Overview
"Gastro-" refers to the stomach. "Oesophageal" refers to the oesophagus, or feeding tube, that connects the mouth to the stomach. "Reflux" refers to backflow. Gastroesophageal Reflux hence refers to backflow of stomach contents into the oesophagus.
GERD is a disorder where patients suffer from sensations of heartburn and acid indigestion and sometimes is confused with chest pain due to cardiac causes. GERD occurs when the lower oesophageal sphincter does not close properly after food has entered the stomach, resulting in a backflow of stomach contents up the oesophagus.
Physiology
Food normally swallowed passes into the stomach via the oesophagus. Upon entering the stomach, the lower oesophageal sphincter (ring of muscle) closes, thereby preventing stomach contents from backflowing back into the oesophagus while the stomach digests and churns the food.
GERD happens when the lower oesophageal sphincter fails to close properly and reflux of stomach contents occurs. This results in a sensation of burning in the chest as stomach contents are normally acidic in nature.
The degree of severity of GERD hence depends on the magnitude of dysfunction of the lower oesophageal sphincter, stomach contents, and back pressure exerted by the stomach.
Causes
From first principles, anything that increases the back pressure exerted by the stomach can potentially cause GERD. These include:
Diet and Lifestyle: Binge eating, excessive consumption of alcohol, smoking, obesity and certain foods and beverages like coffee have all been implicated with GERD
Pregnancy.
Structural abnormalities like a hiatus hernias (outpouching of stomach above the diaphragm).
Symptoms
Patients often complain of "indigestion" or "heartburn", described as a burning sensation behind the breast bone ascending up towards the throat and neck. Often associated with an acidic or bitter taste, the sensation of heartburn can last for as long as 2 hours and is made worse by lying flat.
Heartburn is often confused with chest pain due to cardiac causes. It is important to differentiate the two because heartburn is treatable while cardiac causes for chest pain carries a significant risk of morbidity.
If in doubt, always consult your physician.
Treatment
Lifestyle and Dietary changes are the mainstay of treatment for GERD.
It is recommended to reduce consumption of acidic foods like citrus fruits and juices, tomatoes, foods that compromise the lower oesophageal sphincter like chocolate, fatty foods, alcohol, and any foods known to cause irritation in specific patients.
Control of serving portions and reduction thereof will also help control symptoms of GERD. Eating meals at least 2 hours prior to sleep will reduce incidence of reflux. Reduction of weight and overcoming obesity will relieve GERD.
Cessation of smoking and reduction of alcohol consumption will both help GERD.
Simple changes of posture during sleep like sleeping on an incline can help GERD.
Beyond lifestyle and dietary changes, medications like antacids help combat symptoms caused by stomach acids and can provide partial relief. Use of antacids for the long term, however, risk aberrations in blood calcium and magnesium levels, which in turn can cause serious problems for patients with kidney disease.
Other medications available include prescription medications like histamine antagonists (eg commonly sold Famotidine in Singapore) and proton pump inhibitors (eg. Omeprazole).
Patients with persistent GERD despite the above treatments might require more invasive investigations like having endoscopy of the stomach performed to exclude other problems like peptic ulcers, and in some instances, oesophageal manometry (measure of pressure along the oesophagus) can help identify if there are abnormalities in the peristaltic movement of the oesophagus, resulting in GERD.
In situations where, for example, a patient has severe GERD due to a hiatus hernia, surgery might be necessary to correct the situation. However, surgery will usually be offered as a last resort by your physician because GERD is not life threatening.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care in Singapore. He has attended to patients of a all ages with a wide variety of health conditions.
Check out the housecall services of CMY Medical for more information.
By Tzun Hon Lau
Article Source: Understanding Gastroesophageal Reflux Disease (GERD)
Why Is Bio Identical Hormone Replacement Therapy Gaining Popularity?
Bio identical hormone replacement therapy (BHRT) is a form of therapy that is used to attain an optimum level of hormones in the human body. While BHRT is mainly confined to the United States, there is a significant level of interest directed towards it. What this form of therapy is believed to achieve is to improve the overall hormone levels in the body. Bio identical hormone replacement therapy has garnered interest particularly with women as they are convinced that it helps them during menopause, making them feel stronger and revitalised. BHRT has gained popularity as a number of American women are of the opinion that conventional hormone replacement therapy has several side effects that could be life-threatening.
Bio identical hormone replacement therapy has numerous benefits especially for women as it is believed to prevent the occurrence of a number of chronic diseases that develop with age. Bio identical hormones are made from plant chemicals and share a similar molecular structure to that built in a woman's body. The benefits of BHRT include and are not confined to:
1. It builds muscle strength as a person (especially women) ages. With age, the human body experiences a gradual breakdown in muscle and fat which weakens the physical state of an individual.
2. Bio identical hormone replacement also improves libido as a result of increasing the levels of hormones in the body.
3. BHRT is said to improve energy levels, provide better sleep, and sharpen the mental state of a person.
4. In a fast-paced world where time is of the essence, there is hardly ever enough time for an individual to relax and feel rested. The modern lifestyle is driving people towards depression. Bio identical hormone replacement therapy reduces the risk of depression, leaving one feeling calmer.
5. This form of therapy is also believed to increase bone strength even as a person ages, reducing the risk of osteoporosis. This is a result of BHRT improving the bone density.
6. BHRT is custom-compounded, which literally translates to the hormones being made to suit every individual patient's condition. By this, it makes for a more balanced and accurate increase in hormone levels.
7. As it creates a calming effect on an individual, BHRT also improves sleep. When consumed, natural progesterone helps in promoting a patient's sleep and allows for proper rest.
8. Bio identical hormone replacement therapy reduces the risk of endometrial and breast cancer besides fighting Alzheimer's disease.
There has been some opposition in the practice of BHRT and while there is currently little significant evidence to completely prove that this form of therapy carries with it benefits, it has helped a lot of patients dealing with hormonal imbalance. A lot of reviews and tests are being carried out to show that bio identical hormone replacement therapy can successfully help a patient balance out the body's hormones. For patients suffering from high cholesterol, BHRT is said to improve or stabilise the levels and improve the overall health of an individual, thus increasing one's lifespan in the process.
I am Rohit Bisht, an expert in Sales and Industrial Marketing. I seek information about the latest trends in the market and provide necessary updates about the same. If you want to know more about bio identical hormone replacement therapy you can follow me and read the articles on related topics.
By Rohit Bisht
Article Source: Why Is Bio Identical Hormone Replacement Therapy Gaining Popularity?
Bio identical hormone replacement therapy has numerous benefits especially for women as it is believed to prevent the occurrence of a number of chronic diseases that develop with age. Bio identical hormones are made from plant chemicals and share a similar molecular structure to that built in a woman's body. The benefits of BHRT include and are not confined to:
1. It builds muscle strength as a person (especially women) ages. With age, the human body experiences a gradual breakdown in muscle and fat which weakens the physical state of an individual.
2. Bio identical hormone replacement also improves libido as a result of increasing the levels of hormones in the body.
3. BHRT is said to improve energy levels, provide better sleep, and sharpen the mental state of a person.
4. In a fast-paced world where time is of the essence, there is hardly ever enough time for an individual to relax and feel rested. The modern lifestyle is driving people towards depression. Bio identical hormone replacement therapy reduces the risk of depression, leaving one feeling calmer.
5. This form of therapy is also believed to increase bone strength even as a person ages, reducing the risk of osteoporosis. This is a result of BHRT improving the bone density.
6. BHRT is custom-compounded, which literally translates to the hormones being made to suit every individual patient's condition. By this, it makes for a more balanced and accurate increase in hormone levels.
7. As it creates a calming effect on an individual, BHRT also improves sleep. When consumed, natural progesterone helps in promoting a patient's sleep and allows for proper rest.
