Panduan Kesehatan Tubuh

14.6.08

Increasing Patient Care and Reducing Liability in Seven Simple Steps

When an unconscious patient arrives in the ED, every hospital agrees that timely next of kin notification is vital. Not only is it important to have a family member present to comfort the patient, but to make informed decisions for his care and provide the medical history that can make the difference between life and death. From a liability standpoint, as we know all too well, having a family member making medical decisions, often means that if complications do arise, the family will be much less likely to sue, than if they hadn't been in attendance.

Although most hospitals make notification calls quickly, between personnel shortages and overworked staffers, that call can often be delayed or forgotten.

That's exactly what happened to Elaine Sullivan, a very active seventy-one-year-old woman, who slipped and fell, while getting into the bathtub. When paramedics arrived, they realized that injuries to her mouth and head had made her unable to communicate, or as the hospital later discovered, to give informed consent for her own care.

Although stable for the first few days, she began to slip into critical condition. On the seventh day, Elaine died. But that tragedy was soon overshadowed by another. Despite having her daughter's phone number and contact information clearly indicated on the front of her chart, the hospital failed to notify her family that she'd been hospitalized until six and a half days after her admission, only hours before she died, unnecessarily and alone.

Elaine Sullivan was my grandmother.

In her case, placing that phone call right away, would have saved her life. Not only would my mother Janet and I have had the time to fly back to Chicago to be at her bedside, but we would have made sure she received the care she needed. We also would have been able to give the physicians treating her, the medical history they needed to prevent the complications and drug interactions, responsible for her death.

After researching our own case and others like it, we realized that failing to notify a patient's next of kin wasn't an isolated problem - it's something that's been experienced by countless families nationwide. According to the CDC, nearly one million patients come into the ED every year unconscious or physically unable to give informed consent. And with the growing number of emergency room admissions and baby boomers turning into senior citizens, the problem is only going to escalate. We began meeting with medical and trauma professionals, to create an easy-to-implement solution to this growing problem, by bringing together the best practices of successful trauma teams from hospitals nationwide. The result is the Seven Steps to Successful Notification System.

The complete system is presented in The Seven Steps Information Kit, which is available for download, free of charge, on the NOKEP web site. It's filled with tools your staff can use on the patient care floor to identify and locate your unconscious patient's family or surrogate decision makers, identify John Does and improve patient care and satisfaction by locating patient's medical histories quickly and easily, while complying with HIPAA standards.

Even better, following the Seven Steps system provides the facility with a documentation of the steps taken to find the patient's next of kin, make the notification, and the staff members responsible for making it. This releases you from subsequent liability, while providing proof that your facility has met its statutory responsibility.

Here is a quick look at the Seven Steps.

Step 1: Patient status confirmed

The moment that your staff realizes that an ED patient is unconscious or physically unable to give informed consent, and that there is no family member or surrogate decision maker in attendance, a nurse or physician is tasked with following the notification process through to completion. The staff member indicates the patient's status on his chart along with the time, date and the staffer's initials.

Step 2: Examine the patient's personal effects for emergency contact numbers

If the patient doesn't have emergency contact information in his or her wallet, the staff member looks for it in the patient's personal effects. The System has a comprehensive checklist of places to locate this information, from the usual to the downright creative.

Step 3: Retrieve patient's home number

If the patient doesn't have emergency contact information, the staff member then looks for the patient's home number, going to step five if they find it and four if they do not.

Step 4: Seek other sources for contact information

Next, the staff member looks for the patient's emergency contact information or home phone number on records from previous admissions at the facility, or by calling his personal physician's office, or other locations on the checklist. If the staff member finds the information, he proceeds to step five - if not, step seven.

Step 5: Oversee or make the notification call

When a contact has been identified, the staffer places a call to make the notification. They note on the chart when the call was placed, whom they contacted, the phone number and the result.

Step 6: Need to follow up? Recall main contact or second number

If a message had to be left for the contact, or the contact doesn't come into the hospital within two hours, the staff member places one more call, to the first or a secondary contact. If no one is reached, the staff member proceeds to step seven.

Step 7: Shift to social service or police

When no contact name or number can be located, or if the staff member doing the notification, is unable to speak directly to the contact, they give the information to the social service department or to the local police department, as per your facilities' policy, for follow up.

Along with the Information Kit, the non-profit Next of Kin Education Project has created patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

Just as doctors, nurses, and staffers from every department make up a team to improve the health of the patients in their care, family and friends can play an important part in contributing to the patient's well being. As a medical professional, you are a diagnostician, a caregiver and a healer. But most of all, you are the patient's advocate. And so is his family. This Kit contains tools that will help you and his family work together to increase his care, trust and take patient satisfaction to a whole new level.

By Laura Greenwald


Stem Cell Research

How To Buy Your Way Out Of An Early Death From An Incurable Disease.

How?... With private stem cell research, of course!?Stem cell research holds more than hope for cures. The jury is in on stem cell research. Stem cell research can offer a cure for your incurable illness. With private stem cell research a personal cure for an ill patient can be accelerated. With every michroscope in the lab tuned into your unique disease a rapid cure is guaranteed. Private stem cell research for the wealthy (that will eventually lead to cures for everyone) has arrived!

So now you are all relaxed about your health's future because some countries such as Switzerland and some American states such as California are beginning to endorse stem cell research.We too are excited about this ground breaking research. Unfortunately these researchers will be working with one hand tied behind their back because these countries and California are working with restrictive legislation that forbids or impedes the cloning of human embryos. That's like giving them permission to build the fastest car in the world but with the restriction of not allowing them to put a motor in the car!

That's why the major new cures for cancer, heart disease, stroke, and other incurable diseases will ultimately come from small offshore labs working without restrictive legislation from the western world. Thank God for the sake of our health that there is a world outside the United States and the Western countries. The number one lab in the world offering excellence in medical research is Gen Cells Cures owned by Gerald Armstrong. Our motto is "Have Michroscope will travel" When a government gets in the way of our life -saving research we will pack up our michroscopes and move on.

When Alexander Grahm Bell patented his telephone in 1876 it was the difference of a half turn of a screw that put him in the patent office before Elisha Gray. With only one company in the Grand Unites States openly working on therapeutic cloning, the U.S.A is left in the dust where innovative research and future cures are concerned.The U.S. was once at the forefront of medicine and technology, research and innovation, cures and prevention. Now the job falls into the hands of the few working outside America. In many cases the work will be done by Americans. Even the Korean's who first cloned the human embryo had help from steady American hands, but the work was done in Korea by Koreans, not in America by Americans. We here at Gen Cells Cures have found that the Korean's new technique of squeezing out the DNA from the egg cell works much better than sucking out the DNA with a tiny needle. Their cloning process was a spectacular achievement.

The only American company working openly with therapeutic cloning research in the country is Advanced Cell Tech. When the cure comes it will likely come from Gen Cells Cures or some other little basement lab out in the middle of nowhere. Gen Cells Cures wants the opportunity to find cures for major incurable diseases such as cancer, heart disease, stroke, Parkinson's disease, Alzheimers disease, diabetes and other dreaded incurable diseases. The only problem with Gen Cells Cures and Advanced Cell Tech is that both of these biotechs are always running out of the money needed to do the research. Getting private funding is like pulling teeth. It's not easy work. The cure cannot come from the western world with restrictive legislation backed by ignorance and obscurantism. All that controversy over a stem cell smaller than the period at the end of this sentence. Even if stem cell research (with it's restrictive limitations) had all the funding in the world there will not be a cure found until all the research is completed and that includes the therapeutic cloning stem cell research. Through out history their have always been those people with dark age thinking who have held back scientific progress. Sadly, US President, George Bush is a victim of such limited thinking. Gen Cells Cures michroscopes already have Alexander Grahm Bell's half turn of the screw built in for success with no U.S. competition.

Non-embryonic stem cell research has produced therapies for more than forty ailments including, heart disease, lupus, spinal cord injuries, multiple sclerosis, Parkinson's disease, diabetes, Crohn's disease, brain hemorrhage, brain tumors, retinoblastoma, ovian cancer, sarcomas, scleroderma, multiple myeloma, leukemia, renal cell carcinoma, breast cancer and others. There have been no therapies from embryonic stem cell research so far simply because researchers have been using generic stem cells and there has not been one penny of public or private research money available for the real solution, therapeutic cloning stem cell research. While adult stem cell research received 190 million dollars from the U.S federal government in 2003. Therapeutic cloning stem cell research received zero dollars in funding support in 2003! What can you expect with zero dollars allotted to this life-saving research. Why hasn't there been a cure from therapeutic cloning stem cell research so far? The answer is plain and simple, fear and ignorance has restricted the research!

