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Wednesday, October 30, 2013

Tips on Adopting EMR for Your Office

Like any new software, EMR and EHR can be difficult to implement in a small practice. You have to get your staff acquainted with the system, and work through any kinks they may find. Along the way, you’ll also likely to need support in-house and over the phone.

There are shortcuts to find and your staff will need to adjust to a new method of doing things. The end result will be to personalize patient care and, actually, there may be Federal incentives for you to implement EMRs in your office.

Start Small

Your staff will benefit most from small introductions that get them interacting with EMR software. Start by ditching the photocopier and having staff enter patient information into your electronic medical record software. Inquire with your provider about training documentation, which is often included with the costs you pay for the software, and arrange for staff to spend an hour each day going over training materials and interacting with the software.

Break your staff up into teams that are responsible for different aspects of patient care. Depending on the size of our practice, you may have someone who handles patient intake, and someone else who handles prescription data.

Make sure everyone in your office understands how to retrieve medical records. It also helps to designate staff to go over each other’s work and check it for accuracy.

Designate a Go-To Person

Choose a member of your team to thoroughly train on the program and let that person break the software.

You need someone technologically capable, as well as someone who can patiently work through troubleshooting. Designate this person as a point of contact, and refer all EMR challenges to her.

Find the Shortcuts

Create a master list of shortcuts that cut down on keystrokes and clicks to get to what the staff needs.

Simple keystrokes like copy (Ctrl+C) and paste (Ctrl+V) will help save time. You can usually press “Tab” to cycle through the various text fields and speed up data entry, instead of clicking a mouse.

Encourage information sharing on free cloud services like Google Docs or Microsoft SkyDrive. Have staff maintain spreadsheets and documents online for keystrokes and tips. Creating a central knowledge base will give staff a safe space to learn more about the EMR if they choose.

Have a Backup Solution

Keep any patient data on a local hard drive, an external hard drive and in the cloud. You can purchase a reasonably large external hard drive or NAS server from any online retailer for less than $300. Cloud storage can be pricey, depending on what you need to store, as they often charge by what you need. The advantage is you pay for what you need, but you will end up spending more money over time. You will also need to scale those services as your practice grows, which may entail switching providers or upgrading plans.

If possible, have your IT staff create an automated backup system. Smaller practices without an IT staff should consider outsourcing the work to someone from the Web. Web based EMR applications typically have a backup system in place that requires almost no input on your part beyond initial setup.

Other Tips

Use templates and pre-written statements to fill in common patient symptoms and save time. Once your staff has entered the patient’s prescription, you can tell the patient that her prescription has already been sent to the pharmacist, which is great for patient satisfaction.

Government incentives, like the Medicare EMR Incentive program can help ease the transition with some extra cash. In the case of the Medicare EMR, you receive $44,000 over 5 years, which can cover the costs of purchasing the system or paying for training.

The above guest post is a guest blog entry.

Saturday, October 26, 2013

Importance Of The New Breath Test and Medical Coding Training in Diabetic Care

According to the U.S. Center for Disease Control and Prevention (CDC), 26 million people are affected with certain conditions and nearly 5.7 million are un-diagnosed. Diagnosis for conditions such as diabetes and hypoglycemia is dependent on several tests, which are mostly invasive or cost intensive (due to frequent use).

However, an alternative has been developed that relies on normal human breath to monitor diabetes.

Researchers have known for a long time that people who suffer from diabetes have a characteristic fruity odor which increases at the time of glucose deficiency. This fruit smell comes from a compound known as acetone. The acetone breath test is conventionally used in the status quo to determine alcohol toxicity of drunk drivers.

Background to the test

A hallmark feature of diabetes is that due to lack of insulin, the metabolic pathway of the body is affected. This leads to conversion of fatty acids to ketones. The increased levels of ketones such as acetone cause acidity in the blood, which is medically termed as ketosis or ketoacidosis.

Thanks to advancement in biosensors and nanotechnology, the acetone biomarker can be used for diagnosis of diabetes, remarkably lowering its costs of detection.

