Recently in Best Practices Category

Nearly two dozen medical schools that have recently opened or might open across the country, the most at any time since the 1960s and '70s.

These new medical schools are seeking to address an imbalance in American medicine that has been growing for a quarter century.

Many bright students were fleeing to offshore medical schools, or giving up hope entirely, when they could not get into domestic schools. 

In a weird aberration of "outsourcing", the medical field was outsourcing medical education to foreign countries, and then hiring foreign nationals to work in our American healthcare system, presumably at lower rates and longer hours.

During the 1980s and '90s only one new medical school was established.

"Huge numbers of qualified American kids were not getting into American medical schools or going abroad to study," Dr. Lawrence G. Smith, dean of the proposed Hofstra University School of Medicine, in Hempstead, N.Y., which is not yet recruiting students, said last week. "I think it was a kind of wake-up call."

The proliferation of new schools is also a market response to a rare convergence of forces:

• a growing population;
  
• the aging of the health-conscious baby-boom generation;
  
• the impending retirement of, by some counts, as many as a third of current doctors;
  
• the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system.

Colleges serve a "Gatekeeping Function" as well as education of new practitioners.  By carefully limiting the number of trained professionals, those with established careers have less competition -- and that can be important to personal care services that must maintain a full staff even when they have a light load of patients.  Under-staffing also causes long delays in getting an appointment, and has healthcare consequences when care is delayed.

If all the schools being proposed actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country.

Read more at the REFERENCE SOURCE:  New York Times

Stroke is a leading cause of disability and death among older people

People who experience memory loss or a decline in their thinking abilities may be at higher risk of stroke, regardless of whether they have been diagnosed with dementia...

This study, was published in the February 2, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology.

"Stroke is a leading cause of disability and death among older people, making early identification of people at high risk of stroke extremely important, so preventative measures can be taken," said study author Bernice Wiberg, MD, with Uppsala University in Sweden.

For the study, 930 men in Sweden around the age of 70 without a history of stroke participated in three mental tests.

Trail Making Test B

The first test, called the Trail Making Test A, measures attention and visual-motor abilities.

The second, the Trail Making Test B, measures the ability to execute and modify a plan.

The third, the Mini Mental State Examination, is commonly used by doctors to measure cognitive decline.

During a 13-year period, 166 men developed a stroke or transient ischemic attack, or TIA.

Brain infarction is the most common cause of stroke. Hemorrhage is another kind of stroke.

Brain infarction happened to 105 patients.

It causes tissue damage when the proper amount of blood does not reach the brain.

INDICATOR: Low Performers on Trail Making Test B

The study found that people who were among the bottom 25 percent of performers on the Trail Making Test B were three times more likely to have a stroke or a brain infarction compared to those who scored among the top 25 percent of performers on the test. The other two mental tests did not predict brain infarction or stroke.

Cognitive Decline May Predict Risk of Stroke

"Our results support the idea that cognitive decline regardless of whether a person has dementia may predict risk of stroke," said Wiberg. "The Trial Making Test B is a simple and cost-effective test that, with more research, could be used to identify those persons for whom stroke prevention measures should be considered."

The study was supported by the Medical Faculty at Uppsala University, the Swedish Stroke Association, Swedish Research Council, the Swedish Heart Lung Foundation, the Geriatric Fund and the Uppsala County Association Against Heart and Lung Diseases.

The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as multiple sclerosis, restless legs syndrome, Alzheimer's disease, narcolepsy and stroke.

For more information about the American Academy of Neurology, visit http://www.aan.com.

VIDEO: http://www.youtube.com/AANChannel

Despite a general belief among physicians that extreme obesity is too difficult to treat, except with bariatric surgery, researchers at the Pennington Biomedical Research Center have learned a substantial proportion of individuals with extreme obesity can lose 10-percent or more of their body weight through medical treatment that does not include surgery.

10% Loss Improves Risk Factors and Health

Furthermore, even though those individuals are still obese, they have improvements in risk factors and other health markers.

Weight Loss Surgery Not Often Affordable or Reimbursed by Insurance

"This is important, because surgery is not often affordable or reimbursed by insurance," said leading scientist Dr. Donna Ryan. "In fact, many medical treatments are frequently not reimbursed by insurance if they are for obesity. So this research is needed to show that primary care doctors are capable of helping obese patients lose weight to improve health, even those with extreme obesity. "

Ryan said losing only five-percent of body weight can reap healthy benefits for the extremely obese, and nearly 61-percent of those in her clinical trial achieved that. More than 40-percent lost 10-percent body weight or more.