Gen Cells Cures doesn't like working with generic stem cells created from an egg and a sperm cell. There is no genetic match for our patient and you destroy the embryo that could have gone on to become a baby. The company likes working with perfectly matched cells created from a patient's skin cell and a human egg cell. You have a perfect genetic match and the stem cell is made young again . While we like the applications of adult stem cells and will use adult cells until we unravel the secrets of therapeutic cloning. We would rather have our cure come from perfectly matched fresh young stems cells rather than adult stem cells that are as old as our patient! We see the somatic cell nuclear transferred stem cell brought back to the beginning of life as the key to unlocking the aging clock. We just don't see a skin cell matched with an egg cell as a human being.

Fortunately for those of you with the ways and means and the vision to see the new dawn of stem cell research there is a way out for you and that way out is your own private medical research, (private stem cell research.) Gen Cells Cures is searching desperately for the funding to carry out the research that has been put on indefinite hold in the U.S. and the West. If someone knows a millionaire or a billionaire without a cause, please direct him or her to this stem cell research article. And if you know some one who is in desperate need of a cure, but is poor send him or her to us anyway. Maybe we can find their cure with our dime store michroscopes while we wait for the support to arrive to buy the high quality michroscopes we need to do the job. God tends to look after his flock. Gen Cells Cures offers stem cell research that includes a combination of an accumulation of today's best science and molecular biology that fuses therapeutic cloning stem cell research and genomics, (without political or legislative restraints.) Gen Cells Cures futuristic medical research technologies are available to the public now! Stem cell therapies and cures are just around the corner brought to you by Gen Cell Cures advanced stem cell research... No FDA approval needed! Stem cell research, stem cell research and more stem cell research is your solution and stem cell research is the solution for the world.

You have my permission to publish this article electronically or in print, free of charge, as long as the bylines are included. A courtesy copy of your publication would be appreciated.

by Gerald Armstrong


Online Pharmacies and the FDA

The FDA (Food and Drug Administration) is responsible for overseeing the testing, manufacturing, and distribution of prescription drugs in the United States.

Drug companies in the United States operate in a free market and can charge whatever they want for their medications. The United States remains one of the few nations that do not regulate drug companies to help control costs. As a result, Americans are forced to pay exorbitant amounts of money for prescription medications.

With the internet's increased popularity as a source for goods and services, it was only a matter of time before Americans began to search for online sources of prescription drugs. The FDA is trying to do its part to safeguard the public from online pharmacies that may be less than reputable. Every market suffers its share of dishonest companies seeking to make a quick buck, but in the case of prescription drugs, the effects can be more serious than just loosing money.

The FDA has stated major concerns that people choosing to use an online pharmacy should be aware of. Among the most important is the need for a one-on-one physical exam by your doctor prior to taking any medication. Though a visit to your doctor is not always required by law, it is the smartest way to insure your safety, especially if you are taking a prescription drug for the first time.

Another concern is whether or not the drugs you are buying are FDA approved. You should only buy from pharmacies that supply FDA approved drugs (This applies only to pharmacies based in the United States. All U.S. pharmacies recommended on this web site advertise to sell only FDA approved medications).

The FDA also recommends that you check to see that the pharmacy posts their address and/or phone number on the web site, and that there is a means of contacting their pharmacist should you choose to do so.

It would surprise many to see that the FDA is not as close minded as you might expect with regard to Internet prescription drug sales. They recognize the benefits the Internet can offer individuals, such as convenience, privacy, and access to drugs for the disabled.

Their biggest gripe seems to be with the fact that many people will use the Internet to circumvent important safeguards such as proper supervision by a physician. Taking a prescription drug for the first time can cause side effects that may go unnoticed by the individual. A doctor might be able to spot these effects and adjust the dosage, or recommend you discontinue taking the drug.

The bottom line is that the FDA can only do so much. It will ultimately be up to you, the consumer, to be diligent and responsible when making choices regarding your prescription drug usage.

By: Michael Casamento


Top Ten Reasons Why We Hate IBS!

Irritable bowel syndrome can be a nightmare?constant diarrhea and terrible stomach pains, or unbelievable constipation and never-ending gas. While it's good to stay positive and keep looking for help, sometimes it's even better to just have a good old moan!

So, without further ado, I would like to present the top 10 reasons why we all hate IBS. These quotes have all come from genuine IBS sufferers.

"Other people are sick for a week and they get fussed over, food made for them, blankets brought to them, and generally an amazing amount of sympathy. I'm sick for years and years and somehow I'm less deserving than they are. Is that because I'm making it up? Or because IBS isn't real? Or I should just snap out of it?"

"The pain is usually so intense that focus on school or work becomes impossible! There are many days and weeks that I spend curled up in a ball because the pain is so bad."

"I hate IBS because people think you are just a worrier looking for sympathy, and that you could just ignore it, haha."

"I am usually constipated, but when I have to go there's no stopping me. One of these unstoppable occurrences happened the day of the Chicago marathon this year - and I was a participant. During my 18-week training program, I would often think that "it" could happen that day, but simply hoped it would not. Well, it did and it truly was unstoppable. It was so angering after such long, hard training. I finished the race, but not happy with my time or my comfort."

"Walking through Wal-Mart...your heart beating faster as you approach the restroom...Will I make it in time? Only to the see the "closed" when you arrive. That horrible moment when you know you have to find a place to relieve yourself quickly or it will be the most embarrassing moment of your life."

"I can really identify with this list of how "I hate IBS" because basically it has ruined my life the past year. I have lost a job, a house, most of my family and friends due to this crippling "so-called disease" that NOBODY UNDERSTANDS. If I appear angry that is because I am, terribly so. I also have crippling migraines and I am going for surgery for a severe carpal tunnel problem. I live in chronic pain in the left side of my pelvis. It has made life very difficult to say the least."

"I just had company come from New York and I had to stay in bed during most of the visit because of IBS. They think that I am crazy. The gas and explosive bowel movements sap any living energy out of me. I am a single parent now living on social services which doesn't even cover my rent. I am sooooooo angry at my body betraying me like this."

"I am sick of living with constant fear and never being able to plan anything in advance. My long-suffering husband has to book holidays as late as possible, cancel theatre trips, and always go for aisle seats or none at all. I'd just for once like to say "Yes, I will definitely be able to go that day" and do it."

"Eating becomes something I must plan for fear of making a run for the bathroom immediately after (or even during) a meal."

"I am 12 years old and last year I found out I had IBS. It stinks because I have to go to the doctor more than all my friends and I have to go to Wisconsin children's hospital every month or so. I have REALLY BAD days and I can have GREAT days but the bad ones are hard to deal with. I HATE IBS and I wish I never got it!"

By Sophie Lee


The Pharmaceutical Drug Cartel and the FDA

According to the Los Angeles Times, the California Association of Physicians and Surgeons, and even the Center for Diseases Control's own admission, well over 100,000 people in this country die each year from "properly" administered prescription drugs. This is absolutely shocking!

One study has shown that more than two million American hospitalized patients suffered a serious adverse drug reaction (ADR) within a 12-month period and of these, over 100,000 died as a result. Likewise, roughly 36,000,000 adverse drug reactions are reported annually, resulting in more than 33.6-million admissions or hospitalizations all from drugs that the FDA has pronounced "safe effective." Sources for these statistics can be found at: http://www.cancure.org/medical_errors.htm.

The media is not doing a very good job of reporting this ADR crisis. Instead, we hear the constant media drumbeat about the dangers of firearms, which are currently politically incorrect yet represent a miniscule fraction of the deaths in this country. Doctors who want to politicize gun deaths should clean up their own glass houses first. The real crisis is the failing health care or more accurately described as the sick care system. There are numerous reasons for this crisis.

One reason is that conflicts of interest represent a very real problem for public servants and those entities which have relationships with various government agencies. Numerous researchers have reported that the FDA receives money from the very entities it is suppose to be regulating and one consequence of this is the suppression rather than advancement of disease cures. Consider the following:

"According to a USA Today study, more than half of the experts hired to advise the government on the safety and effectiveness of medicine have financial relationships with the pharmaceutical companies that will be helped or hurt by their decisions. These experts are hired to advise the Food and Drug Administration on which medicines should be approved for sale, what the warning labels should say and how studies of drugs should be designed. The experts are supposed to be independent, but USA TODAY found that 54% of the time, they have a direct financial interest in the drug or topic they are asked to evaluate. These conflicts include helping a pharmaceutical company develop a medicine, then serving on an FDA advisory committee that judges the drug.

