to a cold or another infection, which may be due to a depressed immune system.

The other more physical reason children suffer from ear infections is because of the actual anatomy of the young ear.

In children, the Eustachian tube is nearly horizontal, gradually acquiring a near 45-degree angle. This often slows draining of these tubes and with stagnant fluid, infection may appear.

The obvious question from most parents now is: what can we do? The answer lies in a new level of thinking.

As a chiropractor, my primary objective is to address the root cause of health problems. Treating symptoms, as mentioned earlier, has been proven unsuccessful at best. When dealing with your children and ear infections, my goal is to correct the actual cause, and to allow the body to function at its optimal potential. (http://tinyurl.com/ybqlymw)

There is a direct link between the nerves in the neck (the superior cervical ganglion), the muscles of the Eustachian tubes (tensor veli palatini) and the middle ear.

Let me explain: The middle ear drains any fluid through the Eustachian tubes. These tubes open and close through the action of a muscle and that muscle is controlled by a nerve. This nerve originates in the neck. When this nerve is not functioning normally, the tensor veli palatini muscle may go into spasm, which constricts the Eustachian tube, restricting drainage and causing fluid buildup in the middle ear. This fluid, combined with a stressed immune system, may result in an ear infection.

Ultimately then, this “nerve interference” can cause your children to suffer as they do. My job as a chiropractor is to detect this nerve interference called subluxation, and correct it. A subluxation is a misalignment of a bone in the spine that pinches, stretches or twists a nerve resulting in interference.

By correcting this interference, the child’s body is given the potential to heal and be well. With proper chiropractic care, your child will be able to live a life free from nerve interference, and free from unnecessary medications and antibiotics.

Chiropractic adjustments for children are very gentle and differ tremendously from the adult version. Imagine you are putting a contact in your eye or testing a tomato to see if it is ripe, that is the extent of the pressure used in these treatments. There is no twisting, popping or pulling involved.

Through advances in technology such as Surface EMG and Thermal Scans, a chiropractor can easily detect these subluxations and monitor their correction as well. This enables chiropractors to be accurate and objective, allowing you the best care possible.

A promising study published in the Journal of Clinical Chiropractic Pediatrics now indicates that there is a strong correlation between chiropractic adjustments and the resolution of ear infections. 332 children with chronic ear infections participated in the study. Each child, ranging in age from 27 days to 5 years, was given a series of chiropractic adjustments. The results show that close to 80% of the children in this study experienced NO ear infections within the six-month period following their initial visits. The six-month period included maintenance treatments every four to six weeks.

Correcting the cause through chiropractic has been shown to help over 80% of all children with ear infections.

Treating the symptoms of ear infections with antibiotics has proven to be ineffective. Give your children a fighting chance with chiropractic; it could change your lives!

ABOUT THE AUTHOR
Dr. Stephanie A. Maj has been helping children and adults experience life at their maximum potential through Chiropractic for over 14 years. She is the author of the book, “You Can Be Well” and lectures throughout Chicago on a variety of health issues, and may be contacted at 773.528.8485. Community Chiropractic is located at 1442 W. Belmont, 1E Chicago, IL 60657. Her website is www.communitychiropractic.net.

[Via http://youcanbewell.wordpress.com]

Anti-depressants 'up stroke risk'

Aspirin is prescribed for high cholesterol,it also causes intestinal bleeding.
Pain killers cause serious after effects.
Scans increase the risk to cancer.
Diuretics damage kidneys.
Cancer inducing genes identified now;yet we have already cured it.
Caffeine was perceived to be carcinogenic;now it reduces cancer risk also prevents heart disease.
Take any medicine, you have the same ambivalence.
Or take any prognosis-as many number of opinions as that of specialists.
Is Medicine a Science?
Post menopausal women who take anti-depressants face a small – but statistically significant – increased risk of a stroke, research suggests.
The US study was based on 136,293 women aged 50 to 79, who were followed for an average of six years.
Anti-depressant users were 45% more likely to have a stroke than women not taking the drugs.
The data, published in Archives of Internal Medicine, is taken from the Women’s Health Initiative Study.
When overall death rates were examined, those on anti-depressants were found to have a 32% higher risk of death from all causes during the study than non-users.
The researchers stressed that the overall risk of a stroke was relatively small. Even for women on anti-depressants, it was less than one in 200 chance in any given year.