Physicians Trained in Intensive Medical Intervention

Ryan and her team spread out across Louisiana to recruit and train practicing physicians and their office staffs in eight cities in what she called "intensive medical intervention," in which physicians used a combination of medication, low-calorie diets and behavior changes. All of the techniques were endorsed by national guidelines for obesity management. Training of physicians and their staffs took about a day and a half.

Funded by the Louisiana Office of Group Benefits, which provides health coverage for state employees, the research team contacted state employees, seeking participants to screen for and enroll in the trial. Nearly 400 participants enrolled in the two-year trial, called LOSS, using the nearest trained physicians.

About half of the participants received the intensive medical intervention, the other half received what Ryan called "usual care." 

Program Starts with Low-calorie Liquid Diet

Those in the intense intervention group were immediately placed on a low-calorie liquid diet. They gradually moved to a low calorie, highly controlled diet using meal replacements, and received weight loss medication and group behavioral therapy that included lessons in exercise, activity, self-monitoring and recommendations for walking, water exercise and weight training. The group sessions were supervised by office staff.

Recommended Activities

• exercise
• activity
• self-monitoring
  
• recommendations for walking
• water exercise
  
• weight training

Success in Daily Routine of Doctor's Practice

"We conducted this trial as close to the reality of a typical clinic setting as we could," Ryan said, "We didn't want to learn just if these strategies worked, but if they would work in the daily routine of a doctor's practice."

Challenge of Keeping Weight Off

Ryan noted that the continual challenge in weight loss is keeping weight off, and that means sticking with a routine.

More than 50% of the LOSS participants stuck with it for two years or more, keeping much of the weight off, but Ryan said that does leave room for improving weight loss maintenance.

The LOSS trial results were published in the current issue of the Archives of Internal Medicine.

The Pennington Biomedical Research Center is a campus of the Louisiana State University System and conducts basic, clinical and population research.

UV-blocking contact lenses can reduce or eliminate the effects of the sun's harmful UV radiation.

Overexposure to UV radiation can lead to harmful changes in the cornea, conjunctiva and lens, including cataracts

According to the article, "Prevention of UV-Induced Damage to the Anterior Segment Using Class I UV Absorbing Hydrogel Contact Lenses" (http://bit.ly/5T2feA), overexposure to UV radiation can lead to harmful changes in the cornea, conjunctiva and lens, including cataracts, the most common cause of visual impairment around the globe.

Cataracts

According to the researchers, some estimates say that by the year 2050, there will be 167,000 to 830,000 more cases of cataracts.

Awareness of Eye Damage from UV Exposure

"Unfortunately, people are generally unaware of when their eyes are at greatest risk for damage from UV exposure," said vision researcher Heather Chandler, PhD, from Ohio State University's College of Optometry. "This research involving UV-absorbing contact lenses can provide another option for protection against the detrimental changes caused by UV."

The study exposed rabbits daily to the equivalent of about 16 hours of exposure to sunlight in humans -- enough to induce UV-associated corneal changes. The rabbits who wore UV-absorbing contact lenses (Senofilcon A) were not affected by the UV exposure.

Protection from Sunglasses or Hats

Chandler said wearing sunglasses or hats may not provide enough protection from the sun, and adding adequate UV protection to contact lenses may be a practical solution to the problems caused by too much exposure.

She also said that since this study focused exclusively on acute UV exposure, further long-term studies are needed to determine the efficiency of wearing the UV-absorbing contacts over a longer time period.

Use of UV-absorbing contact lenses

"Not all contact lenses offer UV protection, and, of those that do, not all provide similar absorption levels," Chandler said. "This research will help patients and doctors consider appropriate UV-blocking contact lenses for those who need vision correction, to fill in some of the UV blocking gaps left by more traditional means. The data generated from this study could support the use of UV-absorbing contact lenses and greatly impact the health of a large number of people."

The Association for Research in Vision and Ophthalmology (ARVO) is the largest eye and vision research organization in the world. Members include more than 12,500 eye and vision researchers from over 80 countries. ARVO encourages and assists research, training, publication and knowledge-sharing in vision and ophthalmology.

The ARVO peer-reviewed journal Investigative Ophthalmology & Visual Science (IOVS) publishes results from original hypothesis-based clinical and laboratory research studies. IOVS ranks No. 4 in Impact Factor among ophthalmology journals. It is published online monthly.

Research of hearing loss has been difficult over the years.  New research is tracking how premature infants lose hearing, and how it can be prevented.  This knowledge could have broader application to adults.

Both humans and mice are particularly vulnerable to noise- and drug-induced hearing loss at young ages.

