65 Search Results for "doctor"

• Patient Handout: Popliteal Art

  • From: JKintec
  • Description:

     

    Patient Handout: Popliteal Artery Entrapment Syndrome

    What is Popliteal Artery Entrapment Syndrome?

    ·      It is a very uncommon syndrome in which the major blood vessel in the back of the knee becomes compressed by the muscle or tendon in the calf. The compression of this blood vessel can create a complete blockage of blood flow to the lower leg.

    How do I know if I have Popliteal Artery Entrapment Syndrome?

    ·      You may experience cramping, numbness, or sharp pain in the lower leg and foot

    ·      The lower leg and foot may look pale and feel cool to the touch

    ·      Pain may be experienced when sitting, standing or walking for extended periods of time

    ·      Relief from pain is felt immediately after stopping the exercise

    How is it commonly treated?

    ·      In order to feel relief from the symptoms, surgery in strongly recommended.

    How do I know if I need surgery?

    ·      If these signs and symptoms persist for any extended period of time it is recommended that you go see your doctor.

    ·      Your doctor will be able to use a physical exam along with different imaging techniques to diagnose the syndrome and its severity.

    ·      Surgery is recommended for all but minor cases.

    Is surgery a good idea?

    ·      There are risks associated with any surgery, but according to medical literature there is a high success rate in which normal blood flow within the vessel can be restored and maintained.

    When Can I return to Everyday Activity?

    ·      Patients are typically discharged the same day as the surgery

    ·      You will be able to return to your daily activities, including work, about 3 weeks after surgery

    How do I prevent reoccurrence following surgery?

    ·      Following surgery and recovery, most patients showed no reoccurrence of signs and symptoms of Popliteal Artery Entrapment Syndrome.

    ·      Patient follow ups have been performed up to 8 years following surgery in which patients have been able to sit, stand and walk for prolonged periods of time without pain. 

     

  • Blog post
  • 1 week ago
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• YouTube and You

  • From: skern
  • Description:

    Should an OB/GYN send his patients a “friend request” to become a friend on his Facebook Page? A Harvard law professor recently reported that one of her friends had received such a request, and it made her extremely uncomfortable. She felt that her relationship with her doctor had been a professional one, not a friendship.

    Since you are reading about this on a blog, chances are you know about Facebook. For those of you unfamiliar with Facebook and the social networking phenomenon sweeping the country (e.g. those without teenagers), a “friend request” is an e-mail inviting you to access a person’s Facebook page. That page, created by the person asking you to become a “friend” could include information ranging from his baby pictures to his latest article in JAMA.

    Even though a Facebook page may be completely professional, the notion of being invited to be a “friend” connotes a degree of familiarity that some may consider unprofessional. Certainly, the OB/GYN’s patient did not understand that the term “friend” is a term of art associated with Facebook. Then again, would this patient have felt the same way if the “friend request” had come from her dermatologist or cosmetic surgeon? Would she have felt the same if she were younger and a regular user of the social network? Probably not.

    Forty years ago, physician advertising was illegal. Then, the US Supreme Court ruled that blanket restrictions on advertising violated the First Amendment. Since that time, advertising by physicians, hospitals, and other health care providers has become pervasive. Social networking, however, will pose new challenges with new rules for physicians and other professionals who embrace this medium.

    Businesses are making social networking sites and their own YouTube channels part of their core marketing strategy. “Tweeting” one’s daily activities has become part of the daily routine of elected officials, professional athletes, and CEO’s. Yet when physicians use these same tools, they encounter unique challenges, legal issues, and sensitivities.

    Since patient reaction to social networking efforts may vary dramatically from patient to patient and may also depend upon the specialty of the physician sending the message. Careful thought and some test marketing should precede any social networking activity—be it Facebook, Twitter, or even a practice Web site.

    Conveying important information to your patients is a service that most patients would appreciate. Letting them know, for example, that you’ve received a supply of flu vaccine and giving them your recommendation as to whether they should receive the vaccine can be a valuable service. Expansion of office hours, the introduction of a new physician, changes in insurance plans with which you participate, and other information concerning your practice can provide patients with information that may make your practice more attractive. Telling patients about what you learned at a recent medical conference can let patients know that you continue to update your knowledge base, that you work hard to stay at the cutting edge of medical knowledge, and that new technologies, new drugs, or new procedures may offer benefits not previously available.

