“Your Healthcare. Your Choice.”

by Shain Waugh

What is it?

Bipolar is a mental illness classified as a manic-depressive disorder. This brain disorder causes unusual shifts in a person’s mood, energy, and ability to function. The symptoms of bipolar disorder have been known to be extremely severe in coping challenges. The severe condition tend to affect personal relationships, jobs, academic performance, and even suicide.

About 5.7 million American adults ages 18 and older are affected by this disorder any given year. The disorder usually develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is a long-term illness that must be carefully managed throughout a person’s life.

Symptoms

Manic
• Increased energy, activity, and restlessness
• Excessively “high,” overly good, euphoric mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from one idea to another
• Distractibility, can’t concentrate well

Depression
• acting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness

Causes

Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.
The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

Results & treatments

Results from a new analysis of two major clinical trials have shown that patients with bipolar disorder who received long-term treatment with SEROQUEL plus a mood stabiliser were significantly less likely to have a mood event than patients on a mood stabiliser alone. The data, which highlight the potential of SEROQUEL for maintenance therapy of patients with bipolar I disorder, were presented on Sunday, 27 January 2008 at the 3rd Biennial Conference of the International Society for Bipolar Disorders (ISBD) in Delhi, India.

Treatment
According to experts, “Bipolar disorder is a chronic, lifelong illness and patients suffer frequent relapses when they can become depressed or manic. Maintenance therapy is an important part of managing these patients and can offer long-term relief from these recurrences,” said Professor Eduard Vieta, Clinical Institute of Neuroscience, University of Barcelona, Spain. “Our analysis of data from more than a thousand patients suggest the potential of treatment regimens which include SEROQUEL along with a mood stabiliser to reduce the likelihood of mood events.”

Long-term treatment with SEROQUEL was generally well tolerated - the most commonly reported adverse events in patients treated with SEROQUEL plus a mood stabiliser during the randomised treatment phase were headache (7.4%), nasopharyngitis (7.1%) and upper respiratory tract infection (6.7%). The most common adverse events during the open-label stabilisation phase were sedation (23.8%), somnolence (18.7%), dry mouth (16.5%) and weight increase (13.9%). The analysis also showed a greater incidence of fasting blood glucose increases to hyperglycaemic levels.

References

1. Brecher M, et al. Quetiapine in the maintenance treatment of bipolar I disorder: combined data from two long-term phase III studies. Presented at the Conference of the International Society for Bipolar Disorders, Delhi, India, 27-30 January, 2008.

2. Vieta E, et al. Efficacy and safety of quetiapine in combination with lithium/divalproex as maintenance treatment for bipolar I disorder. Presented at the Conference of the International Society for Bipolar Disorders, Delhi, India, 27-30 January, 2008.

3. Suppes T, et al. Maintenance treatment in bipolar I disorder with quetiapine concomitant with lithium or divalproex: a placebo-controlled, randomized multicenter trial. Presented at the Conference of the International Society for Bipolar Disorders, Delhi, India, 27-30 January, 2008.

4. www.webmd.com/bipolar-disorder/default.htm

by Shain Waugh

General Consumer

The cost of health care in the United States of America is continue to rise. With the integration of health retail clinics into the health care community, has saved the general consumer millions of dollar by simply staying out of the emergency room. Most clinics accept insurance, walk-ins, and for simple procedures patients are usually seen within 15 minutes.

The general consumer’s view of healthcare is changing on a globalized scale. The consumer is expecting more information access, embracing globalize medical tourism, better access to medical facilities, and improved customer service. The health care industry has responed strongly to the demands and desired trends of the community by integrating retail health centers in shopping malls, grocery stores, and pharmacies. The availability of such clinics have created a new business market for the general consumer, in turn, empowering the general public decision on healthcare.

Changing the System

In the changing of the systems, the clinic are orchastrated by nurse practitioners, which are nurses with advanced degrees who can write prescriptions. The salary of a nurse practitioners is usually half the cost of an internal medicine physician. The clinics are typically open 7 days a week and patient, 15 minute visit, and prescriptions can be obtained prior to leaving the facility.

