Category Archives: diseases

How to Correctly Prescribe the Duration of Antibiotic Treatments

Just this week the World Health Organisation WHO has issued a warning that resistance of organisms to antibiotics will become one of the biggest challenges of the upcoming decade. Indeed, the correct prescription of antibiotics is crucial for successful treatment and the WHO states that completing the full length of the treatment is just as important.

But what is actually the correct length of treatment for all the different antibiotics and diseases? How many ward rounds on ICU’s have I spent with microbiologists (the maybe most important specialists on our sides!) wondering on how they always had a straight answer on the correct length of treatment. 7 days, 10 days or sometimes 21 days… a little mystery to most intensivists, until now!

Hitchhiking though the the wide space of the internet I finally found secret to this question. Back in the year 2010 Paul E. Sax, a Professor of Medicine at Harvard Medical School him self, posted an excellent blog for the NEJM Journal Watch website. Inspired by a New York Time article by Harvard Professor Daniel Gilbert he finally gave insight into one of the great mysteries of medicine:

To figure out how long antibiotics need to be given, use the following rules:

  1. Choose a multiple of 5 (fingers of the hand) or 7 (days of the week).
  2. Is it an outpatient problem that is relatively mild?  If so, choose something less than 10 days.  After application of our multiples rule, this should be 5 or 7 days.
  3. Is it really mild, so much so that antibiotics probably aren’t needed at all but clinician or patient are insistent?  Break the 5/7 rule and go with 3 days.  Ditto uncomplicated cystitis in young women.
  4. Is it a serious problem that occurs in the hospital or could end up leading to hospitalization?  With the exception of community-acquired pneumonia (5 or 7 days), 10 days is the minimum.
  5. Patient not doing better at the end of some course of therapy?  Extend treatment, again using a multiple of 5 or 7 days.
  6. Does the infection involve a bone or a heart valve?  Four weeks (28 days) at least, often 6 weeks (42 days).  Note that 5 weeks (35 days) is not an option — here the 5′s and 7′s cancel each other out, and chaos ensues.
  7. The following lengths of therapy are inherently weird, and should generally be avoided:  2, 4, 6, 8, 9, 11, 12, 13 days.  Also, 3.14159265 days.

In this highly data-driven exercise, it is imporant also to note the number of rules — seven, as in days of the week.

That did not occur by chance

Wow, not much more I can add!

Source 

Pathogenesis of TB

Pathogenesis of TB
Droplet inhalation is the primary mode of infection
Infection by drinking milk contaminated with Mycobacterium bovis is now rare in developed nations
M. avium-intracellulare, are much less virulent than M. tuberculosis and rarely cause disease in immunocompetent individuals
The bacilli are obligate aerobes whose slow growth is retarded by a pH lower than 6.5, hence not found in the center of granuloma
caseating granulomas and cavitation, are the result of the destructive tissue hypersensitivity that is part and parcel of the host immune response
Pulmonary alveolar macrophages engulf the bacteria
endosomal manipulation by the bacteria in the macrophaghe impairs phagolysosome formation, allowing unhindered mycobacterial proliferation
bacillary proliferation within the pulmonary alveolar macrophages and airspaces, with resulting bacteremia and seeding of multiple sites
development of cell-mediated immunity occurs approximately 3 weeks after exposure
Macrophages carry bacilli to the draining lymph nodes and are presented in a MHCII by dendritic cell/macrophages( APCs) to CD4+ T cells.
IFN-γ released by the CD4+ T cells of the TH1 subset is crucial in activating macrophages.

How to improve patient satisfaction in the emergency department

How to improve patient satisfaction in the emergency department

In the last several shifts I’ve worked in the ED I’ve had more people stop and compliment me on my care. I’ve heard the usual, “Do you have a private practice?” compliment and, “I’ve been here a lot and you really took the time to hear what I was saying, I appreciate that.”

Kudos are nice. They are what makes a tough shift go by quicker. They remind me why I have decided to dedicate my life to people who find themselves at their worst possible moment of health and well-being. The kudos have also caused me to pause and wonder what the heck I was doing differently since I don’t think today I am treating patients any differently than six months ago.

Patient satisfaction. The mere words strike fear and occasional disdain in the hearts of many medical professionals trying to do the best they can to provide the highest quality care to their patients. I don’t blame them, because I think we are using the wrong terminology to describe the goal we are trying to achieve.

Improving the patient experience is considered one of three main goals of achieving health care’s triple aim. And no this doesn’t mean treating patients like they are in a fast food joint or giving every person as much Percocet as they want.

