Tuesday, April 26, 2016

Health Care and Endocrinology

You may have heard the word Endocrinology used in a sentence by a health care professional, like your family physician or someone that has had to visit an endocrinologist, but not really know what it is or what part of your body is the primary focus for this type of medical need. is a specialty of medicine; some would say a sub-specialty of internal medicine, which deals with the diagnosis and treatment of diseases related to hormones.

Endocrinology also focuses on the endocrine glands and tissues that secrete hormones, and it is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the integration of developmental events proliferation, growth, and differentiation, and the psychological or behavioral activities of metabolism, growth and development, tissue function, sleep, digestion, respiration, excretion, mood, stress, lactation, movement, reproduction, and sensory perception caused by hormones.

From a clinical and research perspective, the Endocrine Society (100 years old this year) does a significant amount of scientific study about this particular field of medicine. The Society offers scientific statements to educate basic scientists, clinical scientists, and clinicians on the scientific basis of disease and its application to the practice of medicine with regard to both prevention and management.

Scientific statements provide an overview of basic and clinical science content on topics of emerging importance. Content is evidence-based to the extent possible but also identifies areas of basic or clinical knowledge that require additional research. Topics are selected on the basis of their emerging scientific impact on disease and broad clinical relevance to the general population. Much more detailed material is located at this website: http://www.endocrine.org/about-us .

According to the Society for Endocrinology, at its simplest, a hormone is a chemical messenger from one cell (or group of cells) to another. Hormones are released in the body and have an effect on other parts of the body. The effect is to communicate with other distant parts of the body. So for example, the adrenal glands may secrete adrenalin, which has an effect on several different organs. An endocrine gland is a gland which secretes hormones. Not all glands are classified as endocrine glands. For example, sweat glands or lymph glands are not endocrine glands).

Hormones are found in all organisms with more than one cell, and so they are found in plants and animals. They influence or control a wide range of physiological activities, such as growth, development, puberty, level of alertness, sugar regulation and appetite, bone growth and other bodily functions. You also find that problems with hormones and the way they work contribute to some of the major diseases of mankind; for example, diabetes, thyroid conditions, pituitary conditions, some sexual problems, some neurological problems, appetite and obesity, bone problems, cancer, and more. Additional info is found at this site: http://www.endocrinology.org/ .

The Journal of Endocrinology is a leading global journal, available through the Society of Endocrinology, that publishes original research articles, reviews and science guidelines. Its focus is on endocrine physiology and metabolism, including hormone secretion; hormone action; biological effects. The journal publishes basic and translational studies at the organ, tissue and whole organism level. You can find more information at this site: http://joe.endocrinology-journals.org/  

The American Association of Clinical Endocrinologists (AACE), founded in 1991, now has over 7,000 members who work together as a professional community of physicians specializing in endocrinology, diabetes, and metabolism committed to enhancing the ability of its members to provide the highest quality of patient care. Their website has significant information on the study of endocrinology and provides a detailed list of definitions for anyone seeking to know more about this type of medicine. More info can be found at this website: https://www.aace.com/about/mission .

On a more detailed basis, according to the American College of Physicians, endocrinologists are frequently involved with the diagnosis and management of these health care problems:
·         Hypothalamic disorders (abnormal sodium and water balance)
·         Pituitary diseases (tumors, over- or underproduction of pituitary hormones)
·         Parathyroid abnormalities (hypercalcemia, hypocalcemia)
·         Thyroid diseases (hyperthyroidism, hypothyroidism, goiter, nodules)
·         Adrenal cortex dysfunction (mineralcorticoid, glucocorticoid, sex hormone abnormalities)
·         Gonadal disease (hypogonadism and reproductive disorders)
·         Pancreatic endocrine disease (diabetes mellitus)
·         Bone metabolism (osteoporosis)
·         Lipid metabolism
·         Iatrogenic effect of glucocorticoids

Training in endocrinology includes two years of additional training following successful completion of a basic internal medicine residency training program. More details are found at this website: https://www.acponline.org/about-acp/about-internal-medicine/internal-medicine-subspecialties/endocrinology-diabetes-and-metabolism .

An additional materials resource is this site: http://www.nature.com/nrendo/index.html , where you can find detailed scholarly journals and research information about endocrinology. And, Healio online has some very good materials about this type of medicine: http://www.healio.com/endocrinology .