Sound levels measured by Clark and Weathers showed that premature infants being airlifted tested were exposed to almost 100 decibels for a period of 12 minutes before takeoff, similar to a lawn mower or chain saw. These levels could be especially damaging to premature babies.

"The laboratory mouse is a well-established model for human hearing," says coauthor Kevin K. Ohlemiller, Ph.D., research associate professor of otolaryngology. "They possess similar inner ear anatomy and physiology and similar patterns of age-related, noise-induced and drug-related hearing loss."

Ohlemiller worked with Elizabeth A. Fernandez, then a doctoral student in the Program in Audiology and Communication Sciences, to see if loud noise and a low dose of kanamycin would exacerbate each other's effects. Because the first month of life is when mice are most vulnerable to noise and drugs that damage hearing, 20- to 30-day old mice were injected with either kanamycin or saline solution twice a day for 11 days. They were then exposed to 110 decibels of noise for 30 seconds.

Two surprising findings arose.

First, this particular strain of mice was very sensitive to noise-induced hearing loss. Significant loss of some sensory cells in the ear resulted in permanent hearing damage, even over the short time span.

Second, a regular, low dose of kanamycin completely protected the mice against this sensory cell damage and hearing loss. The protective effect of repeated doses persists for at least two days after the last injection, the scientists noted.

Researchers plan to use these hearing research findings in a number of ways.

They can map the genes in this strain of mice to determine what makes them so noise-sensitive and possibly figure out how kanamycin protects sensory cells in the ear.

In addition, the findings open up new possibilities for clinical research.

Learning how kanamycin protects the ear's sensory cells could help scientists develop drugs with similar effects. Medications that protect the ears from damaging noise levels could benefit a wide range of groups, from soldiers to airline workers to premature babies.

Basic Science Research PLUS Clinical Problem & Practice

"This very dramatically points out the benefits of having basic scientists who can take a clinical problem and find a result opposite of what we expected," Clark says. "These results not only energize laboratory scientists and begin new lines of research, but they also have implications for clinical practice. This has been an amazing sequence of events, to start a project in a helicopter and end up under a microscope."

Fernandez EA, Ohlemiller KK, Gagnon PM, Clark WW. Protection against noise-induced hearing loss in young CBA/J mice by low-dose kanamycin. Journal of the Association for Research in Otolaryngology. Jan. 22, 2010 (advance online publication).

Funding from National Institutes of Health and the Washington University School of Medicine in St. Louis Department of Otolaryngology supported this research.

Chronic kidney disease affects 26 million people in the United States.

Challenging prevailing wisdom that only children with end-stage kidney disease suffer physical, social, emotional and educational setbacks from their disease, research led by Johns Hopkins Children's Center shows that even mild to moderate kidney disease may seriously diminish a child's quality of life.

The findings, reported in the February issue of Pediatrics, suggest that earlier attention to quality-of-life issues in children with chronic kidney disease is needed.

"Even mild and moderate declines in kidney function may lead to serious physical, emotional, intellectual and social challenges," says lead investigator Arlene Gerson, Ph.D., a pediatric psychologist at Hopkins Children's.

Kidney Disease Screening is Needed

"What this means is we should be thinking about screening children for these challenges and intervening earlier than we once thought."

Recently diagnosed children who report learning problems may benefit from help before grades drop, researchers say, noting that children with chronic diseases currently do not qualify for special education until their scores decline dramatically.

Links Between Kidney Function and Quality of Life

In their study of 402 children, ages 2 to 16, with mild-to-moderate kidney disease, researchers analyzed the link between kidney function, disease severity, age of onset and disease duration, on the one hand, and physical, emotional, psychological and school functioning on the other.

The researchers also compared quality-of-life outcomes between healthy children and children with early-stage kidney disease. Children with mild-to-moderate kidney disease and their parents reported worse overall outcomes on standard quality-of-life questionnaires and worse outcomes on all quality-of-life factors.

Specifically, children with early-stage kidney disease scored on average 75 out of 100 on quality-of-life measures, compared to 83 out of 100 for healthy children. The difference was especially pronounced in school functioning, where children with early-stage kidney disease scored 64 out 100, compared to 80 out of 100 for healthy children.

How Children Cope with Kidney Disease

The study also found that the younger the child at the time of the diagnosis and the longer the child lived with kidney disease, the better the overall quality of life, a surprising finding, suggesting that as time passes children learn to cope better with their condition, the researchers say.

The researchers found that children with impaired growth and shorter stature, a common effect of their disease, had worse overall quality of life and poorer physical functioning, an indicator of the importance of early treatment.