The conflicts typically include stock ownership, consulting fees or research grants.

Federal law generally prohibits the FDA from using experts with financial conflicts of interest, but according to the article, the FDA has waived the restriction more than 800 times since 1998." (1)

The corruption of undisclosed financial ties to the pharmaceutical companies by supposedly unbiased researchers along with the staggering cost involved in bringing new drugs to market, which conveniently eliminates competition from all but the cartel heavyweights has been sparingly reported in the mainstream press. Consider one exception to this silence:

In the book a "World Without Cancer" by G. Edward Griffin. Griffin describes the politics of cancer therapy, in which he blows the lid off the all powerful international chemical and drug cartel that has dominated the direction of health care since early in the Twentieth Century in the United States. Griffin argues that not only has the Rockefeller-Farben cartel (2) been instrumental in fostering chemical based drug treatment as the basis for health care and they have been the dominant adversary against safer non-drug treatments. If Griffin is correct, who is the FDA protecting and serving? Clearly, not the consumer!

It should be noted that pharmaceutical drugs have absolutely no nutritional value, and at best offer temporary relief of symptoms while doing nothing to address the root causes of disease. Additionally, pharmaceutical drugs should be used very carefully because of the toxicity factor also known as the LD50 rating. LD stands for "Lethal Dose" and LD50 is the amount of a drug, given, which causes the death of 50% of a group of laboratory test animals. Also, it is well known that drugs can damage the liver and kidneys.

Do not forget, as sited above, adverse drug reactions are responsible for over 100,000 deaths each year plus the pain and suffering for those lucky enough to survive an ADR. The way to good health does not necessarily include the ingestion of toxic chemicals. Likewise, the reason for disease is not that we are deficient or lacking in deadly debilitating pharmaceutical drugs. In many cases, disease is the result of nutritional deficiencies and the resulting weakening of the immune system.

The recent ongoing attempt to abolish and subvert the Dietary Supplement Health and Education Act (DSHEA) of 1994, which brought a measure of freedom back to consumers, in regards to their personal choices in the area of nutritional supplementation, should raise the ire of everyone who is concerned about their own health. This is an example of the pharmaceutical cartel and their political cronies within and along side of the FDA at work. Never forget, America is about freedom, especially freedom to make informed decisions concerning our own health care information, services we choose, our choice of treatments and products that we believe to be beneficial for our own health and wellbeing. See the National Health Freedom coalition web site (3)

36,000,000 adverse drug reactions and 100,000 deaths annually is a crisis!

Notes:

1. An article by Dennis Cauchon, the USA TODAY Newspaper, Sept. 25, 2000

2. G. Edward Griffin, World Without Cancer, Westlake Village, CA, American Media, 1997.

3. National Health Freedom Coalition at: http://www.nationalhealthfreedom.org/

By Jack Kettler


Emotional Effects of Irritable Bowel Syndrome

Irritable bowel syndrome sufferers often find that they have to deal with two sets of symptoms. The physical symptoms of diarrhea, constipation and pain form the main part of IBS, but sufferers may also develop emotional problems such as mild or moderate depression and anxiety because of the strain that IBS places on their lives.

There's no doubt that IBS can have a huge impact on your mental and emotional health. One of the reasons why people assume that IBS is caused by stress is that IBS sufferers can appear so stressed and unhappy. But is this really surprising? If you had explosive diarrhea, never-ending constipation or stabbing stomach cramps you'd be a bit stressed too!

The nature of IBS symptoms can mean that they are very difficult to deal with, both practically, in terms of being afraid to go out because of fear of diarrhea, and emotionally, because of embarrassment and the sometimes unsympathetic reactions of others.

Sufferers find that their social lives quickly diminish to nothing, or that they can no longer eat the food at restaurants or dinner parties without ending up in pain. Work or school can become a chronic struggle as you drag yourself in on days when you feel ill, knowing that if you didn't you'd get fired or kicked off your course.

You may also feel that you have to pretend to be healthy most of the time in spite of how you really feel, because people get tired of hearing about your condition or begin to say things like "Well why don't you go to the doctor" or "My mum had that and ate lots of bran and now she's fine. That's what you should do."

It can be very hard to bite your tongue and stop yourself answering back. "Oh, go to the DOCTOR, I see, that's where I've going wrong all this time, I thought you had to go to the hardware store. I shall now be cured."

What is important to remember is that anyone who is battling with IBS is going through a very difficult time, and deserves some genuine support, as does anyone with a chronic, long-term condition.

Hopefully, if you explain your condition to family and friends, support will be forthcoming, but if not you should ask yourself how much misunderstanding you are willing to put up with, and whether it is hazardous to your health.

This is what Heather Van Vorous says in The First Year - IBS: "You may even have friends or family dismiss your problem as 'all in your head.' It's up to you to educate these people, and then dump them if they persist in their ignorance at the expense of your health."

If they are truly your friends then they will want to learn about the condition and be ready to accept that their views are based on prejudice and assumption rather than fact.

But if they still believe that you're exaggerating then ask them to explain exactly why they believe that IBS is psychosomatic or 'all in your head', what scientific studies they are basing their views on, and how they explain the success of new drugs such as the selective 5-HT3 antagonist Lotronex. That should keep them quiet.

By Sophie Lee


Three Questions People Are Asking About Health Care in America

Q. Why is there so may uninsured people in America?

A. There are over 44 million uninsured people in this country and over 75 million underinsured because of three main factors:

1. Insurance rates continue to rise each year by 10-25% forcing many people to drop their health insurance.

2. Layoffs in the job market have left many people in a difficult situation when it comes to protecting their families. Many of those that aren't laid off are seeing their insurance benefits cut.

3. More Americans today are facing health challenges that virtually make them uninsurable.

Q. How is America coping with this growing problem?

A. Not very well. The only alternative so far for many thousands of people is to seek medical care in overcrowded, understaffed, county hospitals where they virtually have no choice as to the quality of the Health Care they receive.

Q. So what is the answer to this growing problem for those trapped in the Health Care Crisis?

A. Well, if someone finds themselves trapped in the middle of either not being able to afford traditional major medical insurance, or not able to qualify for insurance because of pre-existing conditions, the alternative is to participate in a health care savings benefit program. These programs allow you to purchase your health care at Managed Care Prices which are the reduced rates that traditional insurance companies pay the doctors and hospitals. The better programs also offer additional membership insured benefits as well like accident benefits, daily hospital benefit, office visit benefit, and accidental death benefits to name a few. The key to finding a program to fit your needs is to look for a company that has been in business for a long time with a track record of assisting people attain these kinds of savings. A program with feature driven benefits is your best value when looking for non-insurance alternative health care solutions in today's market.

By Marc Eskew


Prescription Drugs from International Pharmacies Save Elderly Money

As pointed out by *Jack Shapiro, an internationally-known healthcare marketing consultant "For the first nine months of this year, the U.S. imported $40 billion in pharmaceuticals and exported only $21 billion. In 2003, we imported $50 billion and exported $23 billion." So what makes buying from your local U.S. based pharmacy any safer then purchasing from Mexico or Canada?
Many of today's elderly (U.S.) cross the borders of Mexico and Canada in order to get their prescriptions filled at a huge discount. For some it has become a necessity because they simply can't afford necessary drug treatments any other way.
But what about those who don't live near the borders; how can they take advantage of these savings? Fact is there are a lot of prescription drugs that can be purchased online from international locations for a fraction of the cost people pay here in the United States. A good example of this is www.rxmex.org where many of today's best known brand drugs can be found such as Viagra, Cialis, Levitra, Zocor, Zoloft, Propecia and more. However they not only offer name brand drugs at sharp discounts they also give seniors the opportunity to buy generic versions of most of these name brand drugs for savings that can reach up to 80% less then their name brand counterparts!
When a drug company first invents a drug (eg. Prozac) that company is the only one allowed to make that drug for a certain number of years (approximately 10 years in the US). After this time period, other companies are allowed to make the same drug. These drugs are called generics. The original drug (eg. Prozac) is called a brand name drug. Brand name drugs and their generics are IDENTICAL in terms of active ingredients. The generic pills may look different (because they are made by a different company) but inside is exactly the same active ingredient which works in exactly the same way. The only difference between brand name drugs and generic drugs is that generics are always less expensive.
Most all drugs found at www.rxmex.org require a prescription so this licensed pharmacy can fill most orders by having the purchaser fax them their prescription and the shipped order can be tracked online. Another benefit to ordering this way is that there is no tax to be paid and orders are shipped internationally.
While some headway has been made in the last year or so in regards to reducing prescription drug costs for seniors, for now it's simply not enough for so many of our elderly. With the political clout of today's drug companies who converge on Washington D.C. like vultures I'm not sure the costs will ever get to the point where it should be. Until then places like www.rxmex.org with their name brand and generic low cost versions of many prescription drugs will continue to be another excellent low cost source for today's seniors.
By Stephen Dayton


Pain in the Butt. How to Deal with Hemorrhoids?