You have to weigh the benefits that you get from these anti-depressants against the small increase in risk that we found in this study
Dr Sylvia Wassertheil-Smoller
Albert Einstein College of Medicine
However, they said that because so many women were taking anti-depressants the effect would be significant across the entire population.
It is not clear whether taking anti-depressants is solely responsible for the increased risk of a stroke.
Depression itself is known to be a risk factor for cardiovascular problems.
The researchers tried to take this into account in their analysis of the data – but could not rule out the possibility that it influenced the final results.
The study found no difference in stroke risk between the two major classes of anti-depressants, selective serotonin reuptake inhibitors (SSRIs) or tricyclic anti-depressants (TCAs).
However, the SSRIs did appear to convey a higher risk of hemorrhagic stroke caused by a bleed in the brain.
Lead researcher Dr Sylvia Wassertheil-Smoller, of Albert Einstein College of Medicine, stressed that treatment for depression was important, and that women should not stop taking prescribed medication without first consulting their doctor.
She said: “You have to weigh the benefits that you get from these antidepressants against the small increase in risk that we found in this study.”
Known links
The researchers said follow-up studies were needed before any firm conclusions could be drawn.
Dr Jordan Smoller, of Harvard Medical School, who also worked on the study, said: “We need to study this association more to determine exactly what it signifies.”
Joanne Murphy, for The Stroke Association stressed the study showed that overall risk for women taking anti-depressants was relatively small.
She said “We are already aware of links between depression and the risk of stroke and we are currently funding further studies to look into this.
“Everyone can help reduce their risk of stroke by making lifestyle changes, such as reducing their blood pressure, giving up smoking, reducing alcohol intake, improving their diet and getting plenty of exercise.”
Ellen Mason, of the British Heart Foundation, said: “Severe depression can be debilitating and even fatal, so it is important to weigh up any small increase in the risk of stroke with the benefits of treating depression.”
Bridget O’Connell, from the mental health charity Mind, said antidepressants produced a range of side effects that affected people in different ways.
She said: “Many people can experience huge benefits from taking antidepressants and it’s important they work with their GP to identify both the plus points and the drawbacks, and weigh up what treatment is best for them.”
http://news.bbc.co.uk/2/hi/health/8408783.stm

[Via http://ramanan50.wordpress.com]

Pengmabuk

Bismillah

O you who have believed, indeed, intoxicants, gambling, [sacrificing on] stone alters [to other than Allah ], and divining arrows are but defilement from the work of Satan, so avoid it that you may be successful.

Al-Ma’idah 5:90

I read a very interesting post on alcohol in iLuvislam.com… Actually I wanted to talk about it to last week, but somehow I forgot about it… -.-’

I’m writing this for my Muslim friends who are drinking… I wish that they are reading this, but I highly doubt it…

Every Friday I’ll have a class on ‘Complex Nutrition in Sportsmen’… The whole course deals about how to ensure that athletes get enough nutrients depending on the type of sports… For example, we’re told about what’s good for endurance sportsman/woman and what’s good for power sports… We are also taught about diet, doping and drinking regimes… Which is very interesting, because I never thought that food and also drinks play a very very important (I knew they are important, but not as important as stressed in the class) role in sports… They even design the diet programs to be used from months before and up to 30 minutes before the competition!

And when talking about drinks, being in Czech Republic, of course they will mention about alcohol somewhere along the course… It’s to be expected, since Czech Republic is one of the countries with the highest alcohol consumption per-capita in the world (1st in terms of beer)… And as expected, the professor mentioned about the merits and demerits of alcohol… The presentation also mentioned that beer is a good thirst quencher… I couldn’t help but chuckle during the class…

Half full or half empty? Regardless, it’s the best thirst quencher…

If you want to know more about how can alcohol be bad to your health, please read the article I mentioned above… I won’t mention them here, as that would be unjust to the writer… Honestly, the article mentioned about Blood Brain Barrier, Fetal Alcohol Syndrome, which I think is impressive…

However the harm that drinkers are causing to their brains and livers are only part of the problem… Ever heard about secondary smokers? For alcohol, there are also secondary drinkers… Who are they? They are the people who died when hit by a drunk driver… They are the people who got to clean up the mess (puke, urine or whatever) in the bus next morning… They are the victims of household violence by people under the influence… They are the newborns born with cravings for alcohol…

With that, let’s all stay sober…

For those who love Google Earth, and want to see the effects of alcohol on the world, download this file (got from New Scientist.com)

[Via http://taknakbagitengok.wordpress.com]

Blood-sucking union

Literally.

At a time of year when blood donations are at their lowest levels and are the most urgently needed, the International Brotherhood of Teamsters, SEIU’s sister union and member of Burger’s Change to Win labor coalition, took advantage of the opportunity to go on strike on December 4th against the American Red Cross Blood Services Penn-Jersey Region. Local 929 initiated the strike at midnight just as their contract expired. Hours later, the Red Cross was forced to take legal action when some strikers illegally blocked one blood delivery in particular
“the Red Cross says it had to inform union members that a two-year-old child’s life depended on our blood delivery before they would allow a Red Cross vehicle to exit the yard to get the necessary blood products to the hospital.”

[Via http://jeffreyquick.wordpress.com]