8. Bio identical hormone replacement therapy reduces the risk of endometrial and breast cancer besides fighting Alzheimer's disease.
There has been some opposition in the practice of BHRT and while there is currently little significant evidence to completely prove that this form of therapy carries with it benefits, it has helped a lot of patients dealing with hormonal imbalance. A lot of reviews and tests are being carried out to show that bio identical hormone replacement therapy can successfully help a patient balance out the body's hormones. For patients suffering from high cholesterol, BHRT is said to improve or stabilise the levels and improve the overall health of an individual, thus increasing one's lifespan in the process.
I am Rohit Bisht, an expert in Sales and Industrial Marketing. I seek information about the latest trends in the market and provide necessary updates about the same. If you want to know more about bio identical hormone replacement therapy you can follow me and read the articles on related topics.
By Rohit Bisht
Article Source: Why Is Bio Identical Hormone Replacement Therapy Gaining Popularity?
Eye Floaters Need to Be Evaluated
If you experience floaters around one or both of your eyes, don't ignore it and don't just live with it. Get to the core of what the problem is so it can be resolved. You don't want to allow it to get worse and permanently damage your vision. You may notice those small spots when you look outside in the bright sunlight. You may notice them when you look at blank paper.
For the most part, floaters will be annoying but they aren't going to hinder your overall vision. However, they can cast shadows in areas of your vision and that can make you feel like you don't focus as well as you used to. This is usually only the case if you have large sized floaters. You may notice they seem worse in certain types of lighting.
Consult with a Professional
It is a good idea to consult with a professional if you have floaters. If you haven't been in for an eye exam recently, you need to do so. They are often the result of collagen that gets into the back area of your eye. They tend to occur for adults over the age of 50 but it is possible for them to affect younger individuals.
In addition to the natural aging process, floaters can be the result of an eye injury or a tumor. They can also be an indicator of a serious type of eye disease. Some of these concerns can be treated if they are identified early on and an aggressive form of treatment can be put in motion. If they get too progressive though, then treatment options will be very limited.
If your issue is also associated with migraines, you may have a various serious condition or a tumor that has to be removed. Make sure you share with the professional all symptoms you have including how often, the intensity, and when they started. You also need to let them know if you have any type of pain in or around your eyes.
Treatment
Depending on the situation, they may tell you there is nothing to be done for the floaters. This is often the case if they are very small, mild, and due to the natural aging process. If they bother your vision in any way, surgery may be a good option. The process will involve removing some of the gel around the eyes.
If you have any underlying issues such as cataracts or a detached retina, those issues will be treated. Often, the other problems with the items were seeing floating around will disappear once you heal from those treatments for other ailments. Let your professional know if they improve, get worse, or stay the same.
Recovery
Make sure you follow the advice of your professional when it comes to treatment and recovery. You don't want to risk additional pain or problems with your vision. It is important to do all you can to keep your eyesight as good as you can. Don't hesitate to be seen when there are concerns you may have. Don't just ignore them or wait until the problem gets worse before you find out what it is.
With the floating items, they aren't so much a concern on their own. However, it can be very difficult for the average person to know the difference between that and when it is a symptom of a more serious issue. This is why you should make an appointment to see a professional. They can rule out various concerns or get you treated if they identify something serious.
Your vision is too important to trust to just anyone. Retina Surgeon offers the best techniques and skilled technicians to help you. It doesn't matter if you were referred to us by someone you know or your own eye doctor. Perhaps you are looking for a second opinion. We want you to feel comfortable asking questions and to be well informed about your options. Contact us for a consultation and to learn more about our procedures at http://www.retinasurgeon.uk.com. Our reputation speaks volumes about what we offer and how we treat our patients. It is important to take care of your vision needs as early as possible. Quality care can aid you with healing and improving your vision.
By Mahi Muqit
Article Source: Eye Floaters Need to Be Evaluated
For the most part, floaters will be annoying but they aren't going to hinder your overall vision. However, they can cast shadows in areas of your vision and that can make you feel like you don't focus as well as you used to. This is usually only the case if you have large sized floaters. You may notice they seem worse in certain types of lighting.
Consult with a Professional
It is a good idea to consult with a professional if you have floaters. If you haven't been in for an eye exam recently, you need to do so. They are often the result of collagen that gets into the back area of your eye. They tend to occur for adults over the age of 50 but it is possible for them to affect younger individuals.
In addition to the natural aging process, floaters can be the result of an eye injury or a tumor. They can also be an indicator of a serious type of eye disease. Some of these concerns can be treated if they are identified early on and an aggressive form of treatment can be put in motion. If they get too progressive though, then treatment options will be very limited.
If your issue is also associated with migraines, you may have a various serious condition or a tumor that has to be removed. Make sure you share with the professional all symptoms you have including how often, the intensity, and when they started. You also need to let them know if you have any type of pain in or around your eyes.
Treatment
Depending on the situation, they may tell you there is nothing to be done for the floaters. This is often the case if they are very small, mild, and due to the natural aging process. If they bother your vision in any way, surgery may be a good option. The process will involve removing some of the gel around the eyes.
If you have any underlying issues such as cataracts or a detached retina, those issues will be treated. Often, the other problems with the items were seeing floating around will disappear once you heal from those treatments for other ailments. Let your professional know if they improve, get worse, or stay the same.
Recovery
Make sure you follow the advice of your professional when it comes to treatment and recovery. You don't want to risk additional pain or problems with your vision. It is important to do all you can to keep your eyesight as good as you can. Don't hesitate to be seen when there are concerns you may have. Don't just ignore them or wait until the problem gets worse before you find out what it is.
With the floating items, they aren't so much a concern on their own. However, it can be very difficult for the average person to know the difference between that and when it is a symptom of a more serious issue. This is why you should make an appointment to see a professional. They can rule out various concerns or get you treated if they identify something serious.
Your vision is too important to trust to just anyone. Retina Surgeon offers the best techniques and skilled technicians to help you. It doesn't matter if you were referred to us by someone you know or your own eye doctor. Perhaps you are looking for a second opinion. We want you to feel comfortable asking questions and to be well informed about your options. Contact us for a consultation and to learn more about our procedures at http://www.retinasurgeon.uk.com. Our reputation speaks volumes about what we offer and how we treat our patients. It is important to take care of your vision needs as early as possible. Quality care can aid you with healing and improving your vision.
By Mahi Muqit
Article Source: Eye Floaters Need to Be Evaluated
Skin Conditions and Eczema
The term "Eczema" refer to the group of medical conditions that cause the skin to become inflamed or irritated. The most common type of eczema is known as atopic dermatitis, or atopic eczema.
An estimated 10% to 20% of infants and about 3% of adults and children in the U.S are afflicted with eczema. Infants that develop eczema usually outgrow the condition by ten years of age. However, some individuals continue to be symptomatic throughout life.
Symptoms
Eczema causes itch that might be experienced globally all over the body.
Affected areas usually appear very dry, thickened, or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brownish in colour. Among darker-skinned people, eczema can affect pigmentation, making the affected areas lighter or darker.
In infants, the itchy rash can produce an oozing, crusting condition that often erupts on the face and scalp, though eczematous patches may appear anywhere.
Causes
Causes of eczema are unknown, but it's believed to be an overreaction of the immune system to an irritant.
Families and bloodlines that are genetically prone to allergies have a predisposition to develop eczema.
In some patients, eczema arises only on exposure to the irritative substance. These can include household products like soaps and detergents, animal dander, and other common industrial products.
Stress has been implicated in making existing eczema worse.
Diagnosis
Diagnosis is clinical and made by the bedside. There are no specific tests for "eczema" though tests for substance allergies are available.
Treatment
Treatment aims to control the symptoms of itching and prevent infections. Moisturizing creams and lotions are recommended and these should be applied after bathing while the skin is still damp. Cold compresses can also be used to relieve itching.