Treatments for Children's Kidney Disease

"Timely and individually tailored treatment, be it with nutrition, salt supplements or growth hormones, if needed, can make a big difference. We cannot overemphasize the importance of early intervention in children with early stages of chronic kidney disease," says senior investigator Susan Furth, M.D. Ph.D., a pediatric nephrologist at Hopkins Children's.

The research is part of an ongoing 57-center study funded by the National Institutes of Health to study chronic kidney disease in children.

Heavy backpacks place a measurable strain on the spines of children, with heavier loads causing greater spinal strain and increased back pain, reports a study in Spine, January 2010 

My husband and I started getting concerned about heavy backpacks when our son was required to carry a very heavy backpack weighted down with a year's worth of books when he was in gradeschool.  It just didn't make sense.  It's taken a long time to get the research to prove the problems.  But it's here now, and solutions need to be found -- such as eBook readers.

The next step in convincing schools to "lighten the load" is to show how expensive back pain and back care is to our society.  Maybe business and government can prevent that long term impact on healthcare costs by providing children is an alternative to heavy books.

Test Results for Children's Back Health 

Magnetic resonance imaging (MRI) scans show compression of the spinal discs and spinal curvature caused by typical school backpack loads in children, according to Dr. Timothy Neuschwander of University of California, San Diego, and colleagues.

Backpacks' Effects on Disc Height and Spinal Curve Linked to Back Pain

The study included eight children, mean age 11 years. A special upright MRI scanner was used to image the children's spines in standing position--first with an empty backpack, then with increasing weights of 9, 18, and 26 lb. These weights represented about 10, 20, and 30 percent of the children's body weight.

Two key spinal measurements changed as the backpack load increased.

• Heavier weights caused compression of the intervertebral discs, which act as a cushion between the vertebrae (bones of the spine).
  
• Especially in the lower spine, the disc height became smaller (reflecting greater disc compression) at heavier backpack weights.
• Heavier loads were also associated with increased curvature of the lower spine, either to the right or the left.
  

Half of the children had a significant spinal curve even with the 18 lb weight. Most of the children had to adjust their posture to bear the 26 lb backpack load.

As backpack weight increased, so did the amount of pain reported by the children. At the heaviest load, the average pain score was nearly five (on a ten-point scale).

Parents are increasingly concerned about the heavy backpacks their children have to carry. The new study is the first to use imaging techniques to see how backpacks affect children's spines.

More than 90 percent of U.S. children carry backpacks, typically with weights equal to 10 to 22 percent of their body weight.

Carry Backpacks on One Shoulder or Two?

The results suggest that heavy backpacks cause compression of the spinal disks and increased spinal curvature, both of which are related to back pain reported by the children. Although the children were wearing the backpack straps over both shoulders when the MRI scans were performed, the researchers note that spinal curvature could be even greater if the backpack was carried over one shoulder--as many children do.

Lower Back Pain for Children -- Through Adulthood

"Low back pain in children may be worsened by discogenic [disc-related] or postural changes," Dr. Neuschwander and colleagues write. This could have long-term implications, as children with back pain are at increased risk of having back pain as adults. The researchers call for similar studies to examine the effects of heavy backpacks in children with existing back pain.

About Spine
Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine ranks highest among subspecialty orthopedic titles. Visit the journal website at www.spinejournal.com

Surgeons are less likely than family physicians or patients to view surgery as the preferred treatment option for low back pain, according to a study in the January 1 issue of Spine.

Quality of Life Issues

For patients with back pain, quality-of-life issues are the main factor affecting treatment preferences--which has important implications for shared decision-making between patients and their doctors, according to the new study led by Dr. S. Samuel Bederman at University of Toronto.

Family Doctors Have Highest Preferences for Surgery

The researchers presented hypothetical back pain scenarios to surgeons (orthopedic surgeons and neurosurgeons), family physicians, and patients with back and/or leg pain. The scenarios reflected key factors related to back pain:

• walking ability
• pain duration
• pain severity
• neurological symptoms
• factors inducing pain
• pain location
  

Each group rated their preference for surgery in each scenario, and the factors affecting preferences were analyzed.

Perhaps unexpectedly, surgeons had the lowest overall preferences for surgery, while family physicians had the highest preference for surgery.

• For orthopedic surgeons, the preference for surgery was somewhat lower than for neurosurgeons.
  
• Both the family doctors and patients had a higher preference for surgery than either group of surgeons.

The factors affecting preferences for surgery varied as well. 

