Progress Notes

Important and interesting news items from your health office

Moderate alcohol risky

Posted by on Jun 7, 2017 in Patient Care | 0 comments

Moderate alcohol risky

Consuming Moderate Amounts Of Alcohol May Be Associated With Changes In Brain Structure, Increased Risk Of Worsening Brain Function.

ABC World News Tonight (6/6, story 8, 0:20, Muir) reported that research suggests “moderate drinking may be riskier than previously” believed.

USA Today (6/6, Painter) reports that investigators found “moderate drinkers were more likely than abstainers or light drinkers to develop worrisome brain changes that might signal eventual memory loss.” Additionally, “they…were more likely to show rapid slippage on a language test, though not on several other cognitive tests.” The findings were published online June 6 in the BMJ.

Reuters (6/6, Kelland) reports that investigators came to these conclusions after analyzing “data on weekly alcohol intake and cognitive performance measured repeatedly over 30 years between 1985 and 2015 for 550 healthy” people “with an average age of 43 at the start of the study.” Reuters adds, “Brain function tests were carried out at regular intervals, and at the end of the study participants were given a MRI brain scan.” Also covering the story are CNN (6/6, Christensen) and HealthDay (6/6, Norton).

Adverse Childhood Experiences

Posted by on Jun 5, 2017 in Patient Care | 0 comments

Adverse Childhood Experiences

Childhood abuse raises the risk of serious mental and physical problems later

Research has shown that childhood trauma, ranging from parents’ divorce to alcoholism in the home, increases the odds of heart disease, stroke, depression, suicide, diabetes, lung diseases, alcoholism and liver disease later in life.

It also increases risky health behaviors like smoking and having a large number of sexual partners. And it contributes to “low life potential,” according to the U.S. Centers for Disease Control.

And one more thing: those traumatized as children die earlier.

Childhood Trauma: Too Much to Handle, Too Soon

From 1995 to 1997, the health maintenance organization Kaiser Permanente in California conducted a survey of more than 17,000 of its patients.

The “Adverse Childhood Experiences” or ACE study asked respondents to indicate whether they had suffered any of the following during their childhood:

  • Emotional abuse
  • Physical abuse
  • Sexual abuse
  • Mother treated violently
  • Household substance abuse
  • Mental illness in household
  • Parental separation or divorce
  • Household member in prison

A portion of the respondents were also asked about emotional and physical neglect. The most common experience reported was physical abuse (28 percent), followed by household substance abuse (nearly 27 percent).

The more Adverse Childhood Experiences a person reported, the higher the risk of experiencing poor psychological and physical health later

Can you relate to any of this?

If so, please open up with one of our health providers. We can help you. Click here to read more.

 

Effective Handwashing

Posted by on Jun 2, 2017 in Patient Care | 0 comments

Effective Handwashing

Washing Hands With Cold Or Lukewarm Water May Be Just As Effective As Using Hot Water, Study Suggests.

TIME (6/1, MacMillan) reports that washing hands “with cold or lukewarm water will work just as well as hot water to remove bacteria, according to a new study published in the Journal of Food Protection.”

Handwashing experiments conducted with 21 volunteers revealed “no significant difference in cleaning power between water that was 60, 79 or 100 degrees Fahrenheit.” Investigators also “found that lathering hands for just 10 seconds was sufficient to remove germs.”

No Juice for Babies

Posted by on May 22, 2017 in Patient Care | 0 comments

No Juice for Babies

New Guidelines Say Children Under One Year Old Should Not Be Given Fruit Juice.

The New York Times “Well” blog reports that the American Academy of Pediatrics (AAP) is “advising parents to stop giving fruit juice to children in the first year of life, saying the drink is not as healthful as many parents think.”

The AAP has “toughened its stance against juice, recommending that the drink be banned entirely from a baby’s diet during the first year.” Meanwhile, “The new report, published online in Pediatrics, also advised restricting fruit juice to four ounces daily for 1- to 3-year-olds, and six ounces a day for 4- to 6-year-olds.”

The NPR “Shots” blog reports Steven Abrams, an author of the guidelines, says, “We want to reinforce that the most recent evidence supports that fruit juice should be a limited part of the diet of children.” Also covering the story are CNN and MedPage Today.