Medicinal products like hydrocortisone 15 creams and other prescription creams available from your doctor can help control the inflammation. If an infection sets in, your doctor might prescribe antibiotics.
For further symptom control, antihistamines are sometimes prescribed. Other more advanced forms of treatment include phototherapy with UV radiation and use of cyclosporin for very severe cases.
Prevention
The following will help prevent outbreaks of eczema:
Frequent moisturization of skin.
Avoidance of sudden temperature and humidity change.
Avoidance of sweating or overheating.
Reduction of stress.
Avoidance of scratchy materials such as wool.
Avoidance of harsh soaps, detergents, and solvents.
Avoidance of any known foods that cause outbreaks.
Active and conscious preventive efforts can help to reduce eczema occurrence.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care in Singapore. He has attended to patients of a all ages with a wide variety of health conditions.
Check out the housecall services of CMY Medical for more information.
By Tzun Hon Lau
Article Source: Skin Conditions and Eczema
An estimated 10% to 20% of infants and about 3% of adults and children in the U.S are afflicted with eczema. Infants that develop eczema usually outgrow the condition by ten years of age. However, some individuals continue to be symptomatic throughout life.
Symptoms
Eczema causes itch that might be experienced globally all over the body.
Affected areas usually appear very dry, thickened, or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brownish in colour. Among darker-skinned people, eczema can affect pigmentation, making the affected areas lighter or darker.
In infants, the itchy rash can produce an oozing, crusting condition that often erupts on the face and scalp, though eczematous patches may appear anywhere.
Causes
Causes of eczema are unknown, but it's believed to be an overreaction of the immune system to an irritant.
Families and bloodlines that are genetically prone to allergies have a predisposition to develop eczema.
In some patients, eczema arises only on exposure to the irritative substance. These can include household products like soaps and detergents, animal dander, and other common industrial products.
Stress has been implicated in making existing eczema worse.
Diagnosis
Diagnosis is clinical and made by the bedside. There are no specific tests for "eczema" though tests for substance allergies are available.
Treatment
Treatment aims to control the symptoms of itching and prevent infections. Moisturizing creams and lotions are recommended and these should be applied after bathing while the skin is still damp. Cold compresses can also be used to relieve itching.
Medicinal products like hydrocortisone 15 creams and other prescription creams available from your doctor can help control the inflammation. If an infection sets in, your doctor might prescribe antibiotics.
For further symptom control, antihistamines are sometimes prescribed. Other more advanced forms of treatment include phototherapy with UV radiation and use of cyclosporin for very severe cases.
Prevention
The following will help prevent outbreaks of eczema:
Frequent moisturization of skin.
Avoidance of sudden temperature and humidity change.
Avoidance of sweating or overheating.
Reduction of stress.
Avoidance of scratchy materials such as wool.
Avoidance of harsh soaps, detergents, and solvents.
Avoidance of any known foods that cause outbreaks.
Active and conscious preventive efforts can help to reduce eczema occurrence.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care in Singapore. He has attended to patients of a all ages with a wide variety of health conditions.
Check out the housecall services of CMY Medical for more information.
By Tzun Hon Lau
Article Source: Skin Conditions and Eczema
Model the Process
Cooking is a process that involves specific, orderly steps with well-defined inputs. For some recipes slight variations are allowed but the basic steps and ingredients must be maintained for a good product. For instance, when my wife makes a marinara sauce, she uses crushed tomatoes, salt, onions, garlic, basil, red wine, fennel and parsley. I, on the other hand, use the same ingredients except the fennel but add a bit of sugar and oregano. The steps in making it are the same for both of us: brown the garlic and onion in olive oil and then add the rest of the ingredients and simmer for about a half hour to an hour.
In business, manufacturing and service industries such as healthcare most activities are performed with well-defined processes. In manufacturing there is no room for variation in order to produce a best quality product. In service industries, there may be some variations as in the slight variations of making marinara but the best outcomes are achieved if each task is performed essentially the same. There is more room for variation in the clinical side of healthcare as an orthopedic surgeon may choose to use tissue from the patellar tendon or hamstring to repair a ruptured ACL. Nevertheless, using standardized processes generally results in best outcomes and these processes should be modeled, according to the structure of Business Process Management, which I have been discussing in previous newsletters.
Modeling a process allows for standardization and identification of best steps to use. If each person in a process adopts the standardized process then outcomes will be predictable, thus pleasing the clients and patients. It also eliminates waste, thus producing savings for the business or provider.
Modeling a process can involve paper and pencil or computer software. Most is done with software now. Two common ways to model a process are to use flowcharts or value stream maps, which are used in Lean process management. I have created a simple flowchart which models the process that I use to analyze data that has already been collected for a client. You can find an image of this map by clicking here.
Since I am the only one who employs this process there is no variation; I am consistent from one application to the next for different clients.
What are the components found in process models? Generally, there should always be a definite beginning and end point. Besides the physical steps you may want to include some are all of the following: people involved in the process, information and data, materials, tools, and environmental factors. These are always used in value stream maps.
You may believe that the processes at your site are fairly standard but the 'present state' of a given process may be quite variable. This is especially true if a process has never been documented. For instance, when a medial assistant is escorting a patient to an exam room at an outpatient clinic, she may stop and take the patient's weight and measure her height before proceeding to the exam room. Another MA may take the weight and not measure the height.
To see if there is wide variation in a process that is unacceptable because it leads to errors or poor outcomes, a team of those involved in a process should work with a process champion (a person designated to own a process and optimize it) to 'map the current state' of a process. It is during the mapping of the current state that the variations will appear. In fact, it may appear that there is very little standardization occurring at all.
I was working with a hospital group once and we were mapping the check-out process. In working with the administration and nurses we found that there was a wide variation in how the check-in staff was notified that there was an empty bed available. In fact, there were many workarounds for this process that had been developed by the floor nurses as the standard process did not work well. So, we made a present state map that represented the steps generally used by most staff. Then, we created a 'future state map' that represented the steps that all should use and that was best in notifying the check-in staff of the availability of beds on a unit. After creating the future state map, the process champion worked with the team to develop a plan to implement the new process and make sure that it was consistently followed by all involved staff. This included identifying indicators that could be measured to indicate the success of the implementation.
One of the important steps that a process champion must do before meeting with the process improvement team is to take a gemba walk. This involves the champion going to the place where a process occurs and patiently watching it unfold. She should do this several times and with different staff involved. By observing the process unfold she will be able to assess the amount of variability in the current state. The champion should also observe a process after it has been successfully implemented to be sure that there is no backsliding to the previous state of the process which was probably highly variable and unsatisfactory.
As you can see, to get best outcomes, a process should be explicitly mapped. From this map, a standardized future state map can be created so that all will carry out the process in the same way, thus providing predictably good results. Patients and clients will be happier, staff will be pleased and the providers will be rewarded with increased income.
Donald Bryant helps healthcare providers meet their challenges. Go to http://www.bryantsstatisticalconsulting.com to get the free article "7 Challenges in Healthcare and How to Solve Them" with tips you can
use to start improving patient health, improving the bottom line, finding more time to get things done and to learn more about Lean Healthcare.
By Donald Bryant
Article Source: Model the Process
In business, manufacturing and service industries such as healthcare most activities are performed with well-defined processes. In manufacturing there is no room for variation in order to produce a best quality product. In service industries, there may be some variations as in the slight variations of making marinara but the best outcomes are achieved if each task is performed essentially the same. There is more room for variation in the clinical side of healthcare as an orthopedic surgeon may choose to use tissue from the patellar tendon or hamstring to repair a ruptured ACL. Nevertheless, using standardized processes generally results in best outcomes and these processes should be modeled, according to the structure of Business Process Management, which I have been discussing in previous newsletters.