Benefits to the medical community


The obvious benefit is for the patient, but other important stakeholders are professionals in the healthcare community. The large scale distribution of this test means development of a new line of diagnostics, and possibly a new specialization, in the discipline of ‘breath diagnostics’.

Moreover, students who want to pursue successful healthcare careers but are financially constrained can target this area in an integrated manner. Careers such as diagnostics, coding and technician based courses are dependent on innovation in the field.

Online education courses and medical coding training provide students ample incentive to pursue coding and diagnostic careers while simultaneously gaining career rewarding certificates. On an administrative level, medical coding training will strengthen medical databases. On the macro level, new diagnostics help researchers analyze how different compounds produced within the human breath have a role in pathogenesis.

For instance, researchers are also evaluating how acetone and volatile compounds (VOCs) are characteristic for indicating respiratory disorders during diabetes. This is important since diabetes affected patients are often riddled with co-morbidities (i.e. other diseases arising from the condition).

Sol-Gel Model

Researchers at University of Pittsburgh have been able to develop a model of the breath analyzer that can be used at a global scale. While there are other models in production, this one gathers attention due to its interesting design.

The model successfully employs principle of physics and nanotechnology to good use. It uses titanium dioxide: commonly found in cosmetic products. This compound is merged with small carbon nanotubes, which have a very minute diameter. From then on, it transforms into a sensor.

The titanium dioxide in the nanotube has light illuminating properties, while the carbon nanotubes have electrical properties. The sensor can be activated with light to produce an electrical charge. Therefore, the acetone vapors in the human breath can be detected to very small limits.

Since diabetes patients have to monitor their glucose level routinely, this test becomes an ideal alternative to cost intensive diagnostics.

Financial aspect

Living with diabetes is a financial burden, especially with respect to the current economy. To monitor diabetes, a lot of people rely on glucose meters. The majority of patients pay through their insurance providers for the device. Sadly, the coverage would limit the kind of model or the strip that you can use.

So with such constraints, the breath test for diabetes comes as a very viable option. Especially with a device that is basically a biosensor that doesn’t need to be replaced (like strips), it makes a lot of sense.

Secondly, this test is not only beneficial from the screening aspect, it also helps in diabetes management. By monitoring routinely without having to fear for cost, the test can assist patients in streamlining their glucose levels. The breath test also falls in line with the innovative the A1C test.

The levels of acetone in diabetic patients also give a comparative analysis on a number of indicators. Ketoacidosis in some cases can lead to a coma or death. Furthermore, increased acetone levels would indicate serious electrolyte losses in your body. The most important of these are sodium and potassium.

This leads to the patients developing abdominal pain, excessive stress levels and nausea. The breath test can immediately point out such indicators.

In these ways, the breath test for diabetes would make life easier for diabetic patients across the globe.

The above entry is a guest blog entry.

Monday, October 07, 2013

Medical Procedure Financing: Saying Yes to More Patients

It’s no secret that the 2008 credit crisis hit the medical field hard, and even five years later, a lack of access to financing options can create a barrier between doctor and patient. Day after day, doctors are forced to turn down care for solely financial reasons.

Whereas third-party financing companies once served as an effective ally by loaning patients money to afford procedures they desperately need, tightening approval rates have slashed the number of leads doctors can accept. When middleman financiers are employed, it is entirely possible that only 20-25% of interested patients can end up booking a surgery.  Not to mention that the approval often comes with a 6-10% discount fee paid to the financier.

For doctors looking to expand their business and offer care to more patients, the third-party financing paradigm is looking less and less viable. It’s no wonder many have taken matters into their own hands by setting up their own in-house financing programs. If executed correctly, an in-house financing program can grow the business in terms of the number of procedures performed, while saving money paid in third-party discounts, and even create new revenue streams as interest comes in on monthly payments.

While providing loans in house means taking on a bit of risk, implementing smart payment plan practices can greatly reduce said risks. For example, say a patient seeks a $6,000 procedure, $1,500 of which covers hard costs (such as the surgery center or office overhead, etc.). If the practice requires a down payment of at least $1,500, they’ll still be covered even if the patient defaults immediately after the surgery.