Brain Drain

Posted by on Apr 29, 2017 in Patient Care | 0 comments

Brain Drain

Obesity, diabetes, and brain damage

“It’s well-known that type 2 diabetes can cause medical complications in certain organs, including the brain. But overweight and obese people with early-stage type 2 diabetes have more severe abnormalities in brain structure and cognition than normal-weight people with type 2 diabetes, according to a new study in Diabetologia, the journal of the European Association for the Study of Diabetes.

“Having type 2 diabetes and being overweight, then, can combine to have a greater effect on brain structures.”

Click here to read the full CNN article.

Marijuana abuse

Posted by on Apr 27, 2017 in Patient Care | 0 comments

Marijuana abuse

People Who Live

in states with legalized medical marijuana are more likely to use and abuse marijuana, study suggests.

USA Today (4/26, Hughes) reports people who live in states that have “legalized medical marijuana are more likely to use and abuse cannabis than people” who live in states that have not legalized medical marijuana, according to a study published online April 26 in JAMA Psychiatry. Researchers found that the number of people using marijuana “without a doctor’s note” as well as the number of people with a marijuana use disorder both increased in states with legalized medical marijuana from 2001 to 2013. The article mentions that the study was funded by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.

Reuters (4/26, Seaman) reports in an accompanying editorial, Dr. Wilson Compton and others at the National Institute on Drug Abuse “say policymakers need to understand which parts of medical marijuana laws are tied with positive and negative effects.”

Taking your medications?

Posted by on Apr 18, 2017 in Patient Care | 0 comments

Taking your medications?

Nonadherence To Prescribed Medications Is An “Epidemic” In The US.

The New York Times (4/17, Brody, Subscription Publication) reports, “Nonadherence to prescribed medications” is “an out-of-control epidemic in the” US “that costs more and affects more people than any disease Americans currently worry about.”

The article suggests that nonadherence “explains why so many patients don’t get better, suffer surprising relapses or even die when they are given drug prescriptions that should keep their disorders under control,” cites research on how widespread the problem is, and also outlines why the problem may be so common.

Reasons for Medication Nonadherence

ICD-10 afflictions

Posted by on Mar 11, 2017 in Insurance, Patient Care | 0 comments

ICD-10 afflictions

The World Health Organization

has a wonderful website where all 68,000 of the ICD-10 codes we’re now using to classify and bill for the various conditions we treat are categorized and enumerated.

First a little about symbolism

The WHO logo at left contains an international symbol of medical care also used by the American Medical Association, a serpent lifted up on a pole, that some believe was derived the mythological figure of Asclepius, a supposed half-deity dating to about 1200 BC who was associated with healing and medicine.

However, those of us in the Judeo-Christian tradition trace the symbol back even further to the experience of Moses in the wilderness in about 1450 BC as recorded in Numbers 21.9: “So Moses made a bronze serpent and set it on a pole. And if a serpent bit anyone, he would look at the bronze serpent and live.” This has been carried forward into our faith in this passage quoted in John 3.14-15: “And as Moses lifted up the serpent in the wilderness, so must the Son of Man be lifted up, that whoever believes in him may have eternal life.

In the Bible, the serpent has been a symbol of Satan and the works of darkness, deception, and death from the Garden of Eden until now. And Jesus being lifted up on the cross in the serpent’s place has become the substitute whose life, death, and resurrection brings light, truth, and healing.

And now the code list

ICD-10 stands for the 10th Edition of the “International Classification of Diseases” and has a section that includes a complete list of codes for “persons with potential health hazards related to socioeconomic and psychosocial circumstances” that will give you an idea of the range of personal afflictions and “baggage” that many of us suffer from and/or bring with us into adulthood. Many of these conditions, especially those in the Z61 category, are what we refer to as “Adverse Childhood Experiences” which can have lifelong consequences.

Click here to read one list of serpent bites that people experience, then weep and join us in prayer.

E-Cigarettes

Posted by on Mar 1, 2017 in Patient Care | 0 comments

E-Cigarettes

The good news

is that the smoking rate among New York’s high school students declined to a historic low of 4.3 percent in 2016.

The bad news

is that during the last two years, the use of e-cigarettes among youth nearly doubled from 10.5 percent in 2014 to 20.6 percent in 2016. Many young people are lured by the intentionally sweet flavors and the mistaken belief that e-cigarettes are safe to use.