This is very sensitive area of your body. Too private. Nobody likes when something is wrong over there. However it happens.

Hemorrhoids occur practically in everyone. Though hemorrhoids cause problems in 1 out of 25 people. Mostly those are people between 45 and 65 years of age.

You find a blood on toilet tissue. Bright red blood. Ok, now what? You do not know why you bleed. It could be rectal cancer by the way. It could be hemorrhoids.

So? What are the hemorrhoids?

They look like cushions. They contain blood vessels, some muscle and elastic fibers. People often call them piles.

Not everything over there is a hemorrhoid. There could be other problems. Fissure, abscess, fistula, pruritus (itching), condylomata (sort of hanging skin caused by viral infection), viral and bacterial skin infections can happen in that, so sensitive area.

It is worth to talk to your doctor.

How would a scenario of hemorrhoids look?

A 46-year-old female presents with complaints on rectal discomfort, occasional bright red blood on toilet tissue and prolapsing tissue in of anal area. This is probably internal hemorrhoid.

Another scenario brings a patient who complains on severe rectal pain and prolapsed tissue. The severe pain happens in external hemorrhoids. The pain follows thrombosis (thrombosis is the blood clot in your blood vessels).

There are four degrees of internal hemorrhoids.

It may be interesting for you to know because first, second and sometime third degree can be treated by banding only. Fourth degree and sometime third degree requires surgery.

Do not forget non-hemorrhoid causes of symptoms. To check with your doctor is worthwhile because there could be other problems, including cancer or anal fissure. (By the way for anal fissure medical treatment alone may heal it in 90% of cases).

How are hemorrhoids treated?

Well first you need to understand how do hemorrhoids happen. Several reasons lead to hemorrhoids:

Constipation and extra straining
Chronic Diarrhea and loose stools
Long sitting or standing
Weight lifting
Obesity
Pregnancy and childbirth
Inherited tendency to hemorrhoids.

So, avoid all this and you are free.

Obviously this list of reasons is too wide.

The list of measures is wide too.

Increase the fiber in your diet.

Eat more cereals, fruits, vegetables, grains, etc

Psyllium and methylcellulose are supplemental types of fiber.

Exercise, avoid long standing or sitting, don't strain, keep the anal area clean.

Increase liquids in your diet.

Use stool softeners, stool-bulking agents (not a tasty ones, but what can you do).

Treat diarrhea with anti-motility drugs and fiber.

Not every of these methods are proved scientifically. Nonetheless they are included in the standard recommendations for hemorrhoids treatment.

To treat itching or discomfort you may use suppositories, ointments, creams, and gels. You may find that all in your local pharmacy.

These products contain protectant and anesthetics (pain relievers). Local anesthetics numb the area and decrease burning and itching.

Remember that local anesthetics may cause allergy.

Analgesics (menthol, camphor) relieve pain and itching as well

Vasoconstrictors reduce swelling in the perianal area. Though they may have side effects. Better discuss with your doctor.

Protectants (kaolin, cocoa butter, lanolin, mineral oil, starch, zinc oxide or calamine, glycerin, etc) create a physical barrier to prevent contact of stool and the skin. This reduces irritation, itching, and burning.

Similarly, some agents - astringents - dry the skin. That helps to relieve burning, itching, and pain as well.

To kill or at least suppress bacteria and other organisms use antiseptics. Boric acid, phenol, resorcinol and many others can be used. Again better to discuss with your doctor or at least pharmacist. Many of these drugs are sold over-the-counter.

Corticosteroids. Corticosteroids decrease inflammation and relieve itching, but may cause skin damage. They should be used for few days only.

Sitz bath may also help in relieving the symptoms.

When those methods fail your doctor may perform one of the following:

Sclerotherapy (causes scarring of the hemorrhoid).

Rubber band ligation. The rubber band cut off blood supply and hemorrhoid heals with scarring.

Side effects of any of the treatment may be infection of fat and other tissues surrounding the anal canal, especially if patient has diabetes cancer, AIDS.

Another option - electrotherapy and infrared photocoagulation. Works the same way, cause scarring of the tissue. Cryotherapy uses cold to cause inflammation and scarring. Practically the same, though more time consuming.

Let say your medical treatment fails. What do you do then? Well, you go to surgeon and treat it surgically.

Operations are done in less than 10% of patients. Though it depends.

Surgical procedures include Dilation. It is when surgeon stretches your anal sphincter.

Ligation. Often a Doppler probe helps to measures blood flow and finds the individual artery.

The doctor ties off the artery.

Sphincterotomy. It is when sphincter is partially cut. Whole idea is to reduce the pressure.

Hemorrhoidectomy. Hemorrhoidectomy makes sense for patients with third- or fourth-degree hemorrhoids. The hemorrhoids are cut out.

Stapled hemorrhoidectomy. Stapler cuts off the ring of expanded hemorrhoidal tissue.

There are different considerations why to do this and not that type of treatment. And vice versa.

There are complications (pain, difficulty urinating, bleeding several days after surgery, scarring, infection, stool incontinence). Complications happen relatively rare, but they are still there. Better talk to you surgeon.

I hope you be OK.

You were not alone.

It looks like Napoleon Bonaparte, Carter, Hemingway, Tennyson, Lewis Carroll also were suffering from hemorrhoids.

By Aleksandr Kavokin, MD


Web Therapy: Enhancing Patient Communication with Web Access

According to Jennifer Lyons' chart, she's just a bad slip and fall who's lucky enough to be on her way to a full recovery.

But to Jennifer, who is lying in bed with a broken mandible and broken limbs, nothing could be further from the truth. Jen was visiting the city on a business trip when her accident happened, and now she's lying in a bed 2,000 miles away from her family. Although her husband is flying in later tonight, never in her life has Jennifer felt more disconnected. That is, until her nurse points out the revolutionary screen standing next to her bed. Even though she can't move her mouth, two minutes later, Jennifer is catching up with her children.

Two floors down, Rebecca Forrester is also lying in bed with no family members around her. She's in her eighties and the fall she took is already developing a complication - pneumonia. Her daughter is working in Tokyo and will take a day to get to her side - a day Rebecca may not have. With no telephones in this ICU, Rebecca knows if her daughter doesn't make it to her in time, she may never be able to speak to her again. Until a nurses' aide enters with a wireless web pad. A minute later, Rebecca and her daughter are talking.

In a growing number of hospitals nationwide, hooking up your patients has just taken on a whole new meaning. Whether via wireless web pads, or bedside units, patient Internet access is revolutionizing patient care and patient communication.

Originally conceived as a way to reduce boredom and facilitate patient education, the units quickly began to add other features including relaxation videos, local TV channels, video games and telephones, besides videos and information patients can access on specific healthcare issues. Feedback is already showing what medical professionals have suspected for years -- people simply feel better when they're active and connected with the world around them. Even video games - just a welcome diversion for the rest of us - help patients take theirs mind off pain, requiring less pain medication. But patient Internet manufacturers didn't stop there. They also found a way to add a host of applications that increase bedside patient care in ways never before possible, by bringing the information age right to the bedside.

Many systems now integrate electronic medical record systems, bar code medication systems and even digital imaging directly into the web screen units. This means that doctors and nurses can do chart notes, look up lab results and in some cases order or dispense medications without leaving the patient's bedside. The web screens also make it easy to view diagnostic images or go over them with the patient. Not only does this save time and energy, it increases patient privacy.

But for the patients, it's all about facilitating communication whenever they need it - with loved ones, with friends or even with work. Just because someone is hospitalized doesn't mean they have to be isolated. For Jennifer Lyons, being able to communicate with her children means everything. Not only does she feel connected, because she can check in with them a few times a day, she feels more able to relax knowing that everything is fine at home.

As for Rebecca, she didn't fare as well. The pneumonia took hold and her daughter was unable to get to the hospital quickly enough to be with her before she passed away. But with the wireless web pad and a little help from her nurses' aide, Rebecca and her daughter spent the rest of the day writing back and forth, telling stories, sharing memories and making sure they said everything to each other, that they wanted to say. And to them, that made all the difference. Priceless.