There are many good hospitals and health care organizations in the US that have special sections and staff allocated to the study of endocrinology. One of them is Children’s Hospital of Dallas, and you can find more details about their treatment options at this site: https://www.childrens.com/specialties-services/specialty-centers-and-programs/endocrinology .

Another great location for treatment, especially for adults who need specialty care, is located at the University of Chicago Department of Medicine. Their 3-fold mission: (1) to provide excellence in patient care; (2) to perform cutting-edge basic, clinical and translational research in endocrine diseases, diabetes, obesity and hypertension; and (3) to provide outstanding educational opportunities for medical students, house staff and fellows. More information is located at this site: http://medicine.uchicago.edu/endo/index.html .

Hormones are a huge part of what makes your body tick. Endocrinologists are medical specialists that can help determine what may be out of whack if you are experiencing symptoms or medical issues that need more detailed study and care. Talk with your doctor or a medical professional who can assist you in getting the quality of care you need for any problems dealing with hormonal imbalances. It’s worth your time.

Until next time. 

Friday, April 8, 2016

Health Care and Data Breaches

This blog post is my 500th article!!! 

One of the most critical issues in the healthcare field today, for medical providers and facilities and for consumers, is the breach of personal health care information. The theft of personal medical records is big money on the black market, and ID theft due to that crime is rampant.

According to Modern Healthcare magazine, 2016 is being deemed the “year of data security” in healthcare—if only because 2015 was a substantial wake-up call for the industry. Nearly 90 percent of healthcare providers have been hit by data breaches in the last two years, according to security research firm Ponemon Institute, with many large-scale and criminally driven attacks publicized in 2015. More details are located at this website: http://www.modernhealthcare.com/article/20160227/SPONSORED/160229900/2016-the-year-of-data-security

HIT Consultant reports that one in three Americans were victims of healthcare data breaches in 2015, attributed to a series of large-scale attacks that each affected more than 10 million individuals. These and other statistics are contained in Bitglass’ 2016 Healthcare Breach Report.

Among the most significant findings of the report was that in 2015, 98 percent of record leaks were due to large-scale breaches targeting the healthcare industry. These high-profile attacks were the largest source of healthcare data loss and indicate that cyber attackers are increasingly targeting medical data.

Such breaches include the widely publicized Premera Blue Cross hack involving 11 million customers, and the Anthem hack which resulted in 78.8 million leaked customer records. More info is located at this website: http://hitconsultant.net/2016/01/28/hackers-caused-98-of-healthcare-data-breaches/ .

According to Health IT Security, 80 percent of organizations handling sensitive information report concern for large-scale data breaches, based on a survey conducted by Advisen. This survey included organizations from several different industries, but the most highly represented industry was healthcare, comprising 22 percent of the respondent sample.

Despite the growing concern for large-scale data breaches, the study’s authors report that organizations may not be doing enough. While three quarters of respondents report having some sort of data breach response plan, these plans may not go through rigorous enough testing. You can find more material on this subject at this site: http://healthitsecurity.com/news/large-data-breaches-top-worry-for-health-pros-survey-shows .

Forbes Magazine reported that 2015 was the worst year yet for data breaches. The online mechanism for the Office of Civil Rights (OCR) under Health and Human Services publishes data breaches as reported to them and required by HIPAA. The numbers last year are just staggering:

·         According to OCR, there were 253 healthcare breaches that affected 500 individuals or more with a combined loss of over 112 million records.
·         The top 10 data breaches alone accounted for just over 111 million records that were lost, stolen or inappropriately disclosed.
·         The top six breaches affected at least 1 million individuals–and four of the six were Blue Cross Blue Shield organizations.

While HIPAA is the legislation (passed in 1996) designed to protect patients against loss, theft or disclosure of their sensitive medical information, the fines and penalties don’t appear to be having a discernible effect on either patient privacy or data security.