If insurance can cover a portion of the procedure, the numbers become even more favorable. Say the patient is left with a $2,000 co-pay on the above procedure, and can’t pay out of pocket. Since the insurance is already paying $4,000 — covering our hard costs, and then some — a payment plan can be used to cover the gap. Since hard costs are covered, the down payment can be more modest, but it’s still prudent to collect something incase of a default.

The above solutions are both possible with third-party financing, but keep in mind a third party financier will often require 6-10% of the entire payment, including that crucial down payment. Thus, if a $6,000 procedure requires a $1,500 down payment, the practice is required to pay out $360-$600 to their financing company. And that’s only if the patient is approved for financing in the first place. While the practice assumes slightly more risk by extending their own credit to the patient, many doctors we’ve spoken to assert that the immense upsurge in their number of office visits more than made up for it.

The added administrative work that comes with tracking and billing payment plans can be a concern as well, but modern advances in patient-financing software takes care of this process by automating all the billing along with providing tools to keep patients on track.

With the proper tools and framework, many doctors are seeing in-house financing software as a realistic alternative to traditional methods, allowing them to say “yes” to more procedures, while growing their practice at a comfortable rate.

The above entry is a guest blog entry.

Friday, September 20, 2013

Psychological Harm Caused by Alcohol Abuse

Alcohol abuse doesn’t just lead to the physical dangers that many are well versed on, but it can also lead to many psychological dangers that are just as frightening, if not more so. Bankole Johnson knows the psychological dangers of alcohol addiction all too well.

He currently heads the psychiatry department at the University of Maryland Medical Center.

These types of dangers can lead to actual physical problems as well, so it’s best to identify what they are and avoid them to ensure that you have a bright future laid out ahead of you. So what are these psychological dangers?

Every emotion you have is exaggerated


Sure, there are people that act out happily and show affection when they drink, but it can be to the point where it is too much to bear and makes for awkward situations. Every emotion you feel at the time of drinking is blown up like a picture into a poster.

People that decide to drink when they are angry are more likely to lash out in violent behavior once they have abused alcohol. If you are feeling down or depressed, drinking is only going to make it that much worse and can lead to an emotional breakdown.

It’s normal to have emotions, it is what makes us human. Unless you want those emotions on display for everyone to see, though, then drinking would be a bad idea.

Addiction is a psychological danger

When you become addicted to alcohol, it can be all you think about. How to get your next drink seems more important than remembering birthdays, going to work or going out for a jog. That type of crippling thinking and feeling is addiction.

When nothing else seems as important to you as opening the next bottle, it’s a serious problem. Many associate addiction as physically ailing for a substance, but it is just as much psychological.

Judgment impairment can be dangerous


People are more daring after a few drinks, but not always in a good way. There is a large difference between the person that has one drink with dinner and the person that can put away an entire case.

The worst decision of the night for the person that had just the one drink with food might be a dessert that doesn’t set well. The other person though opens themselves up to a multitude of possibly devastating decisions.

Whether you decide to drive your car, pick a fight with someone at the bar or any other dangerous decision, it can be fatal. Alcohol abuse and impaired judgment go hand in hand, and the consequences are never good.

Long term effects

The person that goes over their limit a bit just once and the person that does it with regularity will both face short term effects, but the latter is much more likely to experience the long term psychological effects.

The list of long term effects is not pretty to look at, either. Depression, loss of relationships with others and alcohol dependence are all crippling psychological dangers.

The more you abuse alcohol, the more likely that these types of dangers are to come to fruition. That sounds like a list of problems that anyone would want to avoid.

Violence

Alcohol is a depressant, so it is known to cause erratic mood swings. It is also known that physical violence is tops on the list of something you can do to someone. Loved ones, friends, complete strangers, anyone.
This isn’t limited to just typical physical violence as well, but sexual violence. The person that abuses alcohol is more likely to lash out with these types of behaviors, which is a frightening thought.