For tools you and your staff can use to facilitate patient communication download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

By Laura Greenwald


When Your John Doe Is Homeless

The patient, known only as John Doe, was difficult to see under the hodgepodge of tubing, the quiet clicking of the ventilator the room's only sound.

From all appearances he was homeless, but in the opinion of his nurse, who has had vast experience in dealing with patients just like him, everyone has a mother or a father, a son or a daughter, and homeless or not, it's a nurse's responsibility to do what he can to help find them. Usually it's just a matter of taking that extra few minutes to connect the dots. "Homeless people are very savvy and self-sufficient when it comes to survival skills," he explains. "They write important phone numbers on the insides of a hat, put them in their shoes, or sew numbers inside the seams of their coats. I go through every stitch of clothing."

If that doesn't turn up any emergency contact numbers or personal information, he examines the patient's body for needle tracks, scars or tattoos and if necessary, sends fingerprints to the police for a background check.

Sometimes the police's theory is that the homeless person had a desire to be a loner, and they see no need to reconnect them with their family after they are injured or dead. But the nurse is quick to disagree.

"Things change, [and] these people are still human beings. I believe that every homeless person is still a father or mother, [or a] son or daughter to somebody out there. These people may have done things they are not proud of, they may have mental illness, but their family has a right to know what happened to them."

From a hospital's perspective, a patient without an identity is a patient without funding. But once a nurse or a social worker positively IDs a patient as a US citizen, the hospital can help the patient apply for Medicaid and then get reimbursement for the bill.

"Identifying people is a reasonable endeavor. It is part of a holistic approach. When you locate family, you find a surrogate to speak on behalf of the patient, to be an advocate. The family should decide on the patient's follow-up and if the patient has died, the family should decide where they are buried."

For tools you and your staff can use to identify John Does download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

By Laura Greenwald


Pediatric Emergency Contact Notifications Made Easier

For the head of the trauma department at one of America's top pediatric facilities, Chicago's Children's Memorial Hospital, having to notifying parents that their children have been the victims of trauma or identify pediatric Jane Does, is an every day occurrence. But just because they look like they're handling it well, doesn't mean that it ever becomes routine.

When a child comes into the ED without a parent, it's usually the result of an accident or traumatic event. Even though their first priority is to tend to the child's medical needs, their next priority is to identify the child. They need to get his parents or guardian down to the hospital, to give consent for his treatment, provide vital medical history and most importantly, to be at their child's side when he needs them most.

You'd be surprised how often a child is brought into Children's Memorial without anything pointing to his or her identity. Many times it's the result of a car accident, where the parents are injured as well as the child, and are taken to another hospital, while the child is brought to Children's for specialized pediatric treatment. Since children don't have driver's licenses or checkbooks, identifying a child can be challenging.

Just the other day, three children ranging from 8 months to 3 years were brought into the ED after a serious automobile accident.

Their parents, who were in bad shape, were taken to another hospital and the paramedics had no clue about their names, ages or medical history. The trauma team began their medical evaluation and as they always do when dealing with an unidentified child, opened a trauma pack for each, using a patient number to identify them. We estimated their ages, did a full physical description including any identifying marks and clothing, then ordered a full set of x-rays, which helps to identify any conditions or injuries that aren't readily apparent.

The team's biggest asset in this situation was the solid relationships that they've built with police, fire department, and other local hospitals - as they work together to get the children identified as quickly as possible. After a major accident like this, the police and fire department were already in the ED coordinating efforts. With their special emergency landline system they're instantly linked by phone with any local hospital they need to reach. As the team began calling to find out where the children's parents were taken, hospitals began to call them, to say, "I know you're looking for the mom and dad of the accident victims. They're not here," saving them precious time. In this case, we found the hospital relatively quickly and found out that even though the children's parents had been seriously injured, the children's caregiver who had also been in the accident, was fine. The hospital sent her over to Children's and she - and later on the parents - were able to give them all the information theyneeded to identify and treat the children.

In the case of a completely unidentified child, especially babies, they depend on our procedures. Usually the fire department, police or DCFS dropped the child off, so they are already aware of the situation and have already begun going through the child's clothing and personal effects to gather evidence and identify the child. The trauma team will send the police or paramedics right back to the scene to gather additional information, medicine bottles, names, and to canvass the area. There is almost always someone who saw something. Someone from pastoral care automatically comes down and a social worker will get involved if it looks like any abuse was involved. Together, they take care of figuring out where to go from here, while the team takes care of the child medically.

If these steps don't elicit any clues to the child's identity, the hospital will get media affairs involved. Children's will never show the face or reveal the name of any child. Instead, they photograph the child's clothing and personal effects and release it to the media along with the child's estimated age, description and the vicinity in which she was found. They work closely with detectives and DCFS to give them all the details they need to chase down any leads they get from the public. Many times just calling DCFS or the police will locate parents or bring about an identification. In the case of severe trauma, abuse or inflicted injury, Children's always balances treating the child, with carefully gathering as much evidence as possible, to help the eventual police investigation. They had a young girl a few years ago, whose brutal attacker was convicted mainly on the evidence gathered and catalogued in the trauma room.

When it comes to providing emergency contact information, kids aren't always the best source. They have seven or eight year old kids come in everyday, who I'm sure are sophisticated in every other way. But get them in a trauma situation and ask them what their mom's name is and they'll say it's "mom". In this case, the first thing they'll do is look at whatever they brought in with them. School-age kids almost always have a backpack. If they don't find anything there, they'll check our records to see if the child is in the system and begin to gently probe the child for information. They ask them where their house is, what their school looks like, information about their friend's houses, maybe a familiar landmark on the corner like a 7/11 or the name of a park. If you can't find their contact information right away, try to find the name of their school. Their books will probably have the name of their school stamped inside.

Schools are also a great source for emergency contact information. They'll often even list alternate people to call in an emergency if the parents are at work or hard to reach. In an emergency, schools will usually send someone directly down to the hospital with the child's emergency card and emergency consent forms. If the injury occurs at school, most schools will send someone from the school along with the child to the hospital, while someone else is calling the parent. For parents, I would suggest that every parent name someone else on the child's emergency card, who knows the child well and would be able to step in to help out during an emergency if the parents can't get there right away.

So once you identify a child, how do you know if the person who comes to the hospital is really his parent or relative? It's not always easy. Remember that the parents didn't expect to have to come to the hospital today, and probably won't be carrying three forms of ID and their child's birth certificate. For people that come in and say they're related to a child who's been in the media, they get as much ID as they can, be it a driver's license, pictures or other proof. With kids, the biggest test is to watch their response when that person goes in the room. Usually you'll here a resounding "Mom!" or "Daddy!" and you know you've got the right person. If there's no response from the kid, or if they're not sure of the adult, it's probably not the right person. Or worse, the child might recoil from the adult, which could indicate an abusive situation.

Treating kids also means caring for their parents. When Children's has to make a notification call they'll begin by telling the person on the phone who they are and ask them how they are related to the child. If it's the mom or dad, they'll tell them that their child has been brought to Children's Memorial Hospital. Of course the parent will immediately ask how the child is. This is always the hardest part of the call. If the child is clearly fine, they'll say "Don't worry, they're fine, we just need you to come down here." But if there is a more serious injury, or if the child hasn't survived, they say that the child has been in an accident, that they need to come down, and if necessary, that they need to get their medical history. If they refuse to get off the phone until they find out what's wrong, the trauma coordinator will say that they're very concerned about their child's health and that they need to come down right away. They'll always try to calm the person down as much as they can - tell them to go and get a pencil and paper to take down the address of the hospital, to take down the hospital's name and they're direct number. They tell them to ask for them right away when they get here so they don't have to waste any time at the desk and then try to make sure they have someone to drive them over. And they finish by reminding them that they need to drive carefully and slowly and to make sure that they get there in one piece!

At Children's the top priority is the restoration of the health of every child who comes through our door, no matter who they are and where they come from.

For tools you and your staff can use to facilitate pediatric notification, identification and communication, download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

By Laura Greenwald


Patient Communication: Picking Up Where Medicine Leaves Off

We've all seen patients who were far beyond the reach of medical treatment suddenly defy the odds and recover. We've also seen patients who were well on the road to recovery, take a turn for the worse for seemingly no reason at all. No matter what the technology or how terrific we are at our jobs, sometimes medicine just isn't enough.