The patient care experience is about more than patient satisfaction. It’s about engagement. By that I mean engagement of the patient in their care to ensure the best possible chance of becoming well.

In health care, we have to do things to patients that would be considered assault in any other situation. In order to have that be OK, we, as providers, need to demonstrate that we indeed care for that person sitting or lying on that stretcher. What’s the best way to demonstrate this caring?

Most of us have heard about AIDET: acknowledge, introduce, duration, explanation and thanks. It’s a good process and helps to remind us to give the same attention and care to every patient and family. That’s good, and we should all practice that. More importantly, the Mom Rule applies here: If my Mom (or sister or son) were sitting in that bed how would I like them to be treated.

AIDET and the Mom Rule help to improve the patient experience once they’re out of the waiting room, but what happens before that? With more and more people on social media — Twitter, Facebook, Yelp, Instagram, Snapchat, and others — have we tried to reach out to patients while they are still waiting (because sometimes people have to wait), or even before they arrive at the hospital?

Have we let them know wait times? Have we set up an alternative to ED care (perish the thought)? How about after the 80 percent of patients have left? Do they all get a call back from the hospital the next day? If not, why the difference in engagement? Too many patients seems like a convenient excuse to me. Especially considering over 60 percent of all admissions come through the ED on average and the ED will be the single largest touchpoint with your community as a whole.

So, back to what I am doing differently today. First, my twenty years of experience as an ER physician certainly counts for something. I’ve learned a few lessons along the way. I try and connect with a patient or family and ask about or comment on a piece of history. “You’re from PA, oh so am I, what part?” “Married 55 years? What a blessing. Congratulations.”

I write my name on the board and let them know if they need to yell at someone I want them to get my name right. I’ve learned to be kind and firm when I say no (kind of like Mary Poppins) to that MRI or refill of Dilaudid. I try and take that extra moment to ask if they have any questions and have started to ask patients to repeat back reasons to return, although I do not do it consistently.

It’s all about engagement and treating someone how I would like my loved one or myself to be treated. Pretty simple and we can do a lot better. That includes me.

Angelo Falcone is chief executive officer, Medical Emergency Professionals (MEP).  He blogs at the Shift.

Article source

http://www.kevinmd.com/blog/2015/06/how-to-improve-patient-satisfaction-in-the-emergency-department.html

Protect Your Body With These 5 Cancer Fighting Foods

Cancer is a horrible disease. Statistics suggest that 1 in 3 UK residents will develop cancer at some point in their life. Fortunately, there are a number of key lifestyle choices you can make to minimise your cancer risk. In this article I explore how eating a healthy diet can protect you from this nasty disease and discuss 5 of the best cancer fighting foods.

1) ALMONDS:

Almonds are healthy and tasty nuts that make an excellent snack. They can be eaten on their own or as part of a dried fruit and nut mix. Additionally, they can be fried with butter and then served with salmon as part of a healthy meal. Eating almonds supplies your body with high levels of many cancer preventing nutrients including copper, dietary fibre, monounsaturated fats and vitamin E.

2) BLUEBERRIES:

Blueberries are a sweet but healthy fruit that can be eaten on their own as a snack or mixed in with porridge and yogurts to make a small meal. They are 1 of the most potent cancer fighting foods available and contain high levels of dietary fibre, vitamin C and vitamin E. However, what really sets them apart is their impressive mix of phytonutrients which can help keep you safe from this nasty disease.

3) EGGS:

You might be surprised to see eggs on this list. You might even think that eggs are bad for you. The truth is eggs are actually quite healthy. They are a brilliant source of protein and contain a good mix of cancer killing nutrients. By having them for breakfast a few times a week you can seriously slash your chances of contracting this unpleasant disease.

4) GREEN PEAS:

Green peas are an extremely powerful cancer fighting food. They contain high levels of copper, dietary fibre, molybdenum, vitamin C and the phytonutrient coumestrol. So if you are still not eating your greens, now is the time to make some changes. Green peas are quite versatile and can be eaten with pretty much any food so there really is no excuse for failing to consume this health boosting food.

5) ORANGES:

Oranges are a tangy snack that are well known for their high vitamin C and dietary fibre content. They also contain an exclusive mix of the cancer killing phytonutrients gallic acid, hesperidin, naringenin and tangeretin. This nutrient combination makes oranges a brilliant health boosting fruit that can shield you from cancer.

SUMMARY:

There is still a lot to learn about cancer. However, the links between cancer and diet are very clear. Healthy, natural foods (especially plant based foods such as fruits and vegetables) offer significant protection from this nasty disease. So give your body the fuel it needs to keep you safe and fill up on these cancer fighting foods.