Embracing Change

The American Medical Association, the American Academy of Family Physicians and the American Academy of Pediatrics, which opposes retail clinics as a source of medical care for children of all ages, have issued similar guidelines related to retail clinics. All three organizations are particularly concerned about increased fragmentation of care.

The three association recommends that its 100,000 plus physician to expand office offer, embrace same-day appointment, and take part in the general community in order to compete with the retail clinics. The health systems currently face a few options in embracing retail clinics. The options entail either medical facilities choose not to become competitive or find methods to integrate into the retail clinic arena.

Summing Up

As retail health centers continue to evolve, and as more organizations test the market, multiple clinical and business models will provide health care organizations the opportunity to evaluate alternatives. Rather than viewing retail clinics as a threat, hospital and other medical facilities leaders should view the clinics as revolution for health care.

By Shain Waugh

China’s Emperors

According to ancient history, emperors of great wealth compensated physicians only when the emperors were well, and charge them when sick. The development of illness at this time meant the medicine did not work and the physician was failing at their job. The emperors vision was to remain health at all times regards of the efforts of the physician. In many cases, the influences of the great emperor’s vision exist in an array of universal healthcare system such as England, which the government compensates the physician for the total number of patients that remain healthy (i.e. stopping smoking).

United States

In the United States, the concept of the informed consumer will in turn lead to enhance quality of service within a medical facility. This means that purchaser, consumer, or general public will get better care if the proper care is designed to meets one’s needs and expectations. The vision for the health care industry is that health plans, clinicians, and institutions will provide better care to attract more patients. However, in most cases, the process still doesn’t make a significant difference. (Refer to Right Medical Physician)

What is Health Care Quality?

As a health care provider, there are an array of definitions of health care quality and the definition lye in the perception of the evaluator. There are some cases that good quality involves the wait time to see the doctor, the quality of food within the hospital, doctor response in calling back, type of medication prescribed, number of referrals from other doctors, or the amount of time the doctor spends with the patient.

The quality of healthcare must be evaluated as taking your brand new 2008, red, GMC Arcadia to the dealership to evaluate an abnormal sound coming from the engine. The technicians in the shop are the nurses, doctors, pharmacists, and physical therapists for this vehicle. These people are either friendly or not, knowledgeable or not, license or not, but the true questions is if they can fix the car right the first time or over time with multiple visits.

Oregonian Reports

According to the Oregonian reports, there are an array of hospitals and physician practices that are increasingly releasing cost and quality data, but reports along with surveys illustrate that the data is not yet affecting the consumer decisions The performance ratings remain crude, potentially misleading, and difficult for experts to understand. For example, “Oregon’s hospital quality rating Web site details hospitals’ experience with procedures, but consumers are limited when trying to select a top performer, in large part because mortality ratings for hospitals are similar.” In most cases, a medical facility with a high morality rates doesn’t make the facility a bad, unsafe, and dangerous facility to be admitted.

The reasoning is that most facilities with high morality are trauma centers and/or crisis centers that are best fit to address a critical situation. On the other hand, facilities with low morality isn’t a good indicator as well because many of these facilities push patients out once stabilized. In recent studies, New York and California showed that public reporting barely affected the flow of patients to hospitals with high death rates and that some hospitals with low death rates did not increase their patient flow.

According to studies, “most patients are not aware of quality comparisons and that those who are familiar with them seem distrustful and find them confusing.” The challenge with this quote from the Oregonian reports is that the general public is over load with healthcare information and left without a reliable source of information involving healthcare trends, changes, and helpful information. It’s proven via surveys that patients prefer advice from trusted friends, family, and personal physicians over published data or government sources.

Tying it Up

The health care providers including the U.S. government, insurance companies, and many pharmaceutical are working to improve the quality of healthcare today. However, the challenge will be for the general community to play a strong role in demanding the level of quality for yourself, friends, and family members. According to a 2004 study of 12 large U.S. communities, 54.9% of the people actually received the care the they designed, needed, and researched.