Modeling a process allows for standardization and identification of best steps to use. If each person in a process adopts the standardized process then outcomes will be predictable, thus pleasing the clients and patients. It also eliminates waste, thus producing savings for the business or provider.
Modeling a process can involve paper and pencil or computer software. Most is done with software now. Two common ways to model a process are to use flowcharts or value stream maps, which are used in Lean process management. I have created a simple flowchart which models the process that I use to analyze data that has already been collected for a client. You can find an image of this map by clicking here.
Since I am the only one who employs this process there is no variation; I am consistent from one application to the next for different clients.
What are the components found in process models? Generally, there should always be a definite beginning and end point. Besides the physical steps you may want to include some are all of the following: people involved in the process, information and data, materials, tools, and environmental factors. These are always used in value stream maps.
You may believe that the processes at your site are fairly standard but the 'present state' of a given process may be quite variable. This is especially true if a process has never been documented. For instance, when a medial assistant is escorting a patient to an exam room at an outpatient clinic, she may stop and take the patient's weight and measure her height before proceeding to the exam room. Another MA may take the weight and not measure the height.
To see if there is wide variation in a process that is unacceptable because it leads to errors or poor outcomes, a team of those involved in a process should work with a process champion (a person designated to own a process and optimize it) to 'map the current state' of a process. It is during the mapping of the current state that the variations will appear. In fact, it may appear that there is very little standardization occurring at all.
I was working with a hospital group once and we were mapping the check-out process. In working with the administration and nurses we found that there was a wide variation in how the check-in staff was notified that there was an empty bed available. In fact, there were many workarounds for this process that had been developed by the floor nurses as the standard process did not work well. So, we made a present state map that represented the steps generally used by most staff. Then, we created a 'future state map' that represented the steps that all should use and that was best in notifying the check-in staff of the availability of beds on a unit. After creating the future state map, the process champion worked with the team to develop a plan to implement the new process and make sure that it was consistently followed by all involved staff. This included identifying indicators that could be measured to indicate the success of the implementation.
One of the important steps that a process champion must do before meeting with the process improvement team is to take a gemba walk. This involves the champion going to the place where a process occurs and patiently watching it unfold. She should do this several times and with different staff involved. By observing the process unfold she will be able to assess the amount of variability in the current state. The champion should also observe a process after it has been successfully implemented to be sure that there is no backsliding to the previous state of the process which was probably highly variable and unsatisfactory.
As you can see, to get best outcomes, a process should be explicitly mapped. From this map, a standardized future state map can be created so that all will carry out the process in the same way, thus providing predictably good results. Patients and clients will be happier, staff will be pleased and the providers will be rewarded with increased income.
Donald Bryant helps healthcare providers meet their challenges. Go to http://www.bryantsstatisticalconsulting.com to get the free article "7 Challenges in Healthcare and How to Solve Them" with tips you can
use to start improving patient health, improving the bottom line, finding more time to get things done and to learn more about Lean Healthcare.
By Donald Bryant
Article Source: Model the Process
Voice of the Patient
Can you imagine having a farmers supply store in downtown San Francisco? It seems highly unlikely to me. There would be few sales. Having such a store there is an example of a business out of touch with its market. To be successful, businesses must supply the right product or services to the right customer in the right place and at the right time.
Should healthcare providers worry about such? Do they need to focus on the customer, the patient? While location is important for providers, does the delivery of services matter? After all, healthcare providers provide a service that is universally needed.
It so happens that the way services are provided makes a difference. With the right services provided in the right way providers will reap many benefits, including patient loyalty, better outcomes for the patient and better income for the practice. I believe that we can all agree that better patient engagement is one of the key factors to better health outcomes. But there is more than engagement between patient and clinicians that drives outcomes for patients and that improves loyalty.
In a recent survey members of the Medical Group Management Association (MGMA) stated that several services helped improve patient satisfaction and engagement. Among them were flexible hours so that patients could have better access to clinicians, variety of communication styles, help with cost containment and management, and care management. Members stated that patients wanted other ways to communicate with physicians and staff, such as electronic patient portals and secure email. Since many more patients have high deductible policies they appreciate help in managing their copays and deductibles. Letting a patient know before services are provided what their costs will be and helping with making arrangements for paying their share if need be puts them much more at ease. Patients also like help in changing their lifestyles if chronic conditions make it necessary.
I am not advocating that providers supply everything that patients want, even if saying 'No' to a request can be difficult. My own physician has said 'No' to some of my requests because it makes good financial sense to do so for the practice; his group is part of an ACO. For instance, recently when I asked if I could be tested for allergies to see which bees and wasps I was allergic to, he said 'No'. My reactions to stings was not severe yet and I should carry an epi pen with me when I am outside in the summer and spring in case I was stung and began to have a reaction. There are many instances when physicians should deny patient requests. For instance, recent research shows that 84% of physicians still prescribe antibiotics for runny and stuffy noses in spite of the fact that research shows this is the wrong thing to do, as it builds up antibiotic resistant bacteria.
It is important that medical providers find out what their patients want that will lead to better outcomes for all. It would be a waste of time and resources to provide services from a list such as those from the MGMA survey above if patients do not want some of those services. Perhaps almost all of the patients in your practice have easy access to services; they do not need more flexible hours. How, then, can you find out what your patients want that you are willing to provide?
There are several good ways to find out from your patients what new services they want or what services you provide that could be improved. Working with a team made up of various office and clinical staff, providers can use focus groups, advisory groups, surveys and patient feedback to staff to find ways to satisfy their patients. It is necessary to use teams to develop and implement these strategies to get patient input so as to get a good variety of ideas and questions.
A focus group is a good way to get ideas to improve your practice which you can then test to see if the suggestions are good. You can conduct a focus group using your own staff as leaders or you can hire a professional to help with this. A professional will definitely get better results but you can certainly conduct one yourself if you follow a few simple steps. One, have a goal for the focus group, such as, "How can our group help improve our services so as you (the patients) believe your needs are better met?" Then, your staff team can help create a set of questions and inquires that can be used while conducting the session. Then, choose a moderator to move the session along and a recorder to write down the response of the patients. Finally, invite some of your patients to be a part of the focus group. I would use no more than 8 or 9 in the session. You may want to provide a reward for their participation.
Another way to find out your patients needs is to create a survey. Your team should help develop the questions for the survey. You may have your patients fill out the survey when they come in for a visit. If you want a broader group of responders, you may take time to do a phone survey of your patients. One member of the MGMA reported recently that his group has staff members call several patients each day over a period of time to collect responses to a survey.
Another effective way to get some insights is to collect feedback from patients during their encounters with your staff. Patients will sometimes let members of your staff know what could be better at your practice. Staff should be trained to write down these suggestions or have the patient write down the suggestion and hand it back to the staff. These suggestions can then be reviewed later at a staff meeting so that the suggestions can be further explored and the staff member who collected the suggestion can add further details. Such suggestions can be used in focus groups or in future surveys.
Changing your services, adding more services, will help satisfy your patients which will lead to better outcomes and improve patient loyalty. Loyalty is important as it is easier to treat a returning patient than a new one; it is also more cost effective to treat returning patients as it generally takes less time to treat them. Further, loyal patients will recommend you to their family and friends as well as provide good feedback on sites that measure patient satisfaction and on social media web sites. Using some of the tools that I described will help you find out what your patients want.
Donald Bryant helps healthcare providers meet their challenges. Go to http://www.bryantsstatisticalconsulting.com to get the free article "7 Challenges in Healthcare and How to Solve Them" with tips you can
use to start improving patient health, improving the bottom line, finding more time to get things done and to learn more about Lean Healthcare.
By Donald Bryant
Article Source: Voice of the Patient
Should healthcare providers worry about such? Do they need to focus on the customer, the patient? While location is important for providers, does the delivery of services matter? After all, healthcare providers provide a service that is universally needed.