Case in point, a few years ago, I saw a woman in her sixties after she had had a moderate CVA. No matter what her doctors did for her, she still wouldn't regain consciousness - defying explanation. Her daughter was thousands of miles away at the time and when the doctor reached her, he told her that her mother mighty not live long enough for her to get to her side. After several minutes, the daughter finally convinced the head nurse to put a phone up to her mother's ear, so she could talk to her. The nurse put the phone by the patient's ear and could hear her daughter talking to her, telling her that she was on her way and that everything was going to be fine. The moment her patient heard her daughter's voice, the nurse watched in amazement as her vitals stabilized, her eye lids began to flutter and her eyes opened, looking straight up at the nurse! Two weeks later, she was out of the hospital and on her way to rehab.

That's the miracle of communications.

Whether a family member, a friend or just a familiar face, our patients need to have the people they love surrounding them, when they're ill, in pain, or afraid. As caregivers, it's part of our job to realize that patients might be too ill or physically unable to initiate the contact they so desperately need, on their own.

I wish that were the end of the story. A few years later, the same woman was injured after a bad fall and taken to a different hospital. Despite being in stable and then good condition, a few days later a lack of the most basic medical care caused the woman to spiral into critical condition. When the hospital called her daughter to notify her of her mother's hospitalization days later, she learned that her mother was now unconscious and may not survive. While trying to get a flight back, she begged the nursing staff to put a phone next to her mother's ear, so she could talk to her, possibly for the last time. But at this hospital, the nurses and doctor refused. In fact her doctor said that she was suddenly opening her eyes and looking around. But despite her daughter's pleas to let her talk to her mom while she could still hear her, he tells her that he has no way to get a phone to an ICU patient. "We'll try and figure something out in the morning," he says. Unfortunately the patient didn't have that much time and she died hours later, never again hearing her daughter's voice.

The next time you're caring for a patient with compromised communication ability, take a moment to see their surroundings from his perspective.

· If your patient can speak, is the telephone close enough to them?

· Do they need help dialing, or able to see well enough to read a number out of their address book?

· If your patient is unable to hold a telephone would they benefit from a speakerphone?

· If your patient can't speak, have a patient representative or volunteer ask them to write the name of someone that they would like to have called for them and hold the phone up to their ear to facilitate communication.

· For patients who cannot speak, patient Internet access can be a real lifesaver, because they can type an email message or have one typed for them.

· Is your patient unable to see or unable to hear? Then take a moment to call a department or caregiver who can bridge those problems to enhance communication.

· Since many hospitals still don't have a means of patient communication in the ICU, you may have to get a bit more creative for patients in care units.

Many hospitals now have low emission wireless phones that can be used in critical care units. Wireless web pads also work well, or what about a regular phone, kept at the nurses' station that can be plugged into an outlet in the patient rooms when needed. Communication isn't just a patient's right - for many it can be their only link to the outside world, or a life-renewing source of strength and love.

Combine that with terrific medical care and watch the miracles flow.

For tools you and your staff can use to facilitate patient communication download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

By Laura Greenwald


Family Notification in Seven Quick and Easy Steps

The Seven Steps to Successful Notification is an easy-to-use system based on time-tested tools successfully used by hospitals nationwide. It provides your hospital staff with all of the steps necessary to:

? Identify and locate your unconscious patient's next of kin or surrogate decision maker.

? Improve patient care by locating your patient's medical history, personal physician, and insurance information.

? Provide the facility with a documentation of the steps taken to find the patient's next of kin, to make the notification, and identify the staff members responsible for making it, thereby releasing you from subsequent liability.

? In states with Next of Kin Statutes, provides proof that the facility has met its statutory responsibility.

Let's see the seven steps in action, through the eyes of the nurse manager of Care Central's Trauma Unit, Carolee Cummins.

Carolee comes on duty this morning just as a hit and run is pulling up at the emergency bay. She meets the gurney and runs along side, paying rapt attention to the paramedic's bullet, while she and her staff do their own evaluation. The paramedic's last comment stops her cold. This pretty thirtysomething, woman who is in grave danger of bleeding out, has no identification with her. Carolee starts a John Doe chart for her patient and turns her attention back to the trauma.

1) Patient Status Confirmed

When a patient like this comes in, Carolee is glad that she and her team use the Seven Steps System. She looks down at her chart page and begins the notification process right in the trauma room, by answering the first question. Is the patient unconscious or physically unable to give informed consent? Had her patient been alert and oriented, she would simply have checked the box marked no, skipped the notification section on the chart and proceeded as usual. After the team confirms that the patient is unresponsive to everything but deep pain, Carolee checks "yes" and asks one of the aides to check the waiting room to see if any family members came in with their patient. "No", the aide confirms, "she came in alone". And so the notification and documentation procedure begins.

2) Examine Personal Effects For Emergency Contact Numbers When Care Central began to use the Seven Steps, they appointed the nurse manager on duty, as the point person for NOK notifications. So as point person, Carolee begins to look for the young woman's emergency contact numbers or clues to those numbers, by examining her personal effects. Most of the time, Carolee finds the emergency information quite easily, right in her patient's wallet, on a driver's license, emergency contact cards, insurance cards or personal phone books. When she finds what she's looking for, Carolee documents on the chart that the contact has been found, and skips down to Step 5.

In this case her search only takes a moment - the only thing the woman had with her were her house keys. If she had a wallet or a purse, it was destroyed in the accident. Carolee goes through the pockets of her patient's jogging shorts and finds one small clue to her identity - a few message blanks from work that she must have stuffed in her pocket to take care of later. They're all made out to Katherine McCauley. Progress.

If Step 2 had turned up nothing and her patient had still been a Jane Doe, Carolee would have skipped down to Step 7, involving Social Service in her search. But since Carolee's patient now has a name, she goes directly to Step 3.

3) Retrieve Patient's Home Number

Now she'll have to get a bit more creative. As Katherine found out the hard way, life can present major challenges for patients, not to mention an emergency department staff. A quick run to the store without taking your ID, interrupted by a sudden heart attack, can put even the most conscientious person into jeopardy. In upcoming sections of this Kit, you'll find details on traditional and untraditional ways of find that contact information quickly and easily. But for now Carolee, goes through her mental checklist of ways she's found contact information in the past: checking the speed dial of a patient's cell phone for numbers labeled "home" or "work"; the contact pages of a Filofax, or the address book of a PDA. Even a briefcase can contain a patient's business card, or a company letterhead on documents.

If Carolee had found a home number or an emergency contact on any of these items, she would have gone right to Step 5. Since Katherine has none of these things with her, Carolee documents that fact and proceeds to Step 4.

4) Seek Other Sources For Contact Information

Carolee almost never gets to this section, but when she does, she knows it's time to crank her investigative skills into high gear! Since she knows her patient's name, her next step will take her to the hospital's medical records department.

Chances are, if Katherine lives in the area, this probably isn't her first visit to Care Central. Even if the old records don't include the patient's next of kin or surrogate decision maker, Carolee will be able to get it, by phoning Katherine's home number, physician or insurer.

If Carolee still hadn't been able to find information on her patient, she would have gone directly to Step 7 and turned the investigation over to Social Service or to the police (depending on her facility's policy).

But Carolee quickly locates Katherine's name on a year old chart, when she was admitted for the birth of her son. Success! Now on to Step 5.

5) Oversee Or Make The Notification Call

Normally, Carolee would turn the actual notification phone call over to one of her RNs. But she's so invested in Katherine at this point, that she places the notification call to Katherine's home herself.

Since her first priority is notifying the patient's next of kin or surrogate decision maker, her aim is to get a hold of the right person as soon as possible. She is disappointed to hear the answering machine pick up. Carolee hates doing a notification this way. She leaves a message for Katherine's husband, hoping that he'll pick it up quickly. Many times the only person Carolee has been able to reach is a relative or friend, so she is always careful to document the name and relationship of any person she talks to. Occasionally the only information she finds is the patient's family physician or insurance company.

In that case she makes sure they know that she needs to speak with the family ASAP and then follows up within an hour or so. Carolee has learned the hard way, never to assume that a third party is going to take care of a notification. Since Care Central is the facility treating the patient and is the one in need of medical history to give Katherine the best care possible, it's Care Central's responsibility to make sure the notification takes place.

Even though Care Central's responsibility is technically met the moment Carolee left the message for Katherine's husband, she feels that it's a good practice to follow up with another phone call if Katherine's husband doesn't arrive or return the hospital's phone call within the next two hours. She documents the results, initials that the section is complete and notes the time that the call occurred.

The entire process has taken Carolee less than ten minutes, and by using Care Central's special chart page, Carolee's hospital now has a documented account of her efforts. If her patient or her patient's family were ever to question that notification was attempted, the hospital will be able to prove that their regulations were properly followed.