Location of Back and Leg Pain

For surgeons, the most important factor was the location of pain. In particular, they preferred surgery for patients with pain predominantly in the leg, rather than the back. Surgery provides better results in patients with problems affecting the spinal nerve roots, which tend to cause leg pain.

Family Physician Preferences for Surgery

In contrast, for family physicians, the most important factor affecting preferences for surgery was neurological symptoms, followed closely by walking ability and pain severity.

Family doctors may be unaware of which factors affect the chances of good outcomes from back surgery, the researchers suggest.

Top Back Pain Patient Concerns

For patients, the most important factors were pain severity, walking ability, and pain duration. "All of these symptoms are highly related to quality of life and have little direct bearing on outcomes following surgery," Dr. Bederman and co-authors write.

Successful Pack Surgery

When other treatments have failed, surgery can help patients with moderate to severe lower back pain. Family physicians play an important role in sending back pain patients for surgical evaluation. However, few studies looked at the factors considered by primary care doctors consider in referring patients for possible spinal surgery. The final decision is generally made through a shared process between the patient, family physician, and surgeon.

Key Metric for Surgery Solutions for Back Pain

The new results suggest that, in various scenarios, surgeons have a lower preference for surgery than family physicians. In addition, the factors that surgeons feel are most important--especially the location of pain--don't match those considered most important by family doctors.

Importance of Quality of Life Factors

The study also highlights the importance of quality-of-life factors--especially pain severity and duration and walking ability--in affecting patients' treatment preferences.

Dr. Bederman and colleagues hope their findings will help in "aligning" the opinions of patients and doctors, thus improving the shared decision-making process and promoting more accurate patient expectations of the results of surgery. "This can directly result in a significant improvement in patient satisfaction with the healthcare process and even overall health status following treatment," the researchers write.

About Spine
Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. According to the latest ISI Science Citation Impact Factor, Spine ranks highest among subspecialty orthopedic titles. Visit the journal website at www.spinejournal.com

EnviroFacts is an online tool that maps your area of choice with specific details about water quality, hazardous waste, air and land toxics, compliance issues and more.

Pollution Map...Online

The free online tool is based on GIS (Geographic Information Systems) where data is input into a visual format like a map. You can customize the type of information to display on your map or even map by topic instead of location to learn more about that issue. Search by Zip Code, City or County.

Check on the UV Index for your area... or who produces air emissions!
Identify Brownfields, or Hazardous Waste Sties... or Water Discharges... or Public Water Systems Violations...

It pays to know where invisible or hidden dangers lurk...

Research a neighborhood before you move there!
Reserach what's IN YOUR current neighborhood!
Find a community service project to clean up for your family and neighbors...

Learn about the natural systems in your community...and how they affect your health:

• Air
• Land
• Facilities
• Water
• Toxics
• Waste
• Radiation
• Compliance
• ...Other

Visit http://www.epa.gov/enviro/ to explore this newly updated program.

The possibilities are endless as you explore your world on a different level. This resource can be used for school or for your own personal interests. Maybe it could lead to community service projects based on the pollution issues in your area or a great visual for a class project. You can also take a look at the Community Service Projects page on EPA's High School Website or just see the resources out there for you to use.

Learning WHAT is in your community is the first, vital step to doing something about the problem -- and avoiding what can be harmful to you and your family.  Knowledge is power!

Learn more

Office of Resource Conservation and Recovery provides the following guidance:

"Consumers can check with their local recycling facility to see if they collect these kinds of contaminated jewelry and trinkets. To find a local recycling facility, they can go to www.earth911.com .

If a local recycling facility doesn't take these articles, consumers can go ahead and throw them in the trash. Our modern landfills are made to be able to hold such contamination without leaking it into the environment."

So, we can dispose of these safely.

For more information on the disposal of waste, please visit our Website. For information on product recalls and keeping people safe in and around the home, visit the US Consumer Product Safety Commission's Neighborhood Safety Network.

Start at the Beginning...

While it is important to know what to do with current products that are, or could likely be contaminated with lead and other elements detrimental to health, it is important to THINK EARLY and not buy them in the first place.

Establishing your own "Purchasing Policies" for gifts, housewares, hobby supplies, etc. make a lasting difference in the level of toxins in your home or workspace.  For example, you can adopt "best practices" that fit your needs such as:

• Buy from certified suppliers (Know which certifications are best in your field)
• Buy just what you need for the anticipated life of your project (Stuff gets old :-)
• Think long term -- limit purchases of fads and temporary fixes
• Buy less, but buy BETTER
• Buy multi-use items vs. single application tools, supplies and furnishings