It so happens that the way services are provided makes a difference. With the right services provided in the right way providers will reap many benefits, including patient loyalty, better outcomes for the patient and better income for the practice. I believe that we can all agree that better patient engagement is one of the key factors to better health outcomes. But there is more than engagement between patient and clinicians that drives outcomes for patients and that improves loyalty.
In a recent survey members of the Medical Group Management Association (MGMA) stated that several services helped improve patient satisfaction and engagement. Among them were flexible hours so that patients could have better access to clinicians, variety of communication styles, help with cost containment and management, and care management. Members stated that patients wanted other ways to communicate with physicians and staff, such as electronic patient portals and secure email. Since many more patients have high deductible policies they appreciate help in managing their copays and deductibles. Letting a patient know before services are provided what their costs will be and helping with making arrangements for paying their share if need be puts them much more at ease. Patients also like help in changing their lifestyles if chronic conditions make it necessary.
I am not advocating that providers supply everything that patients want, even if saying 'No' to a request can be difficult. My own physician has said 'No' to some of my requests because it makes good financial sense to do so for the practice; his group is part of an ACO. For instance, recently when I asked if I could be tested for allergies to see which bees and wasps I was allergic to, he said 'No'. My reactions to stings was not severe yet and I should carry an epi pen with me when I am outside in the summer and spring in case I was stung and began to have a reaction. There are many instances when physicians should deny patient requests. For instance, recent research shows that 84% of physicians still prescribe antibiotics for runny and stuffy noses in spite of the fact that research shows this is the wrong thing to do, as it builds up antibiotic resistant bacteria.
It is important that medical providers find out what their patients want that will lead to better outcomes for all. It would be a waste of time and resources to provide services from a list such as those from the MGMA survey above if patients do not want some of those services. Perhaps almost all of the patients in your practice have easy access to services; they do not need more flexible hours. How, then, can you find out what your patients want that you are willing to provide?
There are several good ways to find out from your patients what new services they want or what services you provide that could be improved. Working with a team made up of various office and clinical staff, providers can use focus groups, advisory groups, surveys and patient feedback to staff to find ways to satisfy their patients. It is necessary to use teams to develop and implement these strategies to get patient input so as to get a good variety of ideas and questions.
A focus group is a good way to get ideas to improve your practice which you can then test to see if the suggestions are good. You can conduct a focus group using your own staff as leaders or you can hire a professional to help with this. A professional will definitely get better results but you can certainly conduct one yourself if you follow a few simple steps. One, have a goal for the focus group, such as, "How can our group help improve our services so as you (the patients) believe your needs are better met?" Then, your staff team can help create a set of questions and inquires that can be used while conducting the session. Then, choose a moderator to move the session along and a recorder to write down the response of the patients. Finally, invite some of your patients to be a part of the focus group. I would use no more than 8 or 9 in the session. You may want to provide a reward for their participation.
Another way to find out your patients needs is to create a survey. Your team should help develop the questions for the survey. You may have your patients fill out the survey when they come in for a visit. If you want a broader group of responders, you may take time to do a phone survey of your patients. One member of the MGMA reported recently that his group has staff members call several patients each day over a period of time to collect responses to a survey.
Another effective way to get some insights is to collect feedback from patients during their encounters with your staff. Patients will sometimes let members of your staff know what could be better at your practice. Staff should be trained to write down these suggestions or have the patient write down the suggestion and hand it back to the staff. These suggestions can then be reviewed later at a staff meeting so that the suggestions can be further explored and the staff member who collected the suggestion can add further details. Such suggestions can be used in focus groups or in future surveys.
Changing your services, adding more services, will help satisfy your patients which will lead to better outcomes and improve patient loyalty. Loyalty is important as it is easier to treat a returning patient than a new one; it is also more cost effective to treat returning patients as it generally takes less time to treat them. Further, loyal patients will recommend you to their family and friends as well as provide good feedback on sites that measure patient satisfaction and on social media web sites. Using some of the tools that I described will help you find out what your patients want.
Donald Bryant helps healthcare providers meet their challenges. Go to http://www.bryantsstatisticalconsulting.com to get the free article "7 Challenges in Healthcare and How to Solve Them" with tips you can
use to start improving patient health, improving the bottom line, finding more time to get things done and to learn more about Lean Healthcare.
By Donald Bryant
Article Source: Voice of the Patient
Paleohacks Cookbook Recipe Review
Are you in search of recipes that promote fat burning and weight loss? Are you in need of a comprehensive guide rich in paleo recipes? The Paleohacks cookbook recipe is one of the simplest and most comprehensive guides when it comes to easy paleo recipes. The idea at the back of paleo weight loss program is pinned on what our predecessors used to eat which consisted mainly of meat. Research into the past lifestyle of our predecessors revealed the lack of modern diseases like obesity, heart attack and diabetes among others. By replicating the same lifestyle, users can finally lead a healthy lifestyle which is what every single person wants.
If you are looking for the best paleo diet guide that will impart a healthier and more fulfilling life, then you need to know about the Paleohacks cookbook recipe.
This is an eBook that teaches you how to prepare a wide variety of Paleo diet meals which are geared towards healthy living and weight loss. As a comprehensive guide, it covers a wide range of meals from snacks like flavored nuts to desserts and the main course. The recipes are formulated to provide meals for breakfast, lunch, snack time and dinner.
You don't have to be an experienced chef in order to prepare the meals nor do you need several hours to prepare the meals. They suit the modern lifestyle and offer a nutritional balance that is beneficial to the overall growth and strengthening of the body.
Benefits of the Paleohacks cookbook recipe
1. Easy to understand language
The main language used in writing the eBook is English. The sentence structure used is easy to understand and readers are not left hanging. The language is clear plus the recipe is written in a step by step instruction mode making it easy for readers to follow from start to end. No technical terms have been used as this would make the eBook difficult to read.
2. Over 150 recipes
Readers have access to over 150 recipes which are designed for breakfast, lunch, snack time and dinner. The recipes promote the use of ingredients which are rich in protein, a nutrient that not only promotes muscle generation and repair but it also helps with fat burning. These easy Paleo recipes are created for people who have a busy life.
3. Instant access
The eBook is available in pdf format which means once payment has been made and confirmed, the reader will download the eBook and store it in a smart device. Access to the recipe is instant as all you need is to power on the device and open the eBook.
4. Highly valuable product
The easy Paleo recipes have been created by a team of professionals who have years of experience in preparing healthy meals that promote fat burning and weight loss.
5.60 day money back guarantee
Yes, you will receive a full refund in case the eBook is not what you expected. The 60 day money back guarantee helps to make sure that you are protected after purchase.
Cons
a. While it is available as an eBook, no hard copy is available at any store
b. The eBook is only available on the official website.
Final Thoughts
If you were looking for a risk free recipe book that promotes the use of natural and organic ingredients, then you need to seek the Paleohacks cookbook recipe. It's a great eBook written by a team of professionals who have experience with the Paleo diet. You can never go wrong with the Paleohacks cookbook recipe.
http://www.paleohacksnews.com/
By Saheem Al Kindi
Article Source: Paleohacks Cookbook Recipe Review
If you are looking for the best paleo diet guide that will impart a healthier and more fulfilling life, then you need to know about the Paleohacks cookbook recipe.
This is an eBook that teaches you how to prepare a wide variety of Paleo diet meals which are geared towards healthy living and weight loss. As a comprehensive guide, it covers a wide range of meals from snacks like flavored nuts to desserts and the main course. The recipes are formulated to provide meals for breakfast, lunch, snack time and dinner.
You don't have to be an experienced chef in order to prepare the meals nor do you need several hours to prepare the meals. They suit the modern lifestyle and offer a nutritional balance that is beneficial to the overall growth and strengthening of the body.
