While most medical errors/adverse events occur in the hospital setting, beware they can occur in any outpatient medical care setting. Worldwide, as many as 4 in 10 patients are harmed in primary and outpatient healthcare settings, with up to 80% of those medical errors preventable, according to the nonprofit Foundation for the Innovation and Development of Health Safety. Think your doctor’s office, walk-in clinic, pharmacy clinic. you recall from an earlier blog 3-17% of all hospital admission suffer an adverse event and medical error is the third leading cause of death in the US (2016).
Errors in outpatient settings generally fall into one of these 3 categories:
- Diagnostic – such as an error or delay in diagnosis
- Treatment – error in an operation, procedure, medication, or test
- Preventive – inadequate monitoring or follow-up of treatment
Common medical errors that occur in ambulatory settings – that includes your doc’s office are prescribing errors 39%, transcribing 11% dispensing 12% administering 38%. Preventable errors include not giving you an earlier appointment, for a potentially serious problem -ex. foot pain or cut on foot in a diabetic. Beware, a leading cause of the error is delayed treatment accounting for over 50% of cases that result in death. Establishing a rapport with support staff is critical, even if they are new how you introduce your need for an appointment can ensure timely care.
For example, after your name state your condition(s) for which you see the doctor, then what your problem presently is: “Hi, this is Ann Richard birthday 6/11/1957, I’m one of Dr. T’s diabetic patients and he told me whenever I have a problem with my skin to get in as soon as possible. Yesterday I cut myself in the garden and bled for a while it still doesn’t look good.’ don’t overdo it and say no need for an emergency room visit. Also if you can’t get in soon ask for the nurse. another option is to have the scheduling person check with Dr. T on your behalf. Another in your armamentarium is “Doc, hates me running to the ER and he told me to insist on getting into his office to be seen”.
Don’t think the responsibility falls on everyone else but yourself! Don’t presume because they gave you an appointment three weeks out that you can really wait three weeks to be seen. Beware, when you have an upcoming visit, start planning, gather what you want them to see from another visit or a study, do not presume your records got to your caregiver. Having your exact issues-what when and how in your condition brought you to be ‘seen’ written. All medical folks seem rushed sticking a copy of your typed issues goes further than the multiple pages you complete on ‘intake’. Believe me! bring more than one copy, present it on signing in and ask to have it put in your record.
Listen well, ask if you think you may become anxious ask if you can record with your phone or take written notes. Most important is that you leave there with exactly the diagnosis or condition even if the doctor isn’t sure he or she should mention what he or she is considering and what the plan is: test(s), medication(s), and referral. It’ll be so important to have this information. If you call by scheduling to have a CAT scan of your right elbow when indeed you need your left elbow or you need your left knee not your elbow -you see why it’s important to have your notes of the ‘plan’. Hence you will not be second-guessing yourself.
The ACA required electronic records in the healthcare setting, no surprise given16% of physicians have illegible handwriting -turbocharge error and a common cause of a prescription error. Now mostly electronic transmission to pharmacies occurs. but if you find that you are giving a handwritten prescription try to read it if you have any questions ask the doctor and if he has already scrambled out of the room ask the nurse then write it down yourself so you’re sure that you get the correct medication. Don’t be shy ask exactly how to spell it. The pharmacist can make mistakes by miss reading and misinterpreting a scratch on the pad
If you had a test don’t think no news is good news, when you have an x-ray the radiologist has to interpret it within 24 hours and get a report out so waiting weeks is a bit ridiculous. The more you sound informed the more you gonna be respected in the better care I believe you will end up getting. Remember you are your own best advocate against the system. when comes to waiting for the medical office to get back to you with the results.
This is an introductory sensitizing blog on a critical topic I wish you to aware of – BEWARE!
Migraine sufferers have a serious burden. A condition that is not easily recognized nor improved.
-40 million folks in the US are impacted by these headaches (HA).
-1 in 4 households is impacted by someone suffering from migraines.
– sufferers are twice as likely to use opioids
-over $6000 additional direct healthcare costs per year
-commonly suffers are 18-65 with the peak at ages 30-50
60% taking recommended treatment
60% are at the poor treatment
Those with migraines, women two to three times more than men, have a lower quality of life, are poorly functioning while those with severe cases having a disability. While everyone’s body is unique, certain triggers may explain that women with hormonal fluctuation suffer more.