    The manner in which that information is conveyed, however, is all important. You wouldn’t call a patient at work to chat about your recent medical seminar, no matter how interesting it may have been. Providing that same information through a social network may be viewed as similarly intrusive if not handled appropriately. As such, though the content of a Facebook page may be professional and informative, the very request to join as a “friend” could convey a message which is anything but professional. Often, it’s not what you say, but how you say it.

    Before you decide to enter the social networking market consider your patient population and your specialty. Ask your patients what they think of the idea. If they are receptive, initially send friend requests to a few select patients who you believe will be open to the idea. Have your office follow-up and see what kind of response you receive. If the response is favorable, consider first sending a note to your remaining patients letting them know that they may receive a friend request. Explain that the request is simply an invitation to access professional information that may be of interest to them, as a “friend of the practice.” By taking the time and effort to explain your purpose, you may avoid unintended negative reaction or even charges of unprofessional conduct.

    In addition to assuring that your patients are receptive to the idea of having your practice as part of their social network, it is equally important to assure that the content of your communication is appropriate. A number of hospitals, including some of the nation’s most prestigious institutions, have already recognized the benefits of these new methods of communication. Their Web sites include information for patients concerning their areas of specialty, awards they’ve won, and patient information ranging from directions to the hospital to information on cancer and heart disease. However, hospitals also have legal departments that review content before it is distributed through the web. Among the things they watch for is any potential breach of patient confidentiality and videos which may portray their physicians and employees in a less than professional light.

    For example, videos mocking patients or their complaints, videos of professionals drinking at social events, dressed in costume for a skit, or acting silly may be fine to share among colleagues. However, patients generally do not want to perceive their physicians in this way. Their vision of a physician is that of a consummate professional—a person they can respect, confide in, and trust. They don’t want physicians to be their drinking buddies!

    Maintaining patient confidentiality is another imperative. Pictures of patients, distributed without their consent, can violate HIPAA. Even pictures of a portion of a patient’s body, which do not readily identify the patient, can cause problems, if the patient realizes that the picture is of his body part, and he has not given his consent to its use.

    Physicians contemplating using social networks should keep certain guidelines in mind. Do not merge your personal social site with your professional site. Your personal site should be limited to your close friends and not be accessible to patients or others. Even then, remember that today’s friend could be tomorrow’s competitor. Don’t post anything on your personal site that you wouldn’t want your spouse or your employer to see.

    Your professional site should be just that—professional. Post your vacation photos on your personal site, not your professional site. Limit your professional site to medical and practice information that your patients can use to their benefit. Be sure that the information you provide is accurate and does not breach any patient confidentiality. And, be sure that it is tasteful.

  • Blog post
  • 2 weeks ago
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• Fatigue And You

  • From: jcopel
  • Description:

    Several years ago, as we all know, the New York legislature, acting in response to the death of Libby Zion, mandated work-hour restrictions for residents. This has been adopted nationwide and now applies to fellows in training as well.

    This week in JAMA, Rothschild and colleagues take a look at attending surgeons and complications after nighttime surgery.¹ The study [abstract] evaluated complications after surgeons and Ob/Gyns had performed surgery the previous night and calculated the time spent from the end of the overnight surgery until the start of the next day’s case as a crude measure of how much sleep the surgeon might have gotten. It’s not perfect, but you know if there was less than 6 hours between the two, that’s the most that the surgeon could have slept. We don’t know if there was a longer interval whether the surgeon slept or not, and that could have made the data less able to detect effects of sleep deprivation.

    It is clear to me that if we require 30-year-old residents to limit their hours, we really need to be consistent and do the same for older physicians. While I no longer take night call, the last few years that I did it was very obvious that I didn’t seem to bounce back from a bad night as quickly as I used to.

    So I think it’s time for us to take the plunge. It won’t be easy, especially for those in small group settings, but I predict that there will be more and more research in this direction, suggesting that fatigue is real, and that we have to get sufficient rest to take good care of our patients. It will be important for practices and hospitals to develop realistic and functional ways for handoffs to occur, since it’s also quite clear that the flip side of mandating rest periods is the need for more frequent handoffs. At the same time, air traffic controllers can hand of thousands of planes to each other every day; surely we can find a way to do safe and effective handoffs.