But e-cigarettes are not safe. Both cigarettes and e-cigarettes contain nicotine, which is highly addictive and can cause permanent changes in young, developing brains.

In addition, although combustible tobacco products contain more toxins than e-cigarettes, the aerosol produced by e-cigarettes is not a harmless water vapor. Rather, it often contains ultrafine particles that have been linked to lung disease; heavy metals such as tin, lead and nickel; and volatile organic compounds such as benzene and toluene.

Research also shows that the use of e-cigarettes by young people is associated with the use of other tobacco products, including cigarettes. The U.S. Food and Drug Administration considers e-cigarettes a tobacco product, as does the Department of Health. Governor Cuomo’s 2017 Executive Budget proposes regulating and taxing e-cigarettes in a similar manner as traditional cigarettes. This proposal would include e-cigarettes in the state’s comprehensive indoor air law and impose a 10 cent per milliliter tax on vapor products, thereby reducing the affordability of vapor products for youth, the age group most sensitive to price.

But we need physicians to weigh in, too. I encourage all health care providers to talk to their patients – young and old alike – about the dangers of e-cigarettes and to discourage their use. For patients who are already using traditional cigarettes or e-cigarettes, there are currently seven FDA-approved medications for smoking cessation, including five nicotine replacement therapies. Medicaid and most insurance plans will cover a portion of the cost of smoking cessation products.

Howard A. Zucker, M.D., J.D., New York State Commissioner of Health

Local confirmation of the bad news

Researchers Break Down Chemicals in E-cig Flavorings, Impact on Lungs

The label may say “cinnamon” or “vanilla” but the true contents of e-cigarette flavorings are acetoin, diacetyl, and other chemical additives that are known to irritate the respiratory tract and impair lung function, according to a collaborative study from western New York scientists.

Senior author Irfan Rahman, Ph.D., professor of Environmental Medicine and part of the Lung Biology and Disease Program at the University of Rochester Medical Center, said the findings suggest that chemical flavorings in e-cigarettes not only cause inflammation but may rapidly impair the critical epithelial cells in the airways, which act as the first defense against infections and toxins. When the epithelial barrier becomes more permeable or leaky due to chemical assaults, life-threatening lung diseases can occur.

Click here to read more about this local URMC study.

‘Frequent fliers’

Posted by on Feb 24, 2017 in Patient Care | 0 comments

‘Frequent fliers’

Risk and cost are high

ROCHESTER — Someone needing a Band Aid or a soda out of a fridge: They sound like jokes, but they are just a few examples EMS workers told News10NBC about non-emergency calls they have to respond to every day. Those people who call 911 for non-emergencies, time after time, are often called “frequent fliers.”

“Non-emergency calls, it depends on the day, but it sometimes outweighs the emergency calls,” said Chief Matt Comer, Greece Volunteer Ambulance.

And those calls can mean that when there is a true emergency, ambulances could have to come from further away. That is because while when you call 911 for an ambulance, one will always come, but it might not be coming from the nearest station. That means that if the ambulances are out on non-emergency calls, people may be waiting longer even when they need help right away.

Click here for a guide about when to use emergency services

If a “frequent flier” has government insurance you are pay for their rides to the hospital and their medical care, even if it is not an emergency.

In Monroe County $9.8 million last year went toward Medicaid for ambulance rides – with a portion paying for those non-emergency calls. But the price tag doesn’t stop there, it continues to add up when “Frequent Fliers” get to the emergency department.

In 2013, New York State had 6.4 million emergency room visits. Out of those, two million were for, what doctors call, common clinical things (i.e. strains, sinus infection, bruises, sore throat, ear ache). Out of that 2 million 90% could have been treated outside of the Emergency Department.

“The price associated with that was 1.3 billion dollars, so at a time when were are all concerned about high-quality affordable health care this is an important issues,” said Dr. Jamie Kerr, Medical Director at Excellus BlueCross BlueShield.

Fixing the problem of “Frequent Fliers” is not easy. EMS works say they try to track the calls, and if they see a problem meet with the patient and their family to try and workout access to care they truly need without calling 911.

by Amanda Ciavarri, WHEC News, February 22, 2017