A recent data breach study estimates that breaches cost the healthcare industry about $5.6 billion annually. As healthcare moves toward connected care, the amount of data exchanged between organizations is only going to grow. So what does this mean? It means that in 2016, the healthcare industry is going to see a huge movement towards encryption in hospitals and other healthcare facilities in order to protect EHRs (electronic health records) and other vulnerable PHI (Personal Health Information). More detailed material is located at this website: http://www.forbes.com/sites/danmunro/2015/12/31/data-breaches-in-healthcare-total-over-112-million-records-in-2015/#3f9cb33b7fd5 .

Oddly enough, however, according to Health IT Security, the first few months into 2016 are showing a slightly different trend, with results from the Department of Health and Human Services (HHS) indicating that stolen devices and improper disposal are the top threats currently facing the industry. Patient names, addresses, phone numbers, Social Security numbers, dates of birth, health insurance numbers, other medical status and assessment information as well as some financial information have been exposed with these incidents.

The top five healthcare data breaches of this year so far do not involve hacking or an IT incident, according to the HHS Office for Civil Rights (OCR) data breach reporting tool. Instead, theft, loss, improper disposal, and unauthorized email access or disclosure have caused the largest incidents in 2016. More info is located at this website: http://healthitsecurity.com/news/top-5-healthcare-data-breaches-in-2016-not-from-hacking .

According to IT Business Edge, a big part of the problem is that security organizations are still focused on preventative security — looking for a silver bullet that will keep an attacker out of their networks in the first place. Despite a Gartner recommendation that organizations shift security efforts toward the detection of network intruders and the emergence of promising new behavioral analytic tools and security strategies, well under 1 percent of enterprises have the ability to find a post-intrusion network attacker. Cyber criminals continue to have the potential for unimpeded, long-term success. More info is located at this site: http://www.itbusinessedge.com/slideshows/2016-security-trends-whats-next-for-data-breaches-06.html .

Hospitals, health systems, payers and any organization with stewardship of healthcare data are prime targets for cyberattacks, according to Becker’s Hospital Review (BHR). And there are plenty of cautionary tales showing just how much damage hackers can do. While no healthcare organization will ever be completely invulnerable to such attacks, they can learn from others' mistakes.

Here are four lessons, according to BHR, healthcare providers can consider when thinking about data breach prevention and preparedness:
1.    Don't fall prey to known vulnerabilities.
2.    Utilize experience-based training.
3.    Consider a third party for security audits.
4.    Create a contingency plan.

Businesses, especially in the healthcare field, must always make every effort to protect patient information. That is their responsibility, and they can be held civilly responsible, and criminally responsible if there is a proven negligent act. As a consumer, you may receive a letter or an email informing you that your personal information may have gotten into the wrong hands as a result of a data breach.  Perhaps a media report alerted you to a security breach at a company where you do business.

Regardless of the type of data breach, medical information is more difficult to recover, manage, and restore, especially for consumers. According to Privacy Rights Clearinghouse, there are helpful tips on what to do if a breach has occurred. Much more detail is located at this website: https://www.privacyrights.org/how-to-deal-security-breach .

Always be diligent to monitor your healthcare information. Take steps to protect your personal data, and never provide your information to businesses that have no protection or privacy capabilities in place. Always ask who will see your information, and request a copy of their privacy policies. If you discover that a breach has occurred, take quick action to reduce the exposure and limit the damage that can be done. It’s your life. Keep it secret. Keep it safe.

Until next time. 

Friday, April 1, 2016

Health Care and FMLA

The Family and Medical Leave Act (FMLA) was passed as a federal law in 1993, requiring covered employers to provide employees job-protected and paid leave for qualified medical and family reasons. Qualified medical and family reasons include: personal or family illness, family military leave, pregnancy, adoption, or the foster care placement of a child. The FMLA was intended "to balance the demands of the workplace with the needs of families."

According to the US Department of Labor, the FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to the following benefits:

--Twelve workweeks of leave in a 12-month period for:
·         the birth of a child and to care for the newborn child within one year of birth;
·         the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;
·         to care for the employee’s spouse, child, or parent who has a serious health condition;
·         a serious health condition that makes the employee unable to perform the essential functions of his or her job;
·         any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty;” or

--Twenty-six workweeks of leave during a single 12-month period to care for a covered service member with a serious injury or illness if the eligible employee is the service member’s spouse, son, daughter, parent, or next of kin (military caregiver leave).  More information is available at this website: http://www.dol.gov/whd/fmla/ .