6) Need To Follow Up? Recall Main Contact Or Second Number

Answering machines and voice mail are wonderful and no one can imagine life without them - unless it's an emergency and you can't get a hold of the person you need to speak with!

Two hours later, the husband still hasn't arrived and Katherine's condition is worsening. Doctors are wondering if she has an undetermined, underlying condition that is keeping her BP from stabilizing despite their efforts. Carolee quickly proceeds to Step 6. Carolee found Katherine's work number on the old chart, but before she tries it, she redials the home number. A breathless Scott answers. Only minutes before, he'd forgotten an important brief and ran back home to get it, allowing him to pick up Carolee's message. A short while later, he arrives at the hospital and fills the trauma team in on his wife's medical history. Changes in her treatment are immediately made and hours later, Katherine, now alert and stable, is on her way to a full recovery.

Had Carolee not been able to reach anyone at Katherine's home, she would have called the second number, then documented the results on the chart, with the time and her initials. If she still hadn't been able to reach anyone in person or if the relative hadn't shown up at the facility, she would have noted that on the chart and proceeded to Step 7.

7) Shift To Social Service Or Police Every once in a while, despite Carolee's best efforts, she has to shift her notification efforts to social service. Even so, she has met the hospital's legal responsibility by making reasonable efforts to notify her patient's next of kin.

The bad news is that her patient still needs intervention. By shifting the notification process over to her social service department or to the police, Carolee is confident that everything possible will be done to find her patient's family. In upcoming sections, you'll find tips and tools to help you deal with identifying Jane/John Does and handling the effort quickly and easily.

For a free copy of the complete Seven Steps to Successful Notification System, in PDF download format, visit the Next of Kin Education Project web site. A sample version of the form is also available on our web site, along with forms you can purchase to use in your own facility. Along with the Information Kit, we've created patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

By Laura Greenwald


Food for Thought

Depression is a disorder marked by sadness, low energy, impaired concentration, and feelings of dejection. Some people believe that depression is normal. Hectic daily activities and the conflict between family and career cause constant stress. Yet depression and anxiety as a response to stress are not normal. They can be signs of illness, which may worsen and result in physical symptoms or an inability to function.

Life was much simpler for the last two generations. Father worked; mother stayed home. This is no longer the model. Some now view families as an "endangered species." There are more single mothers working than ever before. There is greater stress and competition for well-paying jobs. The result: long hours at work, away from the family. Children are raised with limited supervision. Thus we see more children with emotional problems derived from a lack of knowledge as to who they are and what their role is in today's society. Similarly, adults suffer from the loss of nurturing that family time should provide.

Until recently, mental health was not discussed openly. However, there is a growing awareness that choosing therapy can be helpful, even necessary, to cope with today's life. Psychiatric help is often sought for the entire family. Today, being healthy means not only having a sound body, but also a sound mind and spirit.

People exercise their bodies daily, yet they neglect to "exercise" their feelings and emotions. Young men are taught to hide and deny emotions. Women are reluctant to seek help in coping with their depression, anxiety, or distressed relationship. The same fitness fanatic who exercises daily, eats right and has two physicals a year will neglect the mind until a crisis is reached. Emotional problems don't just happen, but are cumulative and they can be avoided at times with the same "daily fitness" and "annual physical" approach we use when caring for our bodies.

The Chinese say "the journey of a thousand miles begins with a single step." Just like it's better to maintain a healthy heart than recover from a heart attack, dealing with emotional issues is easier before the chaos of a crisis breaks. Think about "exercising your emotions" and give your mental health professional a call.

By Debra S. Gorin, M.D.


Onychomycosis - One Of The Many Nail Fungus Out There

Many natural changes in fingers and toenails come with age. Fine ridges, for example, may start developing from the cuticle of the nail tip. This and other similar changes are common, but they are not signs of poor health.

However,there are some nail conditions to watch out for such as small separations of the nail from the nail bed, yellow/brown color, or hardening ,crumbling or thickenings of the nail at the top edge.All these conditions are symptoms of a common fungal infection called Onychomycosis,which infects the nail bed under the surface of the nail causing thickening, roughness, discoloration and splitting of the nail.

It can be caused by a somewhat large variety of fungi and it's typically painless for several years after initial infection. But, if left untreated, the condition will worsen and it'll be unbearable to even wear shoes or walk.

Because fungi thrive in darkness,moist areas such as the inside of your shoes, Onychomycosis appears on toenails more often that fingernails. Like mold or mildew, these parasitic organisms live on dead things, which in this case is the dead nail tissue. Once the fungus is established on dead tissue, it excretes toxins into adjacent living tissue causing its death.

As this tissue dies, it provides new ground for the fungus to expand.

The risk of fungus infection of toenails is decreased using the same methods to decrease the risk of fungus infection of the skin on the feet. Here are some tips to maintain your feat dry and healthy:

1. Indoors, avoid wearing shoes and consider wearing open footwear.

2. Change shoes daily. Try alternating between at least 3 pairs of shoes allowing them time to dry out.

3. Change socks whenever they become damp.

4. Wear high top boots only when needed for work or other activities.

5. Treat every foot fungus promptly. Some fungus require daily application of anti-fungal creams to keep them away.

If the fungus still appears go to your dermatologist to prescribe you both oral and topical treatments for Onychomycosis. Newer, safer and more effective medications are currently available due to nail fungus treatment advancing significantly over the past years. These medications are generally taken for three months. During that time, the medicine incorporates into the nail tissue preventing the fungus to expand. As the nail grows out normally, The diseased nail is displaced and removed.


The Top Seven Myths About Arthritis

Myth #1: "Nothing can be done about arthritis..."

You don't have to put up with arthritis. Now motre than ever, there are excellent medicines that can not only treat the symptoms but also, in many cases, get the disease into remission. Arthritis when diagnosed and treated properly can be controlled.

Myth #2: "It's all due to getting old..."

Arthritis affects all age groups. Arthritis can even affect children. Three out of every 5 people with arthritis are younger than 65 years!

Myth #3: "If I wait, it'll go away..."

Six million Americans believe they have arthritis but have never seen a physician! A proper diagnosis and treatment are important! Who doesn't want to see their children graduate or play with their grandchildren? It's a choice many Americans make every day.

Myth #4: "Arthritis medicines have too many side-effects..."

Yes... Many of these medicines do have potential side-effects! Witness the latest flap over the COX 2 drugs. But...When properly monitored by an arthritis specialist, the chances for severe side-effects are much much lower! Let's face it... any medicine you take has potential side-effects. What you and your physician have to determine is this: Are the potential side-effects- which by the way are relatively uncommon despite what the media would have you believe- worth my quality of life?

Myth # 5: "I'll never get arthritis..."

Seventy million people in the United States (25% of the population) suffer from arthritis!" Also, arthritis strikes 750,000 new people a year. More than 97% of people over 50 will get arthritis. Just because you don't have symptoms now doesn't mean you won't get symptoms soon.

Myth # 6: It's just aches and pains... Nothing I can't live with... Arthritis is the #1 cause of loss of personal freedom. More than 100,000 Americans can't walk independently from their bed to the bathroom because of arthritis. Ten million Americans are limited in their daily activities because of arthritis. Arthritis is the:

* leading cause of physician visits in adults over 65

* most common chronic disease

* most common cause of crippling

* most common cause of impairment and functional limitation in adults

Myth # 7: "My doctor can take care of arthritis..."

Unless your physician is a rheumatologist is remains active on the cutting edge of new research, there is no way he or she can "take care" of this condition. There has been a literal explosion of new treatments in the last three years. These treatments can make the difference between a life filled with joy and a life filled with dread.

By Dr. Wei


Toenail Fungus: Tips For Treatment

The medical term for toenail fungus is "onychomycosis," pronounced on * EE * ko * my * ko * sis. Despite the commonly used term "fungal toenails", onychomycosis describes both fungus and yeast infections in the nail. The prevalence in America is about 2-3%, but some have reported it as high as 13%. Even at a low estimate of 2%, this accounts for 6 million Americans with toenail fungus. Toenail fungus affects men twice as often as it affects women.

The prevalence among elderly individuals and diabetics is 25%. In the 1800s, fungal toenails were very rare. The increased prevalence is linked to the increased exposure to fungus through the use of showering facilities in gyms, the use of hot tubs, saunas and public pool areas. There is an increase in occlusive footwear, an increase in sporting activities, an increase in diabetes and increase in age of the general population.