Benefits of the Paleohacks cookbook recipe
1. Easy to understand language
The main language used in writing the eBook is English. The sentence structure used is easy to understand and readers are not left hanging. The language is clear plus the recipe is written in a step by step instruction mode making it easy for readers to follow from start to end. No technical terms have been used as this would make the eBook difficult to read.
2. Over 150 recipes
Readers have access to over 150 recipes which are designed for breakfast, lunch, snack time and dinner. The recipes promote the use of ingredients which are rich in protein, a nutrient that not only promotes muscle generation and repair but it also helps with fat burning. These easy Paleo recipes are created for people who have a busy life.
3. Instant access
The eBook is available in pdf format which means once payment has been made and confirmed, the reader will download the eBook and store it in a smart device. Access to the recipe is instant as all you need is to power on the device and open the eBook.
4. Highly valuable product
The easy Paleo recipes have been created by a team of professionals who have years of experience in preparing healthy meals that promote fat burning and weight loss.
5.60 day money back guarantee
Yes, you will receive a full refund in case the eBook is not what you expected. The 60 day money back guarantee helps to make sure that you are protected after purchase.
Cons
a. While it is available as an eBook, no hard copy is available at any store
b. The eBook is only available on the official website.
Final Thoughts
If you were looking for a risk free recipe book that promotes the use of natural and organic ingredients, then you need to seek the Paleohacks cookbook recipe. It's a great eBook written by a team of professionals who have experience with the Paleo diet. You can never go wrong with the Paleohacks cookbook recipe.
http://www.paleohacksnews.com/
By Saheem Al Kindi
Article Source: Paleohacks Cookbook Recipe Review
What Is Type 2 Diabetes And How To Manage It
Diabetes is a life-long disease that affects the way your body handles glucose in your blood.
Causes
Insulin, a hormone produced by the pancreas, facilitates the movement of glucose absorbed from food in blood into cells.
Patients with Type II diabetes have insulin resistance and the normal metabolism involving insulin becomes disrupted..
In the initial phase, the pancreas will compensate by making more insulin to maintain normal metabolism but eventually, due to inadequate compensation, sugar will build up in the blood.
Causes of type 2 diabetes include:
Genes. Certain individuals have a genetic predisposition to develop type 2 diabetes
Obesity. Obesity causes insulin resistance.
Metabolic syndrome. People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.
Hepatic Causes. Liver abnormalities can cause abnormally high blood sugars
Abnormal beta cells. Abnormal pancreatic beta cells (the cells that produce insulin) can cause Diabetes Type II
Risk Factors and Prevention
Age: 45 or older
Family members with Diabetes
Ethnicity: African-American, Alaska Native, Native American, Asian-American, Hispanic or Latino, or Pacific Islander-American are all predisposed to develop Diabetes Type 2
Heart and blood vessel disease
High blood pressure, even if it's treated and under control
Low HDL ("good") cholesterol
High triglycerides
Being overweight or obese
Gestational Pregnancy
Polycystic ovary syndrome (PCOS)
Depression
A sedentary lifestyle
Smoking
Stress
Insufficient or excessive amounts of sleep
What Can You Do?
Lose weight. 7% to 10% of weight loss can cut your risk of type 2 diabetes by half.
Exercise. Moving muscles use insulin. Thirty minutes of brisk walking a day will cut your risk by almost a third.
Eat right. Avoid highly processed carbs, sugary drinks, and trans and saturated fats. Limit red and processed meats.
Quit smoking.
Symptoms
Excessive thirst
Excessive amounts of urine
Blurry vision
Increased irritability
Tingling or numbness in your hands or feet
Feeling tired all the time
Poor wound healing
Recurrent yeast infections
Getting A Diagnosis
Blood tests can be performed to determine diabetic statuses.
A1C: This gives an indication of the sugar control over the last 3 months from the point of blood evaluation.
Fasting plasma glucose: This gives a direct measure of the blood glucose level at the point of blood evaluation..
Oral glucose tolerance test (OGTT): This evaluates how your body handles excessive sugar.
Long-Term Effects
Over time, high blood sugar can damage and cause problems with your:
Heart and blood vessels
Kidneys
Eyes
Nerves, which can lead to trouble with digestion, the feeling in your feet, and your sexual response
Wound healing
Pregnancy
The best way to avoid these complications is to manage your diabetes well.
Take your diabetes medications or insulin on time.
Check your blood glucose.
Eat right, and don't skip meals.
See your doctor regularly to check for early signs of trouble.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care. He has attended to patients of a all ages with a wide variety of health conditions.
Check out the housecall services of CMY Medical for more information.
By Tzun Hon Lau
Article Source: What Is Type 2 Diabetes And How To Manage It
Causes
Insulin, a hormone produced by the pancreas, facilitates the movement of glucose absorbed from food in blood into cells.
Patients with Type II diabetes have insulin resistance and the normal metabolism involving insulin becomes disrupted..
In the initial phase, the pancreas will compensate by making more insulin to maintain normal metabolism but eventually, due to inadequate compensation, sugar will build up in the blood.
Causes of type 2 diabetes include:
Genes. Certain individuals have a genetic predisposition to develop type 2 diabetes
Obesity. Obesity causes insulin resistance.
Metabolic syndrome. People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.
Hepatic Causes. Liver abnormalities can cause abnormally high blood sugars
Abnormal beta cells. Abnormal pancreatic beta cells (the cells that produce insulin) can cause Diabetes Type II
Risk Factors and Prevention
Age: 45 or older
Family members with Diabetes
Ethnicity: African-American, Alaska Native, Native American, Asian-American, Hispanic or Latino, or Pacific Islander-American are all predisposed to develop Diabetes Type 2
Heart and blood vessel disease
High blood pressure, even if it's treated and under control
Low HDL ("good") cholesterol
High triglycerides
Being overweight or obese
Gestational Pregnancy
Polycystic ovary syndrome (PCOS)
Depression
A sedentary lifestyle
Smoking
Stress
Insufficient or excessive amounts of sleep
What Can You Do?
Lose weight. 7% to 10% of weight loss can cut your risk of type 2 diabetes by half.
Exercise. Moving muscles use insulin. Thirty minutes of brisk walking a day will cut your risk by almost a third.
Eat right. Avoid highly processed carbs, sugary drinks, and trans and saturated fats. Limit red and processed meats.
Quit smoking.
Symptoms
Excessive thirst
Excessive amounts of urine
Blurry vision
Increased irritability
Tingling or numbness in your hands or feet
Feeling tired all the time
Poor wound healing
Recurrent yeast infections
Getting A Diagnosis
Blood tests can be performed to determine diabetic statuses.
A1C: This gives an indication of the sugar control over the last 3 months from the point of blood evaluation.
Fasting plasma glucose: This gives a direct measure of the blood glucose level at the point of blood evaluation..
Oral glucose tolerance test (OGTT): This evaluates how your body handles excessive sugar.
Long-Term Effects
Over time, high blood sugar can damage and cause problems with your:
Heart and blood vessels
Kidneys
Eyes
Nerves, which can lead to trouble with digestion, the feeling in your feet, and your sexual response
Wound healing
Pregnancy
The best way to avoid these complications is to manage your diabetes well.
Take your diabetes medications or insulin on time.
Check your blood glucose.
Eat right, and don't skip meals.
See your doctor regularly to check for early signs of trouble.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care. He has attended to patients of a all ages with a wide variety of health conditions.
Check out the housecall services of CMY Medical for more information.
By Tzun Hon Lau
Article Source: What Is Type 2 Diabetes And How To Manage It
What Is Thalassaemia?
Thalassaemia is an inherited blood disorder caused by a genetic defect. The condition causes the body to produce abnormal haemoglobin in red blood cells, which in turn causes anaemia.
Haemoglobin within red blood cells is important because it is the primary molecule that carries oxygen around the body. Hence, the lack of functional haemoglobin causes a malfunction in oxygen carrying capability.