But there are some qualifiers for someone who is employed that wants to use this as a legal way to take time off from work for medical or family reasons. In order to be eligible for FMLA leave, an employee must have been at the business at least 12 months, and worked at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles. The FMLA covers both public- and private-sector employees, but certain categories of employees are excluded, including elected officials and their personal staff members.

Generally, the FMLA requires an employee to give his or her employer 30 days' notice of intention to take FMLA leave, and the reason for the leave, according to FindLaw.com. There is no "magic language" that the employee must use in notifying the employer, nor does the employee need to mention the FMLA by name. Instead, the notice must give the employer enough information to know the employee is requesting time off, and why.

This allows the employer to determine if the request qualifies under the FMLA, and allows time to find a replacement for the employee. When the need for FMLA leave arises suddenly, like an unexpected medical emergency, employees may take FMLA leave without prior notice. However, employees must give the employer as much notice as is reasonable under the circumstances. More detailed material about this law is available at this site: http://employment.findlaw.com/family-medical-leave/family-and-medical-leave-act.html .

According to the National Partnership for Women and Families (NPWF), America's workers have used the FMLA at least 200 million times to take time off when they need it most, without having to worry about losing their jobs or their health insurance. However, About 40 percent of the workforce is not eligible for leave under the FMLA. More info is located at this website: http://www.nationalpartnership.org/issues/work-family/fmla.html .

The FMLA can be abused by employees in some cases, especially on intermittent leave. Employers have some options to monitor the requests. One of the biggest employer complaints about FMLA is the productivity problems caused by employees’ use—and abuse—of FMLA intermittent leave. The problem: employees with chronic health problems often take FMLA leave in short increments of an hour or less. According to Business Management Daily, here are four tips on certifying FMLA intermittent leave requests:

1. Ask about the specific condition. Medical certification must relate only to the serious health condition that is causing the leave. Employers can’t ask about the employee’s general health or other conditions.

2. Give 15 days to respond. After requesting certification, give employees at least 15 calendar days to submit the paperwork. If the employee’s medical certification is incomplete or insufficient, specify in writing what information is lacking and allow the employee seven days to cure the deficiency.

3. If the need for leave is doubted, investigate the certification. Under the updated FMLA regulations, an organization can contact the employee’s physician directly to clarify the medical certification. The contact person can be a health care provider, a human resources professional, a leave administrator (including third-party administrators) or a management official, but not the employee’s direct supervisor.

4. If the request is still not convincing, require (and pay for) a second opinion. Use an independent doctor selected by the employer, not a doctor who works for your organization. If the two opinions conflict, the employer can pay for a third and final, binding medical opinion

The law gives employers the right to demand certification from the employee’s doctor of his or her need for leave. More information on this topic is found at this website: http://www.businessmanagementdaily.com/glp/25988/FMLA-Intermittent-Leave.html .

According to FMLAOnline.com, the Family and Medical Leave Act is an on-going challenge for HR professionals. Because its rules are so complex, companies are vulnerable to FMLA abuse, exploitation, and miscomprehension. It takes only one confused or misinformed employee to cost a business tens of thousands of dollars in FMLA lawsuits. There are three different kinds of FMLA leave:

·         Continuous FMLA leave: An employee is absent for more than three consecutive business days and has been treated by a doctor.

·         Intermittent FMLA leave: An employee is taking time off in separate blocks due to a serious health condition that qualifies for FMLA. Intermittent leave can be in hourly, daily, or weekly increments. Intermittent FMLA is often taken when an employee needs ongoing treatment for their condition.

·         Reduced schedule FMLA leave: An employee needs to reduce the amount of hours they work per day or per week, often to care for a family member or to reduce stress.

All FMLA forms and information about an employee’s FMLA leave and condition must be kept confidential and separate from other employee files. It is an FMLA violation for an employer to share information about an employee’s FMLA leave with other employees. Additional material on FMLA policies is located at this site: http://fmlaonline.com/ .

According to HRHero.com, employers must keep accurate records pertaining to the leave and either physically or electronically post a notice of employees’ rights under the FMLA so that the information is accessible to both employees and job applicants. Furthermore, the FMLA requires employers to maintain the employee’s group health benefits while on leave on the same terms that it provided them when the employee was working.