The above entry is a guest blog entry.

Tuesday, September 17, 2013

Plastic Surgery: MedFriendly's Newest Entry

On 9/17/13, MedFriendly, LLC, published a comprehensive online review on plastic surgery. Plastic surgery is a medical specialty that fixes the form and function of some part of the body involving the skin. Detailed information is provided on various plastic surgery techniques, the history of plastic surgery, and the shocking case of Hang Mioku.

The plastic surgery entry is the latest in hundreds of easy to understand entries available for free at MedFriendly.com. All entries on MedFriendly are written in an easy to understand format, with all complex terms defined within the same entry. This prevents the reader from needing to do extra research to understand what the writer is trying to convey. All entries are written on a single page, exposing the reader to fewer ads. Please share this link with others, bookmark MedFriendly and the MedFriendly Blog, and follow us on the MedFriendly Facebook and Twitter pages.

Saturday, September 14, 2013

Egg Donor Agencies: Options After Ovary Removal

In 2013, Angelina Jolie announced that she’s had a double mastectomy as a preventative measure, based on the results of the BRAC Analysis test. Ms. Jolie’s decision not only put the BRCA1 gene, and the BRAC Analysis test, in the spotlight; it also opened a dialogue about other forms of preventative surgery.

In fact, Ms. Jolie, who has a strong family history of breast cancer and ovarian cancer, is even considering having her ovaries removed as a preventative measure.

Removing the Ovaries

Removing the ovaries, or an oophorectomy, is not a new procedure in the prevention and treatment of cancer. The ovaries produce estrogen and other female hormones, and certain types of breast cancer are highly reactive to estrogen. In women who have these types of breast cancer, the oophorectomy is often used as a means of slowing down the growth and spread of the cancerous cells.

In women who do not have breast cancer, but have the BRCA1 and BRCA2 mutations, removing the ovaries not only prevents the onset of ovarian cancer, it could prevent the onset of certain types of breast cancer.

The doctor could remove the ovaries and the fallopian tubes—the tubes that carry the eggs to the uterus--but leave the uterus intact. Or, he could remove the uterus, fallopian tubes, and ovaries in what is called a total hysterectomy.

Oophorectomy Considerations

Unfortunately, once you remove your ovaries, you can no longer have children. Not only will you no longer produce eggs, you won’t produce all of the hormones you need to support a pregnancy. If you have already had all the children you want, that might not be an issue; but for a woman, of child-bearing age, who has never had children, removing the ovaries closes that door forever.

Luckily, thanks to advances in egg collection and storage, as well as hormone replacement therapy, a woman who needs to have an oophorectomy could still have children. Her two best options for having children after the oophorectomy are donor eggs and fertility preservation.

Organizations like My Egg Bank act as egg donor agencies and fertility preservation centers.

Egg Donor Agencies

As egg donor agencies, these organizations harvest eggs from healthy donors. The agencies thoroughly screen the donors, including genetic counseling, family health histories, and testing for genetic diseases.

Once the donor clears the screening, the agency then has the donor take a series of medications designed to stimulate egg production, then harvests and freezes the eggs for future use.

The recipient would receive the eggs by applying to the donor agency to become a patient. After the application process, the bank will provide the recipient with basic information about the donor eggs that are available. This information includes genetic and race information about the donor, and even photos of the donor from early childhood.

The photos give the recipient an idea of what the donor, and by extension the child, might look like without compromising the identity of the donor. This way, the recipient can choose a donor who closely resembles herself, so that the child will be more likely to share similar traits with her family.

If the recipient has a uterus, and the hormones necessary to support a pregnancy, she could opt to have the eggs fertilized by her partner and implanted into her own uterus. If she does not have a uterus, or does not have the hormonal support, she would use a surrogate to carry the fetus.

Fertility Preservation Centers

As a fertility preservation center, the agency would collect the eggs from the recipient before she undergoes an oophorectomy. As with the egg donors, the recipient might need to take medication to stimulate egg production. However, if she has a hormone-sensitive breast cancer, the agency may opt to avoid using hormone-based medications and simply collect whatever eggs they can without them.