The Oregonian reports are a true indicator of how the U.S. health industry is in an uncontrolled status of confusion. We as a health community are so concerned with rising health cost, large premiums, medical errors, and so forth that we as a community become overwhelmed with unreliable healthcare information. Health information should come from one reliable source regulated by the government in a sense. These are many of the challenge the American people face within the land of opportunity, but the quality health care helps people feel better and enjoy a better quality of life, which is what is most important.

by Shain Waugh

In waving bye to 2007 and welcoming 2008, the presence of 2007 still is fresh in the minds of us all. In looking beyond health care and at the world in general, we have achieved so much as globalized nation. However, we have also lost a great deal as well including our respect as an Americans among other countries, the lost of a great politician in Pakistan’s Benazir Bhutto, lost for respect for George W. Bush, decline in the value of the U.S. dollar, and lost a great son, daughter, mother, and father in the Iraq war.

For the industry of health care, 2008 will integrate a great deal of technological integrations the will improve patient safety, reduce medical errors, improve physician evaluation process, justify the difference between medical facilities, reduce the shortage of medical professions, and the possibility of universal health care system in U.S.A.

With this in mind, enjoy this new year, be safe, and let’s make 2008 the best year yet.

Happy New Year!  

by Shain Waugh

Business Entrepreneur

Who said that a physician isn’t a business entrepreneur or independent contractor? The ability to connect with patients on a personnel level is a critical point in remaining competitive, establishing practice separation, and the development of medical marketing intelligence. The ability to connect with patients on their level of thinking, assessing the demand for services, and the ability to supplying or meet the needs for those demand are critical for today’s modern day practices.

As illustrated in past posts “Choosing the Right Medical Doctor“, the greatest challenge for clients today is finding or being able to distinguish between physician practices. So, many physicians have resorted to online video to assist in promoting their business, educating patients about medical disorders, and connecting with patients on a more personal and private level.

The ability to personalize one’s medical practice with online video enables business to establish an array of core competencies such as giving patients an inside view their practice prior to coming to the medical office, understanding the medical team at hand, and develop more of an ease and understanding about a facility’s mission, vision, and practice philosophy.

The major challenge with personalizing one’s practice has been the embracement of technology, increase cost of marketing, and fear of facility misrepresentation. In addition, there are an array of active business that attempt to solve this health care misunderstanding, however, there isn’t a one consistent company or philosophy that assist in truly meeting the needs of our active clients concern with healthcare.

There are many cases were healthcare providers hire companies to produce videos, integrate business within search-engine to increase visibility, while others utilize You Tube or Medem to push the online message. As an example, when searching for a new health care provider, we as consumers ask friends, associate, or consult with insurance companies. However, there is still a limited line in addressing the major problem of identifying to correct physician practice on a globalized scale.

Summing Up

As the healthcare industry evolves and embraces video technology, it will become a standard in delivering a quality message to the general consumer. Physicians will be forced to become more competitive with there medical practice including justifying their business culture, improving quality, organization’s vision, and being health responsible for medical errors. If video becomes a standard of medical facilities then the industry will become as the hotel industry, which is viewed as if a hotel is not visible online then no customer will utilize the facilities services. In time, the government of each country must regulate and make stronger requirements in order to distinguish medical practices.

There are a great deal of consumers inquiring about a quality physician and the only information that they receive is an address, phone number, and a wish of luck. As 2008 approaches, the legacy method of identifying a physician must soon migrate into a more modern standard requirement. However, this all depends on who embraces technology, has the budget funding, government regulations standards in place, and the politicians lobbying for change.

References

http://icyou.comhttp://youtube.com/user/dramatichealth
http://www.medem.com/phy/phy_vrc.cfm
http://www.nyashgroup.com (in development)

By Shain Waugh

Primary Issue

The critical nursing personnel shortage in America is nothing new to those affected by the shortage. It is evident that the long waits in the emergency room, medical surgical or telemetry unit’s patients not being seen by a nurse for hours, patient’s given the wrong medication, nursing staff burnout, and so forth is a significant sign of the challenges involving this shortage. A study in the Journal of the American Medical Association predicted a 20% shortage in the number of nurses needed in the healthcare system by the year 2020. The U.S. Bureau of Labor Statistics reports that more than one million new and replacement nurses will be needed by 2012.