Article Source: http://EzineArticles.com/6673403

Hospital Wear Can Be A Source Of Infection, Research Says!

Certainly, no correlation could be established between people getting infected because of the contaminated uniforms of hospital workers. However, the presence of bacteria drew attention to the seriousness of the situation.

A study was conducted as part of a vast research program that looked into various aspects of infections. Medical workers and doctors voluntarily participated in the study. All participants were responsible and educated people and aware of the importance of medical hygiene and cleanliness.

What were the conclusions?

According to the medical experts, the presence of deadly bacteria in hospital wear is alarming. It indicates that even if hospitals follow what they refer to as state-of-the-art cleanliness norms, there is always a possibility of an outbreak of diseases caused due to infected hospital wear.

A few recommendations to limit the possibility of infection:

  • A further stringent hygiene policy should be followed by hospitals.
  • It should be mandatory for medical staff to change their uniforms daily.
  • In many hospitals, there is an in-house laundry facility. In case it is an outsourced facility, medical staff should be allowed to use it.
  • Medical staff or doctors who are exposed to bodily fluids should be provided plastic aprons.
  • The uniform should be short-sleeved for operational staff as well as doctors. This reduces the risk of cloth-borne infections.
  • The research covered a wide variety of bacteria species and strains that resist antibiotics and are capable of spreading various deadly ailments, including some which were highly contagious or fatal. As per statistics, about 20 percent of the uniforms worn by nurses and around 6 percent of the uniforms worn by doctors were infected. Samples unworn uniforms from the hospital laundry were not infected at all. More than 60 percent staff reported a daily change of uniform and about 80 percent of them had an excellent track record of personal hygiene.

What was the outcome?

It turned out to be quite horrifying that hospital wear can be a source of deadly infections. Since it is quite normal for medical professionals to carry uniforms to home, there is a great risk for their family members as well. Hence, it is important that hospitals implement the recommendations given by the respective research agency. Experts say that it is possible to reduce the risk of contamination by following better hand hygiene and making changes in the design of the uniform. Short sleeves and plastic coating in the abdominal region can reduce the risk significantly. An on-site laundry facility will also make it convenient to change uniforms in case there is a doubt of contamination.

s.

Article Source: http://EzineArticles.com/9037777

7 Reasons Why Prolonged Sitting Can Be Dangerous

In contemporary times, increasing numbers of people have consciously or unconsciously adopted sedentary lifestyles especially because of the nature of their work. Research has shown that up to 50-70% of people now spend 6 hours or more sitting everyday. Having spent several hours in bed, many wake up in the morning, get dressed for work, walk into their air-conditioned cars, never having to trek and eventually end up sitting all day at an office desk. To complete the vicious cycle, at the close of work, they get back into the car and drive back home. This is what a typical day looks like for a business executive, banker or doctor who may sit throughout the day in the consulting room attending to patients. Arguably, the dividends of civilization such as computers, television and the internet are of tremendous benefits in improving the quality of our lives. However, when taken too far, they tend to take a heavy toll on us and cause more harm than good. Recently, a lot of research has been dedicated towards discovering the dangers of prolonged sitting. Some German researchers even likened its negative impact to smoking since it significantly raises the risk of diabetes, heart diseases and stroke. Unfortunately, not even exercise can reverse the havoc that can be potentially wreaked by prolonged sitting. Highlighted below are some medical problems you stand the risk of suffering from when you sit all day at that desk:

Cardiovascular Diseases

Cardiovascular problems like hypertension and heart attack are more frequent among individuals who lead sedentary lives and indulge in prolonged sitting. During a study, people who sat more were found to have more fat deposits around their hearts which can occlude the blood vessels supplying the heart and lead to Coronary Artery Disease. Furthermore, it has been shown that those who sit in an office chair for longer than 6 hours on average per day increase their risk of dying from heart disease by up to 64%. In the same vein, you effectively lose about seven Quality-Adjusted Life Years (QALYs) when you sit for 6 hours or more everyday for up to 10 years.

Obesity

Increased incidence and prevalence of obesity and overweight is observed among individuals who sit for prolonged periods. Excess calories are converted to fats and stored under the skin and around major organs. This is compounded in people who feed on excess junk diets and engage in little or no rigorous activity. A study revealed that one hour of daily walk can reduce your risk of obesity by as much as 24%. When you sit for too long, your muscles contract less resulting in reduced lipoprotein lipase activity. This leads to elevated levels of Low-density Lipoproteins (bad cholesterol) and triglycerides.

Type 2 Diabetes

This type of diabetes accounts for up to 90% of all cases of diabetes. It occurs mostly among elderly obese individuals who lead sedentary lives such as prolonged sitting.