    In complicated issues like this, perhaps the simplest way to find the best answer is to ask what is best for our patients. A well-rested doctor is always the right answer to me.

    Reference

    Rothschild JM, Keohane CA; Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures. JAMA. 2009;302:1565-1572.

  • Blog post
  • 4 weeks ago
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• DrDavidAmron

  • Views: 72
  • Since: 1 month ago

• AHONEY84

  • Views: 42
  • Since: 2 months ago

• FaceDoctor39

  • Views: 17
  • Since: 2 months ago

• tonsillopez35

  • Views: 9
  • Since: 3 months ago

• CCE Headache: Diamond Headache

  • From: MedicalEconomics
  • Description:

    Seymour Diamond, MD, established the Diamond Headache Clinic 35 years ago in Chicago with one overriding philosophy: The headache patient needs a special doctor willing to understand how headaches can ruin a life.

  • 3 months ago
  • Views: 216
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• less than 1-cm.laceration to t

  • From: dwalter916
  • Description:

    A doctor shouldn't take an otherwise well 3-year old with a MINOR cut to the ED . What poor decision-making!

  • Blog post
  • 3 months ago
  • Views: 107
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• 'NouveauTox'

  • From: Eliza
  • Description:

    Well, we did it – we finally got another player in the neurotoxin market. So why’s it so quiet?
    
    After 20 years with a single product, it makes sense just to do the tried-and-true, especially if yours is busy practice with happy patients. But enough with the assumptions, it all started with a message I received from a doctor on the CST FaceBook page who asked, so how do I market this? A loaded question, to be sure…
    
    But you ask and I answer, so here it is:
    
    I went straight to a reliable source: Dr. Joel Schlessinger, a dermatologist in Omaha, Neb., who was a PI on the Dysport trials (and who has done clinical research for Allergan, Mentor/Ortho, J&J). Here’s what he had to say about his experience and approach…
    
    Not only did his Botox patients “delight” (his word) in the fact that Dysport seemed to take effect more quickly than they had previously experienced with Botox – two to three days sooner, in fact – but with his experience using both products, “Clearly there is a difference….With Dysport [there is] the ability to provide a smoother forehead.”
    
    Why?
    
    Apparently, Dysport diffuses and covers a larger area of muscle activity, resulting in a smoother appearance. And no skipped areas, means no wrinkle overlooked. (Ironic, perhaps, given that one of the early concerns regarding diffusion has turned into a benefit.) But the reality is that if too much Dysport is injected, it could lead to problems, he cautions.
    
    Because there is a learning curve with this “nouveauTox,” he also cautions doctors to ease into using Dysport, beginning with younger patients and working the way up to older. As we’re all aware, Dysport might be another type of botulinum toxin, but it’s got conversion and technique nuances that could cause big problems if you don’t know what you’re doing.
    
    Moreover, Dr. S says that Dysport is more “powerful” (his word) than Botox and sees it lasting in his patients for up to six months.
    
    His approach to marketing? Simple: Though he believes that some patients will prefer Botox and some Dysport, he is actively encouraging all his existing Botox patients – as well as new patients – to give it a try. “Some will love the look of Dysport; some will prefer to stay with Botox,” he says, but “Most should give it a try…to compare the two products.”
    
    And, thus, coming full circle to the question at hand, here are a few tips for how to market Dysport:

    1. The “economy” angle: If it lasts longer, it’ll cost you less (ie, fewer office visits required).
    2. The “comparison” angle: Botox user? Try Dysport. Gotta try both before you know which is right for you.
    3. The “quicker onset” angle: Important function coming up? Dysport saves the day!

    Your thoughts?

  • Blog post
  • 3 months ago
  • Views: 495
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• braces_alpharetta

  • Views: 12
  • Since: 4 months ago

• Why free-market reforms can't

  • From: BrandonGlenn
  • Description:

    Healthcare is so unlike traditional consumer products that any attempt to impose free-market principles on health reform is doomed to failure. So says Nobel Prize-winning economist Paul Krugman in his blog, though Krugman doesn't take credit for this economic theory himself. Rather, he summarizes what he calls "one of the most influential economic papers of the postwar era" -- "Uncertainty and the Welfare Economics of Medical Care," published in 1963 and written by Kenneth Arrow.