They are classified as episodic or chronic dependent on frequency, characteristics, and accompanying symptoms. Episodic migraines are defined as at least 5 attacks/month lasting 4-72 hours (untreated or not successfully treated), having characteristics that can include: unilateral location, pulsatile quality, moderate to severe pain aggravated by activity. Also during an attack at least one of the following occurs, nausea vomiting, light and noise sensitivity (photophobia and photophobia).
Chronic migraines defined as HA on more than 15 days/month for 3 months as well as having occurred in someone who has had at least 5 attacks w/o aura or with aura.
New medication and techniques specifically neuromodulation, non-invasive devices have become available as an alternative therapy to medications. In general expensive, the FDA’s recent approval (Jan. 25, 2021) of one neuromodulation device that can link to a smartphone. Also as of Oct. 2020, an over-the-counter ‘Cefaly Dual neuromodulation‘ device in pharmacies, not inexpensive though
Therapy is aimed at prevention as well as treating breakthrough migraines.
While this condition can be frustrating till the correct treatment for you is arrived up – do not despair, new medications and devices are almost monthly for your healthcare provider to share.
More of us have picked up exercise in this lockdown era. Everybody knows exercise is good for you, so more is better? Exercise is tied to good health improved brainpower (cognitive function). Like everything else there’s a dark side – too much of any one thing is BAD!
Many gyms and fitness centers perhaps inadvertently encourage such behavior. The crazy of at-home fitness machines and virtual classes to join. But remember many units have cameras and microphones, hence President Biden might not be able to use one living in the White House.
Like any addiction exercise addiction, entails excessive and obsessive patterns. Dependence raises and can be recognized by 6 characteristics according to an Addiction Behavior Reports article. The same features of any type of dependence as you can see as you read on. The list includes: Salience (a most important aspect of one’s life); Conflicts; mood modification (exercise improves mood by increases endorphins), food to exercise to improve mood; tolerance -an increasing level is needed to satisfy physiological effect; withdrawal symptoms – irritability arises if reduced ceased; relapse -need to get back as soon as possible to achieve ‘high’.
Recognize these characteristics? Eating disorders, self-worth imagining, and OCD may contribute. Sadly drug use may creep into the mix for many individuals.
Treatment is not one size fits all, especially since exercise is good for you. Recognition you are addicted or heading that way is the first step to your getting help from a realistic trainer or therapist. This applies to children as well although with current isolation after school sports are down.
I have said many times before, vitamins are nutrients our body requires but does not make. Most people know about vitamins A, B, C, D, and/or E, but vitamin K goes under most folks’ nutritional radar. Yet it is essential for life because our body requires its presence for blood to clot. Food provides vitamin K also to support healthy aging. Scientists have discovered vitamin K-dependent proteins in many body tissues. Vitamin K, therefore, plays a physiological role beyond blood clotting. For example, in arterial tissue, proteins dependent on vitamin K can help prevent calcification. This is critical because arterial calcification can lead to heart attacks. Also, vitamin K-dependent proteins are suspected to play a role in osteoarthritis.
Like Vitamin B there are also multiple forms of vitamin K. Scientists know of at least 12 forms of this fat-soluble vitamin. Phylloquinone, also known as vitamin K1, is synthesized by plants. Green leafy vegetables, like spinach and collard greens, and vegetable oils, like soybean and canola oil, contain high amounts of phylloquinone. K2, or menaquinones, are produced by bacteria that line the walls of the gastrointestinal tract. This vitamin keeps the walls of the blood vessels strong, as well as the bones tissues. It is found in egg yolks, organ meats, and dairies.k
When I can’t eat foods with Vit. K
In partnership with Tuft University, the U.S. Department of Agriculture, the USDA’s Food Data Central website, houses the most comprehensive nutrition free database in the world. Over 350,000 foods are profiled. This is a great resource please have a look.
Some intake parameters are; men over 18, the adequate intake for vitamin K is 120 micrograms a day, women, it is 90 micrograms a day. One cup of raw spinach contains 145 micrograms of phylloquinone.
Caveat and the truth – it is very difficult to isolate the effect of a nutrient directly to a single health outcome, and even more difficult to recommend supplement use based on the studies that have been done to date. It is always best to eat food containing vitamins than to take OTC supplements.
U.S. News & World Report, an international authority in rankings and consumer advice, released its annual evaluation for Best Diets. If you get a copy you will read of 39 diets in multiple categories.
The MIND diet was ranked fourth for the easiest diet to follow and tied for the fifth for best diet overall and best diet for healthy eating.