The immediate challenge is that as more than 77 million baby boomers approach retirement age, it is anticipated that the demand for healthcare, particularly home and community-based care, will almost certainly outpace the supply of quality caregivers. The key question is to determine do you trust your hospital, physician, clinic, and or pharmacy. For many, it’s a challenging question when there is no true method of evaluating these critical factors.

 Those Affected

The ratios of nurses to patients dictate the number of patients a hospital’s unit can handle in a given day. In some states these ratios have been legislated while in other, unions mandate it. There are exceptions and work conditions for nurses and patients are still poor and unsafe. As case in point, there have been studies that illustrate direct correlations between staffing of nurses and medical errors.  Example:

In the 3^rd quarter of 2007, a South Florida hospital, which will remain unknown among this document, admitted a patient to its medical surgical unit for a non-critical diagnosis. There were two nurses that called off that particular day, which mean the other nurse took on three additional patients totaling ten patients for the night. Due to the stress, limited staffing, and not enough time to evaluate patients, one patient die within the hospital. The patient was not discovered until 7 hours later. The result included the nurse losing her nursing license, hospital being suited for millions, and the facility developing a bad name within its community. The parties involved were affected simply by the shortage of nurses and/or medical professional staff that shift. So, as medical facilities struggle to fill nursing vacancies and other medical positions, the greater the chance for an unsafe working and medical practice environment.

The shortage of nurses is growing worldwide on a global scale. The immediate problem is that for many of the poorer countries such as the Philippines and South Africa, there has been a migration of nurses from these countries to other countries such as U.S., Canada, and Australia. The more financially stable countries have been trying to meet critical needs for nurses by encouraging nurses from these countries to emigrate. Unfortunately, this processes is increasing the problems and not contributing a solution.

Hospitals argue that pressures from their relationships with managed-care providers leave them no choice but to experiment with various staffing practices, which result in varied degrees of success. It is believe that medical facilities cutting back on nursing staff to achieve higher profits. As a medical professional, there have been situations where staff ratios are reduced because the acuity of the patients doesn’t call for such staff. As a case in point, if a nursing in cardiovascular ICU is use to taking care of one open heart patient at a time, then if there are three telemetry patient on the that unit then this one nurse to three patient is efficient.

Possible Solution

In evaluating solutions, there is an array of theories to assist with the challenge. If we take the model of New Jersey hospital, it consists of a two-year program where the students attend one 12-hour clinical day per week at a participating hospital, and the hospital is responsible for training the student. The remaining part of the program consists of online classes.  

The promotion of the nursing profession to men is critical. The nursing profession has a women dominated culture. There are approximately 5.4% of the 2.1 million registered nursed employed in the United States that are men. This is according to the National Sample Survey of Registered Nurses.

The initiation of incentive by the government would assist in the promotion of nurses. A suggestion would be to reduce the amount of taxes that nurse are required to pay. If the normal tax bracket is between 25%-30%, then nurse should be required to pay only 15% tax. This tax reduction will increase a nurse salary without forcing the hospitals or medical facilities to increase wages.

In 2002 the Nursing Reinvestment Act was signed by President Bush to address the problem of our nation’s nursing shortage. This initiative was intended to promote people to enter and remain in nursing careers, thus reducing the growing shortage. The law establishes scholarships, loan repayments, public service announcements, retention grants, career ladders, and grants for nursing faculty. The challenge with this Act is that it has stipulations and not all individuals that become a registered nurse are able to utilize or benefit from the act. 

According to Forbes magazine, medical tourism will be a $40 billion industry by 2010. This is a promising illustration of how people concerned with rising health care cost are able to manage their health care crisis. The soaring medical cost in America are forcing Americans to travel abroad for elective and/or major surgeries. The abroad physicians and hospitals are willing to conduct procedures at 10% to 30% of the cost in America. Its estimate that 750,000 Americans traveled abroad for medical care in 2007.