    To understand Arrow's argument (by way of Krugman) it's important to graps two key differences between healthcare and other consumer products, such as those you'd buy at Walmart, for example. First, because healthcare is often so expensive (Krugman cites the example of triple coronary bypass surgery) consumers are usually not the ones making the decision on exactly what to spend their healthcare dollars on. That decision falls to who is actually paying for care--the insurer. So the idea of "consumer choice" as it applies to healthcare is fiction. The choice clearly isn't in the consumer's hands; it ultimately rests with the one who's footing the bill, which shouldn't come as a surprise.

    Second, unlike when deciding on which brand of shampoo to purchase, buying healthcare is so complicated that patients usually can't rely on personal experience or comparison shopping. For example, let's say an elderly patient is instructed by his doctor that he needs hip replacement surgery. Can or will this patient realistically evaluate all his available options for surgeons or hospitals to provide that surgery? No, most likely he'll seek treatment from wherever or whomever his doctor instructs him to.

    So, for these two reasons, any attempt at market-based reform is fundamentally flawed and built on mistaken parallels between healthcare and conventional consumer products. As Krugman sums it up:

    There are, however, no examples of successful healthcare based on the principles of the free market, for one simple reason: in healthcare, the free market just doesn’t work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence.

     

  • Blog post
  • 4 months ago
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• Using PHP to detect early indi

  • From: OphthalmologyTimes
  • Description:

    Age-related macular degeneration (AMD) is most effectively treated at the earliest stage before conversion to wet AMD. According to one doctor, Leo Semes, OD, FAAO, “Preferential hyperacuity perimetry (PHP) is the most useful tool we have for discerning the earliest indictors of conversion.”

    A noninvasive visual field analyzer for monitoring AMD and detecting conversion to CNV (Foresee PHP, Sightpath Medical) can detect visual field distortions caused by lesions as small as 1,200 µm. The device has 82% sensitivity for early-stage CNV.

    The device combines patient interactive software with an algorithm that measures relative photoreceptor field location as an indicator of early CNV. By testing the patient’s ability to detect the misalignment of visual stimuli in space, the technology homes in on visual hyperacuity—a more sensitive indicator of retinal changes than normal visual acuity.

    The test is simple to administer and easy for patients to understand, according to Dr. Semes. The patient places his or her chin in the support in front of the screen and uses a stylus to identify misalignments in patterns of dots displayed on the screen.

    The device analyzes the patient’s responses to detect retinal abnormalities that may indicate retinal pigment epithelium (RPE) elevation. By varying the locations and size of the dot distortions, the device tests the site and degree of retinal defects indicative of CNV.

    What is your best diagnostic tool for detecting early stages of conversion in AMD?

    For more information see the July/August 2009, issue of Optometry Times.

  • Blog post
  • 4 months ago
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• Group Visits--Revisited

  • From: bgottlieb
  • Description:

    In my September, 2008, blog entry, I discussed group visits as a potential solution to the pressure on primary care providers. Since then, we have planned and implemented our first pilot diabetes group visits. I would like to describe what we have done so that others who are considering group visits might learn from our experiences.

    I work at a community health center in which we have many services under one roof— nutrition, mental health, and dental—in addition to traditional primary care medical services. We have a Diabetes Team comprised of representatives from each of these clinical departments which meets periodically to discuss how we can join forces to provide the best, most integrated care for our diabetic patients.

    For example, through these team meetings we have been able to offer a “fast-track” to dental care for diabetic patients, who experience a variety of dental complications that in turn can threaten glycemic control. We have also developed a system for coordinating the care of diabetic patients who are depressed with our mental health colleagues. This has led to enhanced diabetic outcomes as we are better able to address motivation, self-efficacy, and other mediators of healthy behaviors.

    Our Diabetes Team began planning the group visits about 6 months ago. Our objectives were to improve outcomes for diabetic patients; to improve patient satisfaction with care by adding a peer-interaction component to their experience; and to improve provider satisfaction by developing a model of care that is intensive and effective, and yet uses the scarce resource of provider time efficiently.