Types of thalassaemia
There are two types of thalassaemia: Alpha thalassaemia and Beta thalassaemia.
Patients with Alpha thalassaemia carrying one faulty gene will experience no observable effect. Patients with two faulty genes experience mild anaemia. Patients with three faulty genes will result in chronic anaemia requiring regular blood transfusions. Four faulty genes are incompatible with life.
Patients with Beta thalassaemia can be divided into several forms. Beta thalassaemia major, also called BTM, requires regular blood transfusions and is the most serious. Beta thalassaemia intermedia, also known as BTI or non-transfusion dependent thalassaemia or NTDT, is a milder form of the condition and the severity differs between individuals, from mild anaemia to the need for regular blood transfusions.
Carriers of either Alpha or Beta Thalassaemia genes may not know their carrier status and can only confirm it by blood testing. Knowing one's carrier status is important for people planning to have children, as thalassaemia is an inheritable disease.
People of Mediterranean, Middle Eastern, African or Asian descent are more likely to be carriers. Thalassaemia is common in these regions because it helps to protect the carriers against malaria.
Causes of Thalassaemia
Thalassaemia is a genetic disease and cannot be transmitted from one person to another.
Treatment for Thalassaemia
The most common treatment for beta thalassaemia major (BTM) is to have regular blood transfusions every four-to-six weeks to reinfuse functional haemoglobin in the body. This treatment can raise iron levels in the body to dangerous levels, risking heart, liver and hormone problems. Chelation may be performed to reduce iron levels in such situations..
Bone marrow transplants may cure thalassaemia in young individuals below the age of sixteen but potential cases should be considered individually.
Stem cells in umbilical cord blood transfusion have also been used for thalassaemia treatment.
For Beta thalassaemia intermediate (BTI) patients, treatment will depends on the severity of a person's symptoms. This can range from folate supplements to blood transfusions.
People with BTM are recommended to have a diet high in calcium and vitamin D and to take regular weight-bearing exercise to help strengthen their bones.
Complications of Thalassaemia
Hypersplenism
Delayed puberty
Stunted growth
Irregular heart rhythms
Hepatitis, Hepatic Cirrhosis
Osteoporosis
Thalassaemia Myths
It is important to know the truth about thalassaemia and not to succumb to many myths surrounding the disease. Here are a few samples of misleading information.
Asymptomatic parents will not pass the disease to their children.
Myth: Faulty genes can be transmitted vertically from parent to child.
If only one parent is a carrier, the child will not inherit the genetic disorder.
Myth: As long as one parent is a carrier, every child has a chance of inheriting the genetic disorder and can only be confirmed with blood evaluation.
Routine blood tests during a person's lifetime would have demonstrated carrier status.
Myth: Only specific blood tests for thalassaemia detect carrier status.
If a baby is a carrier, he or she will get ill later in life.
Myth: Carriers do not develop full blown thalassaemia but will have a chance of passing the faulty gene to subsequent generations..
If both parents are carriers, the 25% chance of a child having the disorder would mean one out of four babies will be ill.
Myth: Every pregnancy should be considered as an independent event for statistical evaluation. Hence every baby born has a 1 in 4 chance of inheriting the disease.
Thalassemia will not occur in the Caucasian population.
Myth: While thalassemia occurs more frequently in certain ethnic groups, it has also been found in Caucasians.
It is imperative that I keep my carrier status a secret.
Myth: Blood relatives often carry similar genes. Hence sharing one's carrier status can increase awareness and understanding amongst the community.
My child is only a carrier so I will not discuss it with him.
Myth: It is important to inform a child of his/her carrier status because the faulty gene can be transmitted to future generations.
Only women need screening tests.
Myth: Both sexes need to be tested as a combination of genes is inherited by a child.
Marrying someone from a different ethnic background avoids children being affected.
Myth: Parents of any background have the potential to pass on carrier status or thalassaemia.
Being a carrier protects against malaria.
Partly true: Thalassaemia carriers have a certain degree of protection against malaria.
Thalassaemia can be caught from blood transfusions.
Myth: Thalassaemia is a genetic disorder. It is not transmitted through blood transfusions.
Thalassaemia needs to be treated with iron supplements.
Myth: Use of supplements should be done under medical advice.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care in Singapore. He has attended to patients of a all ages with a wide variety of health conditions.
Check out the housecall services of CMY Medical for more information.
By Tzun Hon Lau
Article Source: What Is Thalassaemia?
Haemoglobin within red blood cells is important because it is the primary molecule that carries oxygen around the body. Hence, the lack of functional haemoglobin causes a malfunction in oxygen carrying capability.
Types of thalassaemia
There are two types of thalassaemia: Alpha thalassaemia and Beta thalassaemia.
Patients with Alpha thalassaemia carrying one faulty gene will experience no observable effect. Patients with two faulty genes experience mild anaemia. Patients with three faulty genes will result in chronic anaemia requiring regular blood transfusions. Four faulty genes are incompatible with life.
Patients with Beta thalassaemia can be divided into several forms. Beta thalassaemia major, also called BTM, requires regular blood transfusions and is the most serious. Beta thalassaemia intermedia, also known as BTI or non-transfusion dependent thalassaemia or NTDT, is a milder form of the condition and the severity differs between individuals, from mild anaemia to the need for regular blood transfusions.
Carriers of either Alpha or Beta Thalassaemia genes may not know their carrier status and can only confirm it by blood testing. Knowing one's carrier status is important for people planning to have children, as thalassaemia is an inheritable disease.
People of Mediterranean, Middle Eastern, African or Asian descent are more likely to be carriers. Thalassaemia is common in these regions because it helps to protect the carriers against malaria.
Causes of Thalassaemia
Thalassaemia is a genetic disease and cannot be transmitted from one person to another.
Treatment for Thalassaemia
The most common treatment for beta thalassaemia major (BTM) is to have regular blood transfusions every four-to-six weeks to reinfuse functional haemoglobin in the body. This treatment can raise iron levels in the body to dangerous levels, risking heart, liver and hormone problems. Chelation may be performed to reduce iron levels in such situations..
Bone marrow transplants may cure thalassaemia in young individuals below the age of sixteen but potential cases should be considered individually.
Stem cells in umbilical cord blood transfusion have also been used for thalassaemia treatment.
For Beta thalassaemia intermediate (BTI) patients, treatment will depends on the severity of a person's symptoms. This can range from folate supplements to blood transfusions.
People with BTM are recommended to have a diet high in calcium and vitamin D and to take regular weight-bearing exercise to help strengthen their bones.
Complications of Thalassaemia
Hypersplenism
Delayed puberty
Stunted growth
Irregular heart rhythms
Hepatitis, Hepatic Cirrhosis
Osteoporosis
Thalassaemia Myths
It is important to know the truth about thalassaemia and not to succumb to many myths surrounding the disease. Here are a few samples of misleading information.
Asymptomatic parents will not pass the disease to their children.
Myth: Faulty genes can be transmitted vertically from parent to child.
If only one parent is a carrier, the child will not inherit the genetic disorder.
Myth: As long as one parent is a carrier, every child has a chance of inheriting the genetic disorder and can only be confirmed with blood evaluation.
Routine blood tests during a person's lifetime would have demonstrated carrier status.
Myth: Only specific blood tests for thalassaemia detect carrier status.
If a baby is a carrier, he or she will get ill later in life.
Myth: Carriers do not develop full blown thalassaemia but will have a chance of passing the faulty gene to subsequent generations..
If both parents are carriers, the 25% chance of a child having the disorder would mean one out of four babies will be ill.
Myth: Every pregnancy should be considered as an independent event for statistical evaluation. Hence every baby born has a 1 in 4 chance of inheriting the disease.
Thalassemia will not occur in the Caucasian population.
Myth: While thalassemia occurs more frequently in certain ethnic groups, it has also been found in Caucasians.