Chemotherapy and radiation therapy can damage the ovaries. In the case of the preexisting cancer, the agency would also need to harvest the eggs before the patient begins treatment, or as soon as possible after.

Once the agency has harvested the eggs, they freeze the eggs and store them until the recipient is ready to use them. 

Cost

The cost varies by facility, and depends on a variety of factors. In-vitro fertilization (IVF) with a donor egg could cost as much as $25,000, not including the cost of medications. It could cost as much as $500 per year to store an egg in an egg bank. Some egg storage facilities, like My Egg Bank, require a non-refundable deposit, and offer financing for the remainder of the cost.

If you are faced with the decision to have an oophorectomy, either as a preventative measure or to treat an existing condition--and you want to have children in the future--IVF with donor eggs, and fertility preservation could be well worth the cost.

The above entry is a guest blog entry.

Friday, September 13, 2013

Does Your Child Need Braces? 3 Ways To Find Out

Determining that your child needs braces or can do without them can be difficult. Children commonly develop teeth at varying rates and primary teeth don’t always help in locating the adult teeth.

A report shows that around 3 million in Canada and U.S. wear braces. While there’s no exact period for when the child may require braces, there are some ways that indicate the time is near.

Identifying the need for braces

1.  Bad/incorrect bites
Ask your child if he/she has any difficulty in chewing. You can also check for cavities as they are also a sign of bad bites. Some types of bad bites include deep overbite, underbite and open bite.

You can start by comparing the position of upper front teeth to the lower teeth. If the front teeth overlap the lower, it is a sign of a deep overbite. Another indication is that the upper teeth’s biting edges will be touching the gum tissue of lower front.

On the other hand, if the jaws are not in the appropriate position and the lower teeth are overlapping the upper, it is an underbite. Open bite is when the lower and upper front teeth aren’t meeting when the child is biting, and it can also cause problem in the child’s speech. According to Dr. Ron Markey, an orthodontist from Vancouver, delaying braces can lead to risks if the teeth are left unattended, even though the risks may take several years to become prominent.

2.  Spacing/crowding problems

The child may have small teeth in a normal jaw or missing teeth. This can lead to uneven spaces because some teeth lead into vacant areas. Uneven spaces shouldn’t be taken lightly as they have a chance of becoming a periodontal disease later on as the gums stay unprotected. Other problems they can lead to is incorrect functioning and an unattractive smile.

People also confuse spacing and crowding as the same problem, but they are entirely different. Crowing occurs when there is no space left for the teeth to go out of the gum. Other causes of crowding are incorrect eruption from the gum or the teeth are larger than the allotted space. Crowding can lead to an improper pattern of the bite, dental decay and an unattractive smile.

Braces can effectively correct crowding and spacing problems. However, Dr. David Morrow orthodontist at York Mills reveals that the first few weeks with braces require some adjustments, and sometimes additional appointments may be needed. This is the reason why appointments should be made at a time when the child has enough free time (from school and other commitments) to adjust.

3.  Cleft lip or cleft palate

Cleft palate stands for a split in the mouth’s roof, while the clef lip means an upper lift split. This problem is very rare and occurs in 1 or 2 children out of 1,000 born. This condition can be inherited by the child if any member of the family has it.

This condition can result in dental problems such as extra teeth, crooked teeth and small teeth. Children with cleft lip or palate require braces because it helps the teeth to grow in a straight position.

If left unattended, it can result in speech and eating problems.

Parents who can identify the need for braces shouldn’t make any delays to make sure that child doesn’t suffer from any complications in the long run.

The above entry is a guest blog entry.

Thursday, September 05, 2013

Do Electronic Cigarettes Reduce your Risk?

The National Cancer Institute indicates that traditional cigarette smoke contains more than 69 toxic chemicals and known carcinogens, including benzene, formaldehyde, and arsenic. Cigarette smoke also contains tar, and carbon monoxide which can damage the lungs and cardiovascular system.