    We decided on a pilot series of group visits that was time-limited so that we could see what worked and what didn’t. We selected patients who are medically and demographically consistent with our most “typical” diabetic patient (older adult, Latino, Spanish speaking, and with multiple co-morbidities), but also those who were motivated and reliable enough to attend regularly, and confident enough to give us critical feedback.

    There was a lot of preparation to be done:

    • Informed consent. Given the appropriately strict guidelines for confidentiality of patient-related information, we had to develop a formal process for explaining to patients what medical information would and would not be shared in a group setting. We borrowed and modified consent forms from our mental health colleagues who use a similar process in their group visits.
    • Reimbursement and documentation. There are several models for reimbursement for diabetes group visits, including billing for the education component of groups led by Certified Diabetes Nurse Educators or billing through standard Evaluation and Management (E & M) Codes with the appropriate documentation.¹ We selected the latter approach, as I planned to be extensively involved with the groups at this stage.
    • Clinical and educational intervention. Each session included an initial meeting with a medical assistant who measured weight and vital signs and provided a brief screen to determine if there were questions or concerns that required an individual meeting with a medical provider. The remaining time, typically 90 to 120 minutes, consisted of a group meeting that reinforced basic understanding of diabetes, self-management techniques, goals for self-management, complications, problem solving, and care of comorbid conditions. Each meeting included a break for a healthy snack and a physical activity component. Participants were each supplied with a canvas bag with the health center’s logo which contained educational materials. They were asked to bring the bag, along with their home readings, medications, and diaries of food, physical activities, and other health-related behaviors, to review each week.

    On Monday afternoons, 6 women, all aged 60 and older (the oldest was 87), came to the health center every week for 6 weeks. Each participant arrived looking somewhat serious. Each wore her “Sunday best,” carried her special bag, and arrived ready to learn. The solemnity quickly melted as people shared the events of their past week, joked about family members, and the universal shared experience–Boston’s bad weather. One woman, the eldest, was a bit more reserved than the others, but even she smiled and joked. They all had opinions and experiences to share. The conversation was loud, rapid-fire, teasing, challenging each other, but with obvious mutual respect and consideration.

    When the topic of physical activity came up, suddenly, a very dignified 72-year-old, recently recovered from carotid surgery, stood up and began to merengue. She was joined by others, but the 87-year-old held back. When others appealed to her to join in she became tearful. Yes, she loved to dance, yes, she loved music, but since her husband died a few years ago she hadn’t been able to listen to music. She hadn’t wanted to dance. The others stopped. They traded stories about loss, widowhood, and how they had coped. Their similarities vastly exceeded their differences.

    During the break I asked what they liked about the groups. I couldn’t have scripted it better if I tried. “We all share what we know.” “If I don’t know something, ____ knows it; if she doesn’t know it, ____does.” “We learn from each other because we have all had to figure out how to do things, how to survive with our diabetes.” Having emphasized the value of learning from peers, they each hastened to add, “But the doctor is also important.” “Sacred” another chimed in. “A messenger from heaven,” another agreed.

    Steering them back to the topic of groups, I said that I thought there were times when they needed a regular visit with me, just one-on-one, and times when a group might be more useful. “Doctora,” began my professorial 72-year-old, “you can’t make us feel good about having diabetes. It is only by talking to other people who share the same problem that we can feel confident that we can take care of our diabetes and still be happy. We can begin to feel good about ourselves again.”

    Confidence, self-efficacy, coping strategies. I couldn’t have said it better myself.

    We don’t have any outcome data yet, but based on the eager participation of our pilot group, and based on a number of studies that demonstrate improvement, or at least equivalence of diabetes outcomes with group visits compared to usual care, we are ready to offer group visits to all of our diabetic patients.^2-4

    Post-script.
    It has been described that Latino patients, in general, develop very close relationships with their medical providers, and feel quite intimate. I have learned this in my 28+ years working in this community: hugs and blessings when patients leave my office, special foods and souvenirs when they return from visits back home, and even a pair of pajamas (!) one Christmas from a patient who was concerned that I was working too hard.