The risk factors for developing toenail fungus are increasing age, male gender, nail trauma, sweaty feet, poor circulation, poor hygeine, foot fungus and a compromised immune system.

Athlete's tend to have a higher rate of fungus infection than non-athletes. The moisture in the shoe combined with repeated nail trauma increases the chance of infection. Hikers, runners, backpackers, soccer, basketball and tennis players, athletes wearing loose fitting shoes that allow jamming of the nails against the shoe and any individual wearing shoes that toe tight are at risk for developing toenail fungus.

There are a number of treatments for onychomycosis. The most aggressive and effective way to treat the fungus is with oral anti-fungal medications. The most common oral anti-fungal medications are Itraconazole (Sporonox ®) and Terbinafine (Lamisil ®). Both medications can be quite expensive as they need to be taken once daily for 3 months. The effectiveness of the medications ranges from 60 to 80%, with a recurrence rate of 15%. Lamisil® appears to be more effective and has fewer drug interactions than Sporonox®.

With both medications there is a long list of benign side effects including nausea, vomiting, abdominal pain, diarrhea, rash, headache, taste disturbances and dizziness. Serious adverse events are very rare, less than 0.5%, but do include hepatitis and acute hepatic necrosis.

There are many other options besides oral anti-fungal medications. Unfortunately, they are not very effective. The most effective topical medication is Ciclopirox (Penlac ®) lacquer. Some studies have shown cure rates up to 60%, but in my experience the effectiveness is about 10-15%. Side effects occur in less than 2% of patients and include burning and redness around the nail.

This medication is only available by prescription and is also quite expensive. A few other prescription medications that help decrease the thickness of the fungal nails are Carmol® 40 and Keralac® Nail Gel. I would not expect to see complete cures with these products, but they can decrease the thickness and discoloration of the nail in some cases.

There are many home remedies and over the counter products that you can purchase. Some home remedies that can be used include bleach, tea tree oil, grapeseed extract, and Vics VapoRub®. With any home remedy or non-prescription topical, you must understand that the effectiveness of the treatment is fairly low, less than 10%. If you do try one of these therapies make sure to use it every day. Roughen up the nail surface with a file and apply the medication with a q-tip. Bleach can cause skin irritation and some individuals have had skin reactions to the Vics VapoRub®. In general these treatments are considered very safe.

Combination therapy can help increase the effectiveness of the treatment. If you choose to take an oral medication, make sure you use a topical anti-fungal agent as well. Nail removal is also an option. Once the nail is removed, the topicals can reach the nail bed and they become more effective. The nail will grow back in over a period of 8-10 months. Permanent nail removal is reserved for those with chronic ingrown nails, ulceration under the nails or pain from the fungal nails.

The best form of treatment is prevention and preventing the fungus from spreading to other toenails may be the best treatment option. I recommend choosing a topical that you feel comfortable with and use it once a week. No matter which treatment option you choose, you should take the following steps to avoid re-infection.

1. Make sure you rotate your shoes often and keep them in a cool dry place.

2. Change your insoles frequently, and make sure they dry out between use.

3. Place an anti-fungal powder or spray in the shoes to help fight off the fungus.

4. Bleach out the shower on a weekly basis and wash your shower mat regularly in hot water.

5. Make sure your athletic shoes fit well to prevent jamming at the toes. Jamming at the toes leads to microtrauma at the nails and increases the chance for fungal infection.

6. If you belong to a gym or health club, wear sandals in the locker room and don't walk around barefoot.

7. Don't keep your shoes in the gym locker where they cannot dry out.

8. If your feet sweat excessively, try using an antiperspirant spray on your feet before your workout.

9. Cut your toenails straight across. Don't cut too short and cause breaks in the skin. This will increase the chance for fungal infection. Don't let the toenails grow too long or they will jam against the shoe and cause bleeding under the nail, again increasing the chance for fungal infection.

The bottom line is that treating onychomycosis is very difficult. If you have fungal toenails that cause pressure, pain or infection, consider talking to your doctor about prescription medications or nail removal. Make sure you take precautions to prevent re-infection and take multiple approaches to eradicate the problem. If your fungal toenails are only unsightly and don't cause any discomfort, try a weekly application of an over the counter topical along with methods to prevent re-infection.

By Christine Dobrowolski


Benefits of a Virtual Top Doctor Consultant

Looking for the best doctor to suite your medical needs can be a problem, especially if you don't have time and you need to research the doctor's credentials. Whether you're in urgent need of help, or just need a second opinion, I will show you how to access all the information you need - through the Internet's Virtual Top Doctor Consultant.

Information on Doctors' Credentials Many organizations house comprehensive credentials, such as licensure, status and so forth. These organizations include:

American Board of Medical Specialists

American Medical Association

Federation of State Medical Boards

Your local State Medical Board

Public Citizen Questionable Doctors

Medical Societies



Then you have other establishments which gather up this information in their own logistical format and provide this information to consumers. Most companies provide information about doctors who have had disciplinary action taken against them. And most consumers want to know whether their doctor has had disciplinary action taken against them. At the same time, most doctors - even the best ones - are sued at one point or other during their careers. It's important to recognize that just because a doctor has been sued (or not) does not mean he/she is incompetent, and that very often he or she is innocent of the alleged malpractice.What is a Virtual Top Doctor Consultant As you probably know by now, there are literally hundreds of different types of consultants. We all want the best health care possible, so why don't we shop around for a doctor like we do for a house or car? Over the past few years, through our own surveys and methodologies, MDNationwide has designed the first top doctor searchable database, which enables YOU to find the best doctor(s) in America without ever talking to anyone.

Virtual Top Doctor Consultant researches thousands of MDs through an extensive process, which reviews:

How many years the doctor has been in service (over five years).

Whether the doctor is board-certified.

Whether disciplinary action has been taken.

The extent of the doctors' Internship, Residency, and Fellowship training

Peer and patient recognition

Their community involvement

Experience with type of surgical procedure

Contacting medical societies

Contacting hospitals



Because YOU come first For peace of mind YOU know these MDs rank amongst the highest in the US

We focus only on helping YOU find the best doctors through our extensive research

YOUR Health is in good hands virtual top doctor consultant

YOU have a team of professional consultants who care about YOU, not just your money.

No, we are not doctors, we are experts in researching and recognizing the BEST MDs.

Doctors don't pay us, Health Insurance companies don't pay us.

We work for YOU; without YOU ours services would not exist.



By Hugo Gallegos


6.6.08

Benefits of a Virtual Top Doctor Consultant

Looking for the best doctor to suite your medical needs can be a problem, especially if you don't have time and you need to research the doctor's credentials. Whether you're in urgent need of help, or just need a second opinion, I will show you how to access all the information you need - through the Internet's Virtual Top Doctor Consultant.
Information on Doctors' Credentials Many organizations house comprehensive credentials, such as licensure, status and so forth. These organizations include:
American Board of Medical Specialists
American Medical Association
Federation of State Medical Boards
Your local State Medical Board
Public Citizen Questionable Doctors
Medical Societies

Then you have other establishments which gather up this information in their own logistical format and provide this information to consumers. Most companies provide information about doctors who have had disciplinary action taken against them. And most consumers want to know whether their doctor has had disciplinary action taken against them. At the same time, most doctors - even the best ones - are sued at one point or other during their careers. It's important to recognize that just because a doctor has been sued (or not) does not mean he/she is incompetent, and that very often he or she is innocent of the alleged malpractice.What is a Virtual Top Doctor Consultant As you probably know by now, there are literally hundreds of different types of consultants. We all want the best health care possible, so why don't we shop around for a doctor like we do for a house or car? Over the past few years, through our own surveys and methodologies, MDNationwide has designed the first top doctor searchable database, which enables YOU to find the best doctor(s) in America without ever talking to anyone.
Virtual Top Doctor Consultant researches thousands of MDs through an extensive process, which reviews:
How many years the doctor has been in service (over five years).
Whether the doctor is board-certified.
Whether disciplinary action has been taken.
The extent of the doctors' Internship, Residency, and Fellowship training
Peer and patient recognition
Their community involvement
Experience with type of surgical procedure
Contacting medical societies
Contacting hospitals

Because YOU come first For peace of mind YOU know these MDs rank amongst the highest in the US
We focus only on helping YOU find the best doctors through our extensive research
YOUR Health is in good hands virtual top doctor consultant
YOU have a team of professional consultants who care about YOU, not just your money.
No, we are not doctors, we are experts in researching and recognizing the BEST MDs.
Doctors don't pay us, Health Insurance companies don't pay us.
We work for YOU; without YOU ours services would not exist.

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