If you smoke, stopping now can greatly decrease your risk of cancer and respiratory disease, relieve the symptoms of sleep apnea, and potentially improve your quality of life.

Unfortunately, quitting is often easier said than done because cigarettes are highly addictive.

One way to decrease your traditional cigarette intake, and reduce your disease risk, is by substituting electronic cigarettes for traditional cigarettes.

About Electronic Cigarettes

Electronic cigarettes are battery-operated devices that contain the nicotine that you would find in a traditional cigarette, but without the smoke, tar and most of the chemicals. Electronic cigarettes have cartridges that contain a nicotine “juice.” A battery heat’s the juice, creating a vapor, that the smoker inhales just like cigarette smoke.

Electronic cigarettes are available in both disposable and reusable varieties.

Where to Buy Electronic Cigarettes

You can buy brands like Victory Electronic Cigarettes from online retailers. Some brands also sell their products in the smoking section of drug stores, grocery stores, and convenience stores.

The Cost of Electronic Cigarettes

Electronic cigarettes are also comparatively cheaper than traditional cigarettes.

A single pack of name-brand cigarettes, such as Camel or Marlboro, can cost between $5 and $8, depending on where you buy them, due to taxes and other factors.

Specialty cigarettes, such as American Spirits or Nat Sherman, can cost upwards of $10.

Conversely, a single disposable electronic cigarette costs $8 to $10 and is equal to roughly two packs of traditional cigarettes.

The base cost of a reusable electronic cigarette is $20 for a rechargeable battery and two disposable cartridges equal to two packs of cigarettes each.

Refill cartridges generally retail for $10 to $15 for packs of three to five cartridges.

The Risks of Electronic Cigarettes

Currently, electronic cigarettes are still under investigation as to their safety.

The “juice” in the cartridge usually contains a mixture of liquid nicotine, diethylene glycol, and chemicals called nitrosamines, which are also found in cigarettes. Harvard University indicates that diethylene glycol is a highly toxic substance, and nitrosamines are known carcinogens. Electronic cigarettes can also contain other toxic chemicals.

However, the researchers at Harvard also indicate that they are uncertain about the levels of these chemicals, or exactly how toxic or dangerous they are to smokers.

The Benefits of Electronic Cigarettes

Although electronic cigarettes can contain toxic chemicals, they are at a much lower concentration than their traditional counterparts.

The Consumer Advocates for Smokefree Alternatives Association (CASAA), Consumer Advocates for Smokefree Alternatives Association (CASAA), reports that a study conducted by Professor Igor Burstyn, of the Drexel University School of Public Health, indicates that the chemicals in electronic cigarettes pose little-to-no risk to smokers.

Additionally, the chemicals in electronic cigarette vapor also pose little-to-no health risks from exposure through second-hand smoke.

Although the CASAA report is promising, and electronic cigarettes do have far fewer chemicals, smokers should use caution, just as they would when ingesting any other chemical substance.

The above entry is a guest blog entry.

Tuesday, September 03, 2013

Types of Medical Malpractice Involving Kids

When your kids undergo treatment whether it’s for a common cold or a serious injury, the medical professional is required to follow certain protocols. However, negligence and failure to do so can have serious repercussions in the form of injury or damage to the child’s health.

Dauphin Country-based Dr. Andrew Shapiro advised surgery to insert ear tubes and remove tonsils and adenoids on his patient Keonte Graham. Graham was 11 months when the surgery took place.
The patient however required brain surgery following the original surgery which was for sleep apnea. After the operation, Graham was said to suffer from breathing problems and was kept in the recovery room for 5 hours while his blood level oxygen was low.

Dr. Shapiro faced a lawsuit later on, which revealed that he failed to carry out proper physical examination after the operation and neglected to instruct the medical staff for monitoring the level of oxygen in the patient’s blood.

You should keep in mind that even minor mistakes from doctors and other healthcare professionals can have life-altering effects on your kids, and some can even resulted in death. Your child can be the victim of negligence in any healthcare environment.