Leave taken under the FMLA is job-protected, which means that employees must be given the same job or an equivalent job when they return. Employees or the Department of Labor can sue the employer for lost wages, benefits, reinstatement, attorneys’ fees, and liquidated damages for willful violations. Additional information is located at this site: http://topics.hrhero.com/family-and-medical-leave-act-fmla/ .

The FMLA is a definite benefit for qualified employees, and employers have certain protections under the law if there is suspected abuse or violation of FMLA. Going forward, both employees and employers must know the law and follow it to avoid any problems. Both family and medical leave is important in circumstances that mandate time away from work. The key is to understand how it works and how to manage it.

Until next time. 

Tuesday, March 29, 2016

Health Care and Your Gallbladder

The gallbladder is a 4-inch, pear-shaped organ. It’s positioned under your liver in the upper right section of your abdomen. The gallbladder stores bile, a combination of fluids, fat, and cholesterol. Bile helps break down fat from food in your intestine. The gallbladder delivers bile into the small intestine. This allows fat-soluble vitamins and nutrients to be more easily absorbed into the bloodstream. If you have problems with your gallbladder, you can feel very sick and not know exactly what’s going on until you get medical attention.

According to Every Day Health.com, the gallbladder releases bile, via the cystic duct, into the small intestine to help break down the foods you eat — particularly fatty foods. Typically the gallbladder doesn't cause too many problems or much concern, but if something slows or blocks the flow of bile from the gallbladder, a number of problems can result. Most gallbladder symptoms start with pain in the upper abdominal area, either in the upper right or middle. Below are common symptoms of gallbladder conditions:

·         Severe abdominal pain
·         Pain that may extend beneath the right shoulder blade or to the back
·         Pain that worsens after eating a meal, particularly fatty or greasy foods
·         Pain that feels dull, sharp, or like cramps
·         Pain that increases when you breathe in deeply
·         Chest pain (angina)
·         Heartburn, indigestion, and excessive gas
·         A feeling of fullness in the abdomen
·         Vomiting, nausea, fever
·         Shaking with chills
·         Tenderness in the abdomen, particularly the right upper quadrant
·         Jaundice (yellowing of the skin and eyes)
·         Stools of an unusual color (often lighter, like clay)

Some gallbladder problems, like simple gallstones that are not blocking the cystic duct, often cause no symptoms at all. They're most often discovered during an x-ray or CT scan that's performed to diagnose a different condition, or even during an abdominal surgery. More detailed info is located at this website: http://www.everydayhealth.com/gallbladder/symptoms/ .

Gallstones form when substances in bile harden. Rarely, you can also get cancer in your gallbladder, according to the National Institutes for Health (NIH). Many gallbladder problems get better with removal of the gallbladder. Fortunately, you can live without a gallbladder. Bile has other ways of reaching your small intestine. More details are found at this site: https://www.nlm.nih.gov/medlineplus/gallbladderdiseases.html .

According to HealthLine.com, any disease that affects your gallbladder is considered a gallbladder disease. Symptoms of a gallbladder problem may come and go. However, you’re more likely to develop a gallbladder problem if you’ve previously had one. While gallbladder problems are rarely deadly, they should still be treated. You can prevent gallbladder problems from worsening if you take action and see a doctor. More info is found at this website: http://www.healthline.com/health/gallbladder-problems-symptoms#3 .

Some problems associated with the gallbladder are gallstones, gallbladder attack and gallbladder disease. Gallbladder pain is usually caused by biliary colic, gallstones, cholecystitis, pancreatitis and cholangitis, according to LiveScience.com. Gallstones in particular are troublesome, and they are solidified particles of substances in the bile. They are made of a combination of bile salts, cholesterol and bilirubin. 

Gallstones can be as small as a grain of sand or as large as a golf ball. Gallstones can block the gallbladder ducts so that bile cannot reach the small intestine as effectively, which may prevent the gallbladder from doing its job and can lead to other gallbladder diseases. And, while most gallstones pass on their own, some require a minor procedure or even surgery.