The MIND diet was ranked in the following seven categories:
- Easiest Diets to Follow: No. 4
- Best Diets for Healthy Eating: No. 5 (tie)
- Best Diets Overall: No. 5 (tie)
- Best Heart-Healthy Diets: No. 7 (tie)
- Best Diets for Diabetes: No. 7 (tie)
- Best Weight-Loss Diets: No. 29 (tie)
- Best Fast Weight-Loss Diets: No. 34 (tie)
This blog addresses the MIND DIET (from Rush University Medical Center), which has been on the list for 6 years. They have just completed. A 3-year study (funded by NIH) is about to be completed, published preliminary findings regarding this diet. Data leans to this diet providing long-term protection against cognitive decline and Alzheimer’s disease, it also promotes overall health, including cardiovascular benefits.
The MIND diet is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. Both have been found to reduce the risk of cardiovascular conditions,
(ex. hypertension, diabetes, heart attack, stroke).
This diet identifies ‘healthy’ and ‘unhealthy’ foods and addresses them.
‘Healthy’ food group:
– two or more daily servings of vegetables, of which one serving is a leafy green,
– three servings per day of whole grains,
– a serving of beans three times weekly,
– one ounce of nuts/nut butter,
- a half cup of berries five days per week,
- two tablespoons of extra virgin olive oil a day;
- poultry twice weekly,
- at least one fish meal weekly.
‘Unhealthy food must have limitations:
- no more than one teaspoon a day of butter,
- eating less than five servings a week of sweets and pastries,
- less than four servings a week of red meat,
- no more than two ounces of whole-fat cheese weekly,
- no more than one meal of fried foods per week.
Nuances exist for example having difficulty limiting the intake of red meat to less than four servings per week could still be considered a healthy eater, provided they were reaching the goal of at least one serving of leafy green vegetables each day.
Many books and internet sites exist on the MIND diet, they can help you follow eat to live long and healthy! MIND Diet
It happens way more than you might think, between 2001-2010 annual retractions exploded by 1,000%, according to some estimates. Issues that lead to retraction includes duplicate publication, fraud, authorship issues, ethical issues, and error.
Scary! So do you just wait and see? Perhaps one of the most notable comes from a prestigious medical journal and on a topic very much touted in all media. Note box below: published in 2013 retracted 2018.
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Publication: The New England Journal of Medicine (NEJM) Authors: Estruch R, et al. Year published/retracted: 2013/2018 Number of citations (pre-retraction/post-retraction): 2266 (1895/371) goes here
In a randomized trial (Spain), the authors stated that adherence to a Mediterranean diet replete with extra-virgin olive oil or nuts decreased the frequency of severe cardiovascular events in participants at high risk for cardiovascular disease. It took 5 years for a retraction based on a careful re-review of the “because of irregularities in the randomization procedures.” This put the validity of the deduction in serious question.
Other retractions have occurred many years after publications, in such journals as The Lancet, Cancer Research. Many took years to retract, meanwhile, medical practice drew on their deductions for the basis of medical care. This past year 2020 saw many retractions as the COVID-19 pandemic gave rise to possible therapies. Noteworthy is the role of hydroxychloroquine. The NEJM and Lancet both prestigious publications had similar retractions in May of 2020.
CAUTION: There is sadly a lack of integrity and competence that rises to the top in all walks of life. But when this affects your physical and mental wellbeing, one can’t help wondering when will another retraction come? Hopefully, we will not see, years from now, the retraction of studies/conclusions that are used to develop and obtain emergency approval of the SARS-CoV-2 vaccines.
Please always weight risk versus benefit and decide for you which outweighs
The key to all things 2021 is you, you are the driver, effector, and receiver. A clean slate- write your own version! Please start by giving yourself a break!
Practice self-compassion, take care of yourself first.
Take care of your basic needs:
sleep 7-9 hours
eat a balanced meal seated put your cutlery down between bites, be aware of chewing,
get outdoors at least 3 times a week and walk for 20 minutes, plug into calm meditative tunes
Be Present -you’ve heard that before, my fitness instructor said it so many times till it finally sunk-in. stop dwelling on the past or worrying about what is next. Notice 5 things you see, name 4 things you hear, notice 3 sensations you can feel, inhale, and ID 2 smells, and before you move on note a taste.
Be aware of your breathing, plan, and maintain a daily schedule, putting yourself first.
Promise to sit and handwrite a note, letter, or even attempt a poem. You can!