Sitting for too long leads to accumulation of excess fat around body tissues, hence they become less responsive to the action of insulin, a hormone that drives glucose into body cells.
A study revealed that when you sit for a full 24-hour period, glucose uptake in response to insulin falls by up to 40% which sets the stage for Type 2 diabetes.

Low Back Pain

People who sit for several hours at an office desk are more likely to suffer from lumbar disc herniation and low back pain because a bad posture is one of the most important causes of low back pain. Similarly, increased incidence of osteoporosis (loss of bone mass) has been observed in women who sit for too long. Some studies carried out among women revealed that a woman loses up to 1 percent of bone mass per year when she sits for more than 6 hours a day. Such women are at an increased risk of pathological fractures and low back pain.

Cancers

Certain cancers such as colon, endometrial and lung cancers have been found to be commoner in people who sit for prolonged periods. According to a journal published by the National Cancer Institute, prolonged sitting increases the risk of endometrial, colon and lung cancers by 32 percent, 24 percent and 21 percent respectively. More still, deaths from cancers were found to be 40 percent less in physically active individuals compared to those who were inactive.

Deep Vein Thrombosis

Sitting for too long obstructs blood flow and venous return from both legs which leads to stasis of blood in both lower limbs. This may manifest as swollen legs, varicose veins (tortuous, dilated veins) or less commonly deep vein thrombosis (DVT). The latter refers to the formation of blood clots in the deep veins of the legs. Unfortunately, this can sometimes become life-threatening if such clots are dislodged and carried to the lungs to obstruct pulmonary circulation (pulmonary embolism). Massive pulmonary embolism is a medical emergency that can lead to death if not promptly managed.

Anxiety and Depression

It has also been shown that lack of activity contributes to mood disorders like anxiety and depression which lead to significant morbidity and mortality.

In conclusion, taking breaks from prolonged sitting by standing once every hour and maintaining at least 30 minutes of exercise per day will go a long way in mitigating the dangers of prolonged sitting.

Article Source: http://EzineArticles.com/9053053

7 Key Questions to Ask When Choosing Your Cosmetic Clinic

If you’re thinking of having cosmetic treatment you need to find a clinic/practitioner you can trust. You want your treatment done in a sensitive way to make sure you keep a natural look, and you want it done safely and with the best products.

Sadly we all see examples of poor treatment either in magazines or on television, and walking down the local high street as well. But remember that most of your friends who are having treatment probably just look great, and no-one knows they have had any treatment.

In good hands treatments like Botox or dermal fillers can be very effective and safe, but all medical procedures involve possible risks of side-effects or complications, so you are better finding the best trained and most experienced practitioner.

How can you best decide which of these people you can trust with something as precious as your face?

I suggest you should be as questioning when it comes to choosing your clinic as you would when making any important decision. It makes sense to be cautious.

The following advice is based on my experience over the past 9 years running my own cosmetic clinic and meeting people who have had a bad experience elsewhere.

RULE NUMBER 1:

Assess Your Practitioner Before They Assess You!

Just as you wouldn’t buy the first house you see, you shouldn’t assume that the first person you see about your appearance is going to suit you best either.

You need to find out what you can about their background and skill, and decide how comfortable you feel with their advice and the way they talk to you.

So, here are my top suggestions:

1. “What Is Your Background/Qualification?”

In the UK you may find the answer ranges from a plastic surgeon, doctor, nurse, dentist, physiotherapist, pharmacist, beautician or none of the above. (Anywhere else in Europe and the USA no-one except medically qualified doctors can administer injectable cosmetic treatments.)

Which of these would you feel will have knowledge of dermatology and diagnosis of related medical conditions, anatomy, and the knowledge and experience needed to help should any problems arise after treatment?

Don’t be afraid to ask questions – I am very surprised how few people ask searching questions about me and my practice. No practitioner should be surprised to be asked these things and shouldn’t be offended – in fact the more offended or uncomfortable they are the more likely they’re not as qualified as you’d like!

2. “How Long Have You Been Doing These Treatments And What Specialist Training Do You Have?”

Good question and of some help, but remember that just because someone has been offering treatments for a long time is no guarantee that they’re good! As a trainer of practitioners from relative beginner to more experienced I’ve seen a very wide range of skills, even when they’ve been offering treatment for a long time.

Good training is essential, but do they have evidence that they have been assessed after they’ve had training? Remember that simply attending a training session is no guarantee that they are good.

3. “Are You A Member Of A Recognised Professional Body?”