According to the Mayo Clinic, factors that contribute to the risk of gallstones include obesity, high-fat or high-cholesterol diets, diabetes and taking medicines with estrogen. Women, people over 60, Native Americans and Mexican-Americans are also at a higher level of risk. Symptoms of a gallbladder attack may be similar to those of a heart attack and other conditions, so it is important to consult a doctor for a correct diagnosis. More info about the gallbladder is located at this site: http://www.livescience.com/42965-gallbladder.html .

Gallbladder problems are more common than you may think. Gallstones affect more than 25 million Americans with 1 million new cases diagnosed annually, according to the American Gastroenterological Association. And there are other things that go wrong with the gallbladder besides just gallstones, according to GallbladderAttack.com. People can go for years with digestive symptoms and never realize that they may be related to a gallbladder problem.

That's because they are so interwoven with other digestive symptoms such as indigestion, gas, bloating, constipation, diarrhea and nausea. Much more detailed material is located at this website, including some naturopathic options for treatment: http://www.gallbladderattack.com/gallbladdersymptoms.shtml .

Because gallstones are related to diet, particularly fat intake, the incidence of gallstones varies widely among nations and regions. For example, Hispanics and Northern Europeans have a higher risk for gallstones than do people of Asian and African descent. People of Asian descent who develop gallstones are most likely to have the brown pigment type, according to the University of Maryland Medical Center (UMMC).

Also, having a family member or close relative with gallstones may increase the risk. Up to one-third of cases of painful gallstones may be related to genetic factors. Studies indicate that the disease is complex and may result from the interaction between genetics and environment. Some studies suggest immune and inflammatory mediators may play key roles.

The UMMC reports as well that people with diabetes are at higher risk for gallstones and have a higher-than-average risk for acalculous gallbladder disease (without stones). Gallbladder disease may progress more rapidly in patients with diabetes, who tend to have worse infections. As well, being obese or overweight is a significant risk factor for gallstones. In such cases, the liver over-produces cholesterol, which is delivered into the bile and causes it to become supersaturated.

Men are also at increased risk for developing gallstones when their weight fluctuates. The risk increases proportionately with dramatic weight changes as well as with frequent weight cycling. For a significant in-depth study of gallbladder health issues, visit this website: http://umm.edu/health/medical/reports/articles/gallstones-and-gallbladder-disease .

If you have gallbladder disease, your gastroenterologist may recommend removing your gallbladder, according to the Florida Medical Clinic. You may need a referral from your family doctor if you don’t already have a specialist in this area of treatment. The surgical removal of the gallbladder is called a cholecystectomy. Gastroenterology is the study of the normal function and diseases of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. More details are found at this site: https://www.floridamedicalclinic.com/recognizing-the-symptoms-of-a-gallbladder-attack/ .

If you feel you may be experiencing symptoms of a gallbladder attack, get to your doctor or a medical facility as soon as possible to rule out other possible health issues. Get an action plan to deal with your pain and for any treatment that is recommended. The short and long term effects of getting a proper diagnosis and follow through is critical to reduce pain and suffering.

Until next time. 

Monday, March 14, 2016

Health Care and Head Trauma

From a simple bump to a concussion to death, getting a quick diagnosis for head trauma is critical. Brain dysfunction can be caused by an outside force, usually a violent blow to the head, and can result in many serious side effects. Brain injury or trauma often occurs as a result of a severe sports injury or car accident.

According to the Merck Manuals,
in the United States, about 13 in 10,000 people sustain minor head injury, and about 3 in 10,000 sustain severe head injury each year. In the United States, from 2002 to 2006, about 1.7 million civilians had traumatic brain injury (TBI) each year. About 1.4 million were treated and released from emergency departments. About 275,000 were hospitalized and discharged alive, and 52,000 died.

TBI (traumatic brain injury) is responsible for about 33% of all deaths caused by injuries of any kind. About 5.3 million people have permanent disabilities due to head injury. About 25% to 33% of people in the United States who have a severe head injury die. More information is located at this site: http://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/overview-of-head-injuries .

About half of head injuries result from motor vehicle crashes, and head injuries occur in more than 70% of severe motor vehicle crashes. Other common causes are falls (especially in older adults and young children), assaults, and mishaps during sports or recreational activities. Mishaps in the workplace (for example, while operating machinery) and firearms also cause head injuries.