COVID-19 has now surpassed heart disease and cancer as the leading daily cause of death in the U.S. One American is dying of COVID-19 every 40 seconds at this posting.
The point is that now it is more than ever preventable. Everywhere you turn there is information on the 2 new COVID-19 vaccines – how they work, what they do and not do follow by how the company plays a key role. And they are free! I tuned in to the full FDA advisory committee meetings of both drug companies’ (Pfizer, Moderna) vaccine submissions in order to get all the medical information available.
My blog objective is to let you in on the finer points of what is factually known to date. Critical is understanding FDA emergency use approval (EUA) meaning for the CIVID-19 vaccines. Incomplete data is why full approval did not occur. Questions exist and include how long immunity lasts and are what are the side effects beyond the known 60 days. Follow-up for 2 years is typical for full safety FDA endorsement.
The two EUA approved vaccines use mRNA to carry information (S protein found on the surface of the SARS CoV-2 virus) into cells, telling cells to make the S protein then our body sees the S protein and starts to mount a defense against the foreign protein. The mRNA is gone from the body by 24 hours. A booster for 21 (Pfizer) or 28 days (Moderna) is required. All vaccines are free. Plenty of scammers out there, be careful. Yes, your insurance will cover the administrative fee for actually giving you the ‘jab’.
We always have a choice, and you may have a choice which vaccine and when to receive the ‘jab’ (British term). If your COVID-19 risks are greater than the risk from taking an emergency use approved vaccine, then you should take a EUA vaccine. After vaccination, you are told to continue to mask up and socially distance. No determination yet for up to how long you must do so. The educated guess from both vaccine producers is that in 7-14 days after 2nd jab (booster) immunity can begin, yet unsure if you could be an asymptomatic spreader after having both jabs.
To be clear, presently, there are other vaccines in final human testing – Phase 3. These are more traditionally constructed. That is a different weakened virus (ex. adenovirus) that is coated with the S protein is introduced into the body. The body immediately starts to defend activating the immune system (listen to this podcast for more on the immune system).
So many questions persist regarding the nature of the protection acquired from these mRNA vaccines. Does the vaccine keep you from infecting others? Can it truly block transmission of the virus, which is often spread by infected people who show no signs of sickness?
How long does immunity last? It is unknown to date if either vaccine offers complete indefinite protection against infections.
Studies show that the immunity for those who receive the vaccine lasts longer than immunity developed post COVID-19 infection (only 6-8 months due to B cell memory). Second, the studies have shown that antibody levels are 5-20% higher in those vaccinated as compared to those who had natural infection. Third, studies in those recovering from COVID-19 infection showed that the body’s response did not always produce antibodies correctly. Strange! Since, if someone has had chickenpox, there is no need to get immunized for chickenpox, but recovery from COVID-19 infection does not always produce full protection.
Post Vaccine or no vaccine you must Wear Mask and social distance.
News Flash-new variant virus was discovered in the UK & South Africa, believed to be 70% more transmittable yet it is unknown if present approved vaccines will offer protection against these variants.
The holiday season 2020 landscape will challenge, more than in the previous years. The holidays typically see an increased presence of sadness or depression* and this year there is quite a bit more to contend with. Many have lost loved ones this past year and some were unable to be there when they passed. Compounding this is the personal fear of contracting a possibly deadly disease – COVID-19. Facing one’s own mortality is yet another stressor.
No surprise with the lockdowns that all abuses have dramatically increased globally. In the US, findings include an increase in child abuse risk. In UK one in five crimes during lockdown was domestic abuse-related. From FIFA to Pope Francis speaking out and with protests in France to Turkey, all calling for the elimination of violence in the home. Many have already reacted to increase stress by increasing their alcohol consumption. A recent study published in the Journal of Drug and Alcohol Abuse, correlated time in lockdown with the increase in harmful drinking.
All of us must take positive steps to maintain good mental health. Strain and tensions abound as eluded to above, but how we face them with support and a few self-steps can make a difference. If you have negative emotions process them. You come first, don’t ignore your needs to satisfy others. Avoid toxic and negative individuals. Especially with lockdowns and social distancing, don’t allow yourself to feel isolated. In this age of FaceTime, Whats App, and Zoom visits with all your besties, make a date to see each other.
Take stock of all and I know you’ll find positive and worthwhile aspects of your existence!
*Recall depression is not sadness it is prolonged (weeks) of feeling sad helpless, hopeless, irritable, and or guilty much of every day.