It is imperative that I keep my carrier status a secret.
Myth: Blood relatives often carry similar genes. Hence sharing one's carrier status can increase awareness and understanding amongst the community.
My child is only a carrier so I will not discuss it with him.
Myth: It is important to inform a child of his/her carrier status because the faulty gene can be transmitted to future generations.
Only women need screening tests.
Myth: Both sexes need to be tested as a combination of genes is inherited by a child.
Marrying someone from a different ethnic background avoids children being affected.
Myth: Parents of any background have the potential to pass on carrier status or thalassaemia.
Being a carrier protects against malaria.
Partly true: Thalassaemia carriers have a certain degree of protection against malaria.
Thalassaemia can be caught from blood transfusions.
Myth: Thalassaemia is a genetic disorder. It is not transmitted through blood transfusions.
Thalassaemia needs to be treated with iron supplements.
Myth: Use of supplements should be done under medical advice.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care in Singapore. He has attended to patients of a all ages with a wide variety of health conditions.
Check out the housecall services of CMY Medical for more information.
By Tzun Hon Lau
Article Source: What Is Thalassaemia?
What Is Roseola?
Roseola, a common infection affecting children less than 2 years of age, is a mild infection characterised by fever, rash, and generalized irritability in infants.
Two common strains of herpes virus cause roseola. Duration of disease can last beyond a week in some cases.
Roseola typically isn't serious. However, in some cases, uncontrolled high fevers can result in complications.
Treatment of roseola includes bed rest, fluids and anti-pyretic medications.
Symptoms
Roseola can be dormant in the child up to a week or 10 days. Once the disease erupts, the symptoms include:
Fever. Roseola typically starts with a sudden, high fever greater than 39.4 C. Other symptoms experienced include a sore throat, runny nose or cough. Swollen lymph nodes can also occur. The fever usually lasts 3-5 days.
Rash. Once the fever subsides, a rash typically appears - but not always. The rash consists of many small pink spots or patches, are generally flat, and usually has a global distribution all over the body. The rash, which isn't itchy or uncomfortable, can last from several hours to several days before fading.
Other signs and symptoms of roseola may include:
Irritability in infants and children
Mild diarrhea
Decreased appetite
Swollen eyelids
When to see a doctor
Seek immediate medical care if the child has a seizure due to uncontrolled fevers.
Call your child's doctor if:
The fever is uncontrolled.
The illness is prolonged and unresolving after a week.
Call your doctor
If immunocompromised, contact your doctor. Monitoring for a possible infection will be necessary.
Causes
The most common cause of roseola is the human herpes virus 6, and in rare cases, herpes 7.
It is spread via respiratory secretions or saliva. Hence children in close contact with other children become infected easily.
Roseola is contagious even if no rash is present. Hence the disease can spread insidiously.
Risk factors
Older infants are at greatest risk of acquiring roseola because their immune system is still developing. Newborn babies receive antibodies from their mothers that protect them in the first 6 months of life. Hence, the most common age of infection is between 6 to 15 months.
Complications
1. Seizures in children
Uncontrolled fevers can result in seizures in children. This often presents as a brief loss of consciousness, jerking of limbs, and or temporary loss of bladder or bowel control.
Although frightening, febrile seizures in otherwise healthy children are generally short-lived and are rarely harmful. However, seek medical care if unsure.
Complications from roseola are rare. The vast majority of otherwise healthy children and adults with roseola recover quickly and completely.
2. Concerns for immunocompromised individuals
Immunocompromised individuals, for example, those who have recently received a bone marrow or organ transplant, may contract roseola as a new infection or due to reactivation of the dormant virus in their body.
These patients may experience potentially serious complications from the infection, such as
pneumonia or encephalitis.
Preparing for your appointment
Prior to seeing the doctor, encourage your child to rest and drink lots of fluids.
Tests and diagnosis
Diagnosis is usually clinical though a blood test can be done to check for antibodies.
Treatments and drugs
Most children spontaneously recover within a week of the onset of the fever.
Medications to control fever can be used for symptom control.
Prevention
Avoid exposing your child to an infected child. If your child is sick with roseola, keep him or her home and away from other children until the fever subsides.
Most patients are immune by the time they are of schooling age. However, basic hand washing is recommended to prevent the spread of the disease.
Adults who never contracted roseola as children can become infected later in life, though the disease tends to be mild in healthy adults. Infected adults however can pass the disease to children.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care. He has attended to patients of a all ages with a wide variety of health conditions.
Check out the housecall services of CMY Medical for more information.
By Tzun Hon Lau
Article Source: What Is Roseola?
Two common strains of herpes virus cause roseola. Duration of disease can last beyond a week in some cases.
Roseola typically isn't serious. However, in some cases, uncontrolled high fevers can result in complications.
Treatment of roseola includes bed rest, fluids and anti-pyretic medications.
Symptoms
Roseola can be dormant in the child up to a week or 10 days. Once the disease erupts, the symptoms include:
Fever. Roseola typically starts with a sudden, high fever greater than 39.4 C. Other symptoms experienced include a sore throat, runny nose or cough. Swollen lymph nodes can also occur. The fever usually lasts 3-5 days.
Rash. Once the fever subsides, a rash typically appears - but not always. The rash consists of many small pink spots or patches, are generally flat, and usually has a global distribution all over the body. The rash, which isn't itchy or uncomfortable, can last from several hours to several days before fading.
Other signs and symptoms of roseola may include:
Irritability in infants and children
Mild diarrhea
Decreased appetite
Swollen eyelids
When to see a doctor
Seek immediate medical care if the child has a seizure due to uncontrolled fevers.
Call your child's doctor if:
The fever is uncontrolled.
The illness is prolonged and unresolving after a week.
Call your doctor
If immunocompromised, contact your doctor. Monitoring for a possible infection will be necessary.
Causes
The most common cause of roseola is the human herpes virus 6, and in rare cases, herpes 7.
It is spread via respiratory secretions or saliva. Hence children in close contact with other children become infected easily.
Roseola is contagious even if no rash is present. Hence the disease can spread insidiously.
Risk factors
Older infants are at greatest risk of acquiring roseola because their immune system is still developing. Newborn babies receive antibodies from their mothers that protect them in the first 6 months of life. Hence, the most common age of infection is between 6 to 15 months.
Complications
1. Seizures in children
Uncontrolled fevers can result in seizures in children. This often presents as a brief loss of consciousness, jerking of limbs, and or temporary loss of bladder or bowel control.
Although frightening, febrile seizures in otherwise healthy children are generally short-lived and are rarely harmful. However, seek medical care if unsure.
Complications from roseola are rare. The vast majority of otherwise healthy children and adults with roseola recover quickly and completely.
2. Concerns for immunocompromised individuals
Immunocompromised individuals, for example, those who have recently received a bone marrow or organ transplant, may contract roseola as a new infection or due to reactivation of the dormant virus in their body.
These patients may experience potentially serious complications from the infection, such as
pneumonia or encephalitis.
Preparing for your appointment
Prior to seeing the doctor, encourage your child to rest and drink lots of fluids.
Tests and diagnosis
Diagnosis is usually clinical though a blood test can be done to check for antibodies.
Treatments and drugs
Most children spontaneously recover within a week of the onset of the fever.
Medications to control fever can be used for symptom control.
Prevention
Avoid exposing your child to an infected child. If your child is sick with roseola, keep him or her home and away from other children until the fever subsides.
Most patients are immune by the time they are of schooling age. However, basic hand washing is recommended to prevent the spread of the disease.
Adults who never contracted roseola as children can become infected later in life, though the disease tends to be mild in healthy adults. Infected adults however can pass the disease to children.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care. He has attended to patients of a all ages with a wide variety of health conditions.
Check out the housecall services of CMY Medical for more information.
By Tzun Hon Lau
Article Source: What Is Roseola?
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