Often, injury is caused by direct impact. However, the brain can be damaged even if the head has not been hit. For example, violent shaking or sudden deceleration can damage the soft brain as it collides with the rigid skull. In such cases there may be no visible injuries to the head.

According to the Mayo Clinic, Most head trauma involves injuries that are minor and don't require specialized attention or hospitalization. However, even minor injuries may cause persistent chronic symptoms, such as headache or difficulty concentrating, and you may need to take some time away from many normal activities to get enough rest to ensure complete recovery. Call 911 or your local emergency number if any of the following signs or symptoms are apparent, because they may indicate a more serious head injury.

·         Severe head or facial bleeding
·         Bleeding or fluid leakage from the nose or ears
·         Severe headache
·         Change in level of consciousness for more than a few seconds
·         Black-and-blue discoloration below the eyes or behind the ears
·         Cessation of breathing
·         Confusion
·         Loss of balance
·         Weakness or an inability to use an arm or leg
·         Unequal pupil size
·         Slurred speech
·         Seizures

·         Any of the signs or symptoms for adults
·         Persistent crying
·         Refusal to eat
·         Bulging in the soft spot on the front of the head (infants)
·         Repeated vomiting

Keep in mind that even a minor head bump can cause a large swelling. And the speed, momentum and size of the people (full-grown adolescents versus young children), and the forces involved (such as impact with a concrete floor or other hard surface) may increase the possibility of serious injury. More information about head trauma is found at this website: http://www.mayoclinic.org/first-aid/first-aid-head-trauma/basics/art-20056626 .

There are several types of brain trauma, according to Family Doctor. The following categories should be treated immediately by medical professionals:

A concussion is a jarring injury to the brain. Most of the time it doesn't involve a loss of consciousness. A person who has a concussion may feel dazed and may lose vision or balance for a while after the injury.

      A brain contusion is a bruise of the brain. This means there is some bleeding in the brain, causing swelling.

      A skull fracture is when the skull cracks. Sometimes the edges of broken skull bones cut into the brain and cause bleeding or other injury.

      A hematoma is bleeding in the brain that collects and clots, forming a bump. A hematoma may not be apparent for a day or even as long as several weeks. So it's important to tell your doctor if someone with a head injury feels or acts oddly. Watch out for headaches, listlessness, balance problems or throwing up.

It's normal to have a headache and nausea, and feel dizzy right after a head injury. Other symptoms include ringing in the ears, neck pain, and feeling anxious, upset, irritable, depressed or tired. The person who has had a head injury may also have problems concentrating, remembering things, putting thoughts together or doing more than one thing at a time. These symptoms usually go away in a few weeks, but may go on for more than a year if the injury was severe. More details are available at this site: http://familydoctor.org/familydoctor/en/diseases-conditions/head-injuries.html .

Sport’s professional participants sustain severe brain injuries at far higher rates than the general population, according to the New York Times. They also appear to confirm what scientists have said for years: that playing football increases the risk of developing neurological conditions like chronic traumatic encephalopathy, a degenerative brain disease that can be identified only in an autopsy. An article reporting the link between concussions and long term health problems is found at this site: http://www.nytimes.com/2014/09/13/sports/football/actuarial-reports-in-nfl-concussion-deal-are-released.html?_r=0 .

Head trauma, or traumatic brain injuries (TBI), result in permanent neurobiological damage that can produce lifelong deficits to varying degrees. The impact on a person and his or her family can be devastating.   More info is available at this website: http://www.traumaticbraininjury.com/ .

Head trauma should be treated without delay. Always check with your doctor or a health care professional if you or a loved one suffers an injury or accident to the head. Although many blows to the head may not cause any difficulties, it’s always best to take an extra measure of preventive medical care to rule out the possibilities of any long term problems.

Until next time.

Friday, February 26, 2016

Health Care and Ambulatory Care

Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.

According to Modern Healthcare magazine, there is a new trend toward building medical facilities that focus on treating and releasing patients on an ambulatory basis. One of the big drivers of the trend toward bedless hospitals is cost. Under pressure from insurers and consumers, hospital systems have been shifting to lower-cost outpatient care, from which they generally earn higher margins than inpatient care.

But a lot of this also is driven by consumer demand and the evolution of technology. Many health systems are forgoing traditional hospital expansions and building free-standing emergency centers away from main hospitals. More details about this topic are located at this site: http://www.modernhealthcare.com/article/20150912/MAGAZINE/309129973 .