In the UK this might include General Medical Council (GMC), British College of Aesthetic Medicine (BCAM), British Association of Aesthetic Plastic Surgeons (BAAPS), General Dental Council (GDC) or Nursing and Midwifery Council (NMC).

You can always check with the relevant governing body if you are unsure of someone’s qualifications.

4. “How Many Treatments Have You Carried Out And What Complications Have There Been?”

For this one, you just have to see how the question is answered as they could say what they like, but it still gives you a guide. No-one with experience will say that there has never been a complication, and shouldn’t be ashamed of saying so, as these are a medical fact of life. If someone insists that they never see any problems then you might question them further. If they can quote their own rate of complications then you should be impressed – this means that they monitor their treatments and results and take their practice and education seriously.

5. “How Easily Can I Contact You Or See You If I Have A Query Or A Problem?”

Some practitioners can be extremely hard to get ahold of when it comes to asking for advice following a treatment, especially if there is a problem. This is distressing and stressful if you are the patient. For example if your practitioner travels to a clinic only once a month they will not be available very often, so make sure you feel comfortable that advice in person will be available if you need it. For a more invasive procedure you should be given a mobile phone number to ring in case you have any worries out of normal hours.

6. “If I Have A Problem That You Can’t Deal With What Would You Do?”

There may very rarely be a situation where more specialist advice is needed if an unusual problem arises. Someone who has thought this through will have a ready answer to this question, which might be that they have a more experienced contact in the profession, or the product manufacturer will provide back-up and advice (I know from experience that not all manufacturers are good at this)

7. “Which Products Do You Use And Why?”

I’m sure you have heard about the breast implant scandal where industrial grade ingredients were being used in medical products to make them very cheaply. This ended up making more profit for the clinics using them but had disastrous results for the patient.

There are plenty of people in the industry who believe that there will be problems in the future because untried and untested treatments are frequently being launched with little proof that they are safe over a long period.

There are at least 4 major brands of botulinum toxin (the main ones being Botox itself, Xeomin, Azzalure and Dysport) with other manufacturers, not always reliable, appearing around the world; there are several hundred different types of filler available in Europe. Cost for the different brands varies greatly, but a clinic using a cheaper brand may still charge the same as a clinic using a more expensive one. You need to be sure that your clinic chooses their recommended filler/s because they are effective and safe, not because they are the cheapest and maximise their profit!

A well-established company will have done a lot of research to back up their claims of safety, effect and durability, while others may only have tested their product on a small sample of people over a short period of time – I know which I’d rather be treated with!

The same is true with lasers – the cost to buy can range from £20,000 to £80,000 for equipment that is supposed to do the same job. Ask yourself why someone would buy such an expensive machine if a cheaper one would work as well and be as safe?

That’s the seven questions but here are a few other things to think about before making your final decision about who to trust:

“Are You Being Given A True Choice Of Available Treatments Or Just Being Advised To Have A Treatment That Your Practitioner Happens To Do?”

If you are asking for advice on a particular problem you want to be sure you are offered the full range of options so you can make a choice based on the risks, benefits and costs of any treatment. Ethical advice would also include suitable treatments not offered by your practitioner – GMC guidance lays down that this is an important part of the consent process.

For example it is now agreed that the most basic part of facial rejuvenation is to have enough volume or “lift” in the cheeks, but there will be practitioners who don’t have the skill to treat this area so will never offer it to you.

Positive points

If your practitioner is involved with research into new treatments, is asked for opinions on products by companies in the aesthetic field, or if they are appointed as a trainer by one of the big companies then this is a good sign that they are respected within their profession.

A good practitioner should make their own assessment of your situation and make suggestions to you that you might not have thought of rather than just give you the treatment you’ve asked for – they should be the expert advising you after all.

Don’t forget to use your gut instinct. If someone appears open and easy to talk to the chances are that they will listen and be sympathetic to you when it comes to treatment, and you’re more likely to be happy with the results; if they don’t appear to listen or explain things, don’t seem confident when asking your questions, or you just don’t feel comfortable with the clinic setting then you would do better to look elsewhere.

Negative points

If you’re not comfortable with the person during the consultation then go elsewhere.

Beware if the clinic you are in seems more concerned about selling you a treatment or series of treatments than listening to your concerns. Be especially wary if you are told that a certain price will only be valid if you book today, or if you are told that you could have additional surgery at the same time at a special rate. This is purely a sign that the clinic works on commission and may care more about its profit than your well-being.

My final piece of advice

In the end, there is no harm in going to see a few clinics so you can check out different opinions on what would suit you best. This way you’ll get an idea of where you feel most comfortable.

Article Source: http://EzineArticles.com/7101228

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