Medical Cost in U.S. versus Other Countries:

• Bone Marrow transplant $ 400,000 versus $30,000*
• Liver Transplant $500,000 versus $40,000*
• Heart-valve Replacement $200,000 versus $10,000*
• Open Heart Surgery $50,000 versus $44,400*
• Neurosurgery $29,000 versus $8,000*
• Knee Surgery $16,000 versus $4,500*
• Metal Dental Bridge $5,500 versus $500*
• Full Face Lift $20,000 versus $ 1,250*

*South Africa, India, and Thailand.

There are an array of medical tourism companies that assist travels find the hospital, clinics, or medical facilities that find the desired procedure. These hospitals are accredited under the international arms of JCAHO, which also regulates U.S. hospitals. Medical tourism presents important concerns and challenges as well as potential opportunities. This trend will have a significant impact on the health care landscape in industrialized and developing countries around the world.

India has been known for their rejuvenating treatments such as yoga and ayurvedic massage, but the quality of their heart by-pass surgery has draw the attention of many throughout the world. According to economist, for the cost of a face lift in the U.S., one can due the following

• Passport U.S. $ 130
• Indian Visiting Visa $ 150
• Flight to India $1,500
• Hotel (6-10 day) $1,000
• Accommodations $1,000
• Face Lift $1,250

Total $ 5,010
Savings $14,990 (approximately)

The most significant aspect of undergoing treatment in India is the low cost compared to either the U.S.A. or Britain. There is a great deal of money that’s saved with medical tourism such as 60% over the normal cost. The treatments includes the procedure, treatment, transportation, and hospital stay as illustrated above. It appears that India found a significant niche in improving its economy, visitors, and technological health integrations with medical tourism.

by Shain Waugh

I remember visiting my great grandmother a few months back at her nursing home, which is located in West Palm Beach, FL. The feeling of security, assurance, and a piece of mind was there with me once visiting the actual facility. The facility was well manicured, pleasant aroma, highly recommended by others, and located in a safe neighborhood. However, the quality of patient care was extremely poor, unprofessional, inappropriate, and bewildering to me as a medical professional. If a patient has ‘drop foot’, that foot must be supported by a non-pressure heel support boot for example, and not left unsupported.

Over the years, nursing homes have declined in its quality of care, value, and public image due to a decline in government funding, nursing shortages, and employee’s desensitization to patient’s needs. The decline in quality has de-compensated so greatly that its has become a primary factor for Medicare and Medicaid. According to the Des Monies Register, there are approximately 128 nursing homes within the U.S.A. that does not meet health and safety regulations. However, only 54 have been made public, which leaves this game of “Nursing Home Russian Roulette” open to all patient’s family members.

Presidential hopeful Senator Obama has voice serious concern and objections to the retention of this list. Since there are 16,000 active nursing home in the U.S.A, there may be others that should be migrated on this list. Most nursing homes have some deficiencies, but the ones illustrated poses immediate threats to the patients well beings.

An intermediate solution for family is to evaluated these facilities personally, obtain second opinions, consult physicians, research nursing home blogs, contact medicare/medicade, understand the facilities plans for quality, and remember your family member comes first.

by Shain Waugh

Since the dawn of time, one of the most critical elements in being satisfied with your health care experience is choosing the right physician. The relationship one has with their health care provider should mean better communication, effective treatment, and life longevity. The challenge that we face today is selecting the right doctor. There is an array of reference sites such as the American Board of Medical Specialties, American Medical Association, Administrators in Medicine, WebMD, Mayo Clinic, etc.

However, these references only provide information on a physician’s qualifications, physical location, specialty of practice, insurance, etc. There is no true method of evaluating a physicians performance besides referrals or viral reporting (word of mouth). In past survey studies of the general public, three out of every five people are unhappy with their current physician and three out of every five people are actively looking for a new physician.

The question for this dialogue is what do we do as a community to become more informed about physician’s medical practices? What are some tactical strategies that you the reader have utilized successfully? Your feedback provides great insight to those of us struggling to address this question each day.