Patients do not stay overnight in the facility, according to the Virginia Department of Health. The term "ambulatory care" encompasses a large variety of healthcare settings that include but are not limited to physician offices, urgent care centers, dialysis facilities, ambulatory surgical centers, cancer clinics, imaging centers, endoscopy clinics, public health clinics, and other types of outpatient clinics. Information and studies are available at this website: http://www.vdh.virginia.gov/epidemiology/surveillance/hai/ambulatory.htm .

According to Healthcare Design, the prospect of this greatly expanded customer base, along with a focus on wellness and incentives to deliver care more efficiently, has U.S. hospitals and health systems looking at how and where they treat patients who will be more actively engaged in their own health and well-being.  Going to where the customer is—out in the community—is a primary strategy that has hospitals and health systems around the country busily forming networks of ambulatory care centers, physician practices, and urgent care centers.

To attract patients who will have a number of choices for where they receive their healthcare, providers are also upgrading facilities to support a new model of delivery that will rely heavily on technology and teamwork. Details on this topic are located at this site: http://www.healthcaredesignmagazine.com/article/ambulatory-care-centers-make-their-move .

A body of research dedicated to patient safety in ambulatory care has emerged over the past few years. These efforts have identified and characterized factors that influence safety in office practice, the types of errors commonly encountered in ambulatory care, and potential strategies for improving ambulatory safety, according to the Patient Safety Network.

Ensuring patient safety outside of the hospital setting poses unique challenges for both providers and patients. A new model for patient safety in chronic disease management, modified from the original Chronic Care Model. This model broadly encompasses three concepts that influence safety in ambulatory care:
·         The role of patient and caregiver behaviors
·         The role of provider–patient interactions
·         The role of the community and health system

Part of the overview of ambulatory care includes the quality of patient safety both during and after treatment. Improving outpatient safety will require both structural reform of office practice functions as well as engagement of patients in their own safety. While Electronic Health Records (EHRs) hold great promise for reducing medication errors and tracking test results, these systems have yet to reach their full potential.

Coordinating care between different physicians remains a significant challenge, especially if the doctors do not work in the same office or share the same medical record system. Efforts are being made to increase use of EHRs in ambulatory care, and physicians believe that use of EHRs leads to higher quality and improved safety. Tools to help track and improve patient quality of life and treatment options during and after release need continual review for efficacy and improvement.

Patient engagement in outpatient safety involves two related concepts: first, educating patients about their illnesses and medications, using methods that require patients to demonstrate understanding (such as "teach-back"); and second, empowering patients and caregivers to act as a safety "double-check" by providing access to advice and test results and encouraging patients to ask questions about their care. Success has been achieved in this area for patients taking high-risk medications, even in patients with low health literacy at baseline. More detailed info is located at this website: https://psnet.ahrq.gov/primers/primer/16/patient-safety-in-ambulatory-care .

According to the US Bureau of Labor Statistics, industries in the Ambulatory Health Care Services subsector provide health care services directly or indirectly to ambulatory patients and do not usually provide inpatient services. Health practitioners in this subsector provide outpatient services, with the facilities and equipment not usually being the most significant part of the production process. If  you are considering a career in ambulatory care, this site provides an in-depth overview of that trend in healthcare as well as the growth potential: http://www.bls.gov/iag/tgs/iag621.htm .

Additionally, the Accreditation Association for Ambulatory Health Care (AAAHC) was founded in 1979 to: "encourage and assist ambulatory health care organizations to provide the highest achievable level of care for recipients in the most efficient and economically sound manner. The AAAHC accomplishes this by the operation of a peer-based assessment, consultation, education and accreditation program." If you are a patient in an ambulatory medical facility, you’ll want to know if that location and its staff are part of this organization. More information on the AAAHC is found at this website: http://www.aaahc.org/about/history/ .

Ambulatory care is getting more traction in the medical community due to changes in the overall healthcare environment. Ease of access, quality of care, and cost are contributing factors to its growth in locations and popularity. Although not a complete answer to all medical needs, ambulatory care helps cut the expense of unnecessary inpatient medical care.  

Until next time.