Types of Malpractice Children Can Suffer From

1.  Use of defective medical devices

The FDA recently asked parents to report medical device defects used for children. Despite the strict testing procedures that medical devices have to go through, some defective ones still manage to get through. Medical devices that have resulted in medical claims during the last few years include implants, defibrillators, prosthetic devices and diagnostic testing tools.

The injuries and damage caused to the child’s health as a result of a defective device can be considered for a product liability lawsuit. All states have certain procedures for filing such cases, which is why legal resources are important for parents seeking compensation. Professionals can also help in determining whether the defective use of a device is subject to a product liability lawsuit or a medical malpractice lawsuit.

2.  Negligence of the healthcare professional


Negligence is one of the common types of medical malpractices in U.S. and other countries. Some of the negligence can be in the form of failure to monitor the health of the child before recommending the treatment, delays in diagnosing of congenital issues and failure to provide special care to the child during recovery at the medical workplace or hospital.

The claims can be filed for any types of injury due to negligence. Some of the common negligence claims involving children include Cerebral Palsy and Erb’s Palsy. In case serious injures where the child requires assistance over the long term, the defendant can be taken to court and asked to compensate for ongoing needs of the child.

3.  Lack of practitioner experience

It can also happen that a doctor with inadequate experience performs treatment on the child, which can result in undesirable outcomes because they may fail to follow the standard procedures.
In this case, the lawsuit should be filed on the basis that the practitioner breached the applicable standard protocols which resulted in injury to the child. The practitioner will be asked to provide proper documentation and evidence of his applicable method in the past, and there’s a high chance those with lack of skills and poor experience will fail to do so.

It’s wise to stay proactive about complications that can arise when your child undergoes medical treatment. Doing so will allow you to take instant action in case your child falls victim to medical malpractice.

The above entry is a guest blog entry.

Monday, September 02, 2013

Nintendo and the Wii: Interactions with Health and Science

Media stories often focus on the negative effects that violent video games have on society, but it is important to also point out that video games have a positive impact in treating numerous health care conditions and in advancing science.

The most well known video game system that does this the Nintendo Wii, which utilizes numerous motion sensitive devices (e.g., balance board, handheld motion controller, skateboards, exercise bikes), to detect motion in three dimensions, allowing the player to interface with the game more realistically. Because of this role that the Wii has in motor feedback, it plays an important part in physical rehabilitation. For this reason, it is sometimes referred to as “Wii-hab”.

FEATURED BOOK: The Ultimate History of Video Games

The main settings and ways that the Wii has been helpful can be broken down into the following areas: a) neurological disorders in adults, b) developmental disorders and disabilities, c) non-neurological disorders, d) the elderly and fall prevention, e) exercise, measurement, and scientific testing, and f) surgical training. Information about each of these sections from the scientific literature is described below. The article ends with a discussion of medical problems (some of which may surprise you) that have resulted from using the Nintendo Wii and other Nintendo-based systems.

NEUROLOGICAL DISORDERS IN ADULTS:


As an example of the Wii’s rehabilitation benefits, use of the system has been shown to improve short-term motor abilities, postural stability, quality of life, and non-motor skills in Parkinson’s disease (PD) (Herz et. al, 2013; Holmes et al., 2013) although beneficial effects of the Wii Fit have not been found in all Parkinson’s patients (Pompeu et al, 2012).  PD is a type of brain disorder that leads to serious difficulties with muscle movements.  The Wii has also been used a home assessment device to measure motor abnormalities in PD such as tremor and motor slowness (Synnott et al., 2012).

The Wii has been shown to build confidence in abilities, achieve goals in leisure activities, and remove barriers from exercising in patients with multiple sclerosis (MS) (Huurnin et al., 2013). Multiple sclerosis is a condition in which people develop multiple areas of abnormal patches (also known as plaques or sclerosis) in the brain and/or spinal cord (depending on the stage of the illness). Others have found that the Wii improves balance in patients with MS (Brichetto et al., 2013). Both the Wii and PlayStation 2 have been used in stroke rehabilitation to improve motor movements, with use of games with the PlayStation 2 video camera improving movement and movement intensity (Neil et al., 2013).