    I expected (actually, it was part of my motivation to do group visits) that minus the formality and constraints of a typical office visit, the group visits would be even more friendly, more special. I, too, cast aside my usual shapeless pants in favor of a fitted skirt. I should know by now that my patients will exceed my expectations, so I shouldn’t have been surprised when, at the end of this visit, the 87-year-old, the most reserved, came up to me and said, “Doctora, you have great legs!”

    References

    1. Davis AM, Sawyer DR, Vinci LM. The potential of group visits in diabetes care. Clinical Diabetes. 2008;26:58-62.doi:10.2337/diaclin.26.2.58

    2. Wagner EH, Grothaus LC, Sandhu N, et al. Chronic care clinics for diabetes in primary care: a system-wide randomized trial. Diabetes Care. 2001;24, 695-700. doi:10.2337/diacare.24.4.695

    3. Clancy DR, Huang P, Okonofua E, et al. Group visits: promoting adherence to diabetes guidelines. J Gen Intern Med. 2007;22:620-624.

    4. Sadur CN, Moline N, Costa M, et al. Diabetes management in a health maintenance organization: efficacy of care management using cluster visits. Diabetes Care. 1999;22:2011-2017.

  • Blog post
  • 5 months ago
  • Views: 200
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• drmendezurena

  • Views: 62
  • Since: 5 months ago

• Ethnic Rhinoplasty Specialist

  • From: sporemedical
  • Description:

    Enter the operating room and see first-hand how nose surgery is performed and learn about each specific procedure with Beverly Hills Rhinoplasty Specialist Dr. Paul S. Nassif, a  distinguished facial plastic and reconstructive surgeon internationally known for his innovative surgical techniques and expertise in revision rhinoplasty & ethnic rhinoplasty for Asian, Hispanic, and African American patients.

    Dr. Nassif specializes in rhinoplasty for a number of ethnicities including Hispanics, Middle Easterners, African Americans and Asians. He has extensive experience in each ethnicity which allows him to create a nose that enhances the unique features of each individual patient regarless of ethnicity.

    Produced by Spore Medical for Dr. Nassif to use in his viral video marketing campaign.

  • 5 months ago
  • Views: 67
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• Plastic Surgery Patient Descri

  • From: sporemedical
  • Description:

    Enter the operating room and see first-hand how nose surgery is performed and learn about each specific procedure with Beverly Hills Rhinoplasty Specialist Dr. Paul S. Nassif, a  distinguished facial plastic and reconstructive surgeon internationally known for his innovative surgical techniques and expertise in revision & ethnic rhinoplasty for Asian, Hispanic, and African American patients.

  • 5 months ago
  • Views: 35
  • Not yet rated

• Ethnic Rhinoplasty Specialist

  • From: sporemedical
  • Description:

    Enter the operating room and see first-hand how nose surgery is performed and learn about each specific procedure with Beverly Hills Rhinoplasty Specialist Dr. Paul S. Nassif, a  distinguished facial plastic and reconstructive surgeon internationally known for his innovative surgical techniques and expertise in revision & ethnic rhinoplasty for Asian, Hispanic, and African American patients.

  • 5 months ago
  • Views: 42
  • Not yet rated

• Plastic Surgery Patient Descri

  • From: sporemedical
  • Description:

    Enter the operating room and see first-hand how nose surgery is performed and learn about each specific procedure with Beverly Hills Rhinoplasty Specialist Dr. Paul S. Nassif, a  distinguished facial plastic and reconstructive surgeon internationally known for his innovative surgical techniques and expertise in revision & ethnic rhinoplasty for Asian, Hispanic, and African American patients.

  • 5 months ago
  • Views: 82
  • Not yet rated

• Cosmetic Surgery Patient Descr

  • From: sporemedical
  • Description:

    Enter the operating room and see first-hand how nose surgery is performed and learn about each specific procedure with Beverly Hills Rhinoplasty Specialist Dr. Paul S. Nassif, a  distinguished facial plastic and reconstructive surgeon internationally known for his innovative surgical techniques and expertise in revision & ethnic rhinoplasty for Asian, Hispanic, and African American patients.

  • 5 months ago
  • Views: 42
  • Not yet rated