The Wii Balance Board provides visual and balance feedback which has been found to be helpful in reducing hospital stays, improving sensory organization, dizziness, balance and vertigo in patients with acute vestibular neuritis. Acute vestibular neuritis refers to attacks of dizziness and spinning sensations that decrease over three to six weeks (Sparrer et al, 2013). The Wii Fit (Plus) has also been shown to be a useful balance treatment in patients with other vestibular and neurological diseases (Meldrum et al., 2012).

DEVELOPMENTAL DISORDERS & DISABILITIES:


In children, Wii Fit training has been shown to improve motor performance in those with developmental coordination disorder (Ferguson et al, 2013). It has been hypothesized that the Wii would be beneficial in improving the motor functions of children with cerebral palsy (Gordon et al., 2012). However, when this topic has been studied, children with spastic cerebral palsy preferred the Wii Fit over conventional physical therapy but it did not improve their motor functioning (Jelsma et al., 2013). Cerebral palsy is a type of brain damage that occurs during pregnancy, during birth, during infancy, or during early childhood that causes the child to have difficulties with movement and posture.

Researchers have shown that the Wii remote control can be turned into a high performance 3D object orientation detector and used with children with disabilities to improve their ability to perform a designated occupational task (i.e., rotating a 3D cube to make a requested pattern) (Shih et al, 2012a; Shih and Chang, 2012) and other occupational activities (Shih et al, 2012b) and physical activities (Shih, 2011; Shih et al., 2011a, Shih et al., 2012c), including limb action (Shih et al., 2010a) and standing posture (Shih et al., 2010b). Playing Wii games was found to improve highly practiced motor skills and postural control in a child with Down syndrome (Berg et al, 2012). Down syndrome is an abnormality that is present from birth that results in mental impairments and a characteristic physical appearance (small facial features, large tongue that sticks out, a flat back area of the head, and hands that are short and broad).

The Wii remote controller has helped people with disabilities keep their head in an upright position to obtain desired environmental stimulation during a head position correction program (Shih, Shih, and Shih, 2011). Use of the Wii remote has also helped reduce hyperactive limb behavior in children with attention deficit hyperactivity disorder (Shih et al, 2011b).

NON-NEUROLOGICAL DISORDERS:


In non-neurological disorders, the Wii balance board has been used in research on improving postural control impairments in people who undergo reconstruction of the ACL (anterior cruciate ligament) which is in the knee(Howells et al, 2013). However, one study did not find that the Wii Fit provided additional benefit compared to conventional physical therapy in patients who have undergone ACL reconstruction (Baltaci et al., 2013). The Wii balance board has been found to be a potentially acceptable rehabilitation adjunct to physical therapy in patients who have undergone total knee replacement (Fung et al., 2012). There have been indications that use of the Wii may help with improving pain, anxiety, active range of motion, function, and enjoyment in patients undergoing acute burn rehabilitation although this has not been scientifically proven (Yohannan et al., 2012). Residents of long-term care facilities using the Wii bowling game in addition to standard physical therapy for arm dysfunction enjoyed the therapy more and tended to report more improvements than a physical therapy program without the Wii bowling game, but not significantly so (Hsu et al., 2011).

THE ELDERLY AND FALL PREVENTION:

Elderly people playing the popular Wii Sports game in residential care centers have had fun using it, feel a sense of empowerment and achievement, and feel that it allows for greater socialization (Keough et al, 2013; Williams et al., 2010). Use of the Wii has been shown to increase exercise capacity, energy expenditure, motivation to exercise, and decreased barriers to exercising in the elderly , such as an elderly man who suffered heart failure (Griffin et al., 2012; Klompstra et al, 2013). Staff at health care centers where the Wii was used for at least three months believes that Wii activities promote physical (mobility, range of motion, dexterity, coordination, distraction from pain) and psychological benefits (social engagement, self-esteem, mastery, ability to pacify challenging behaviors) with aged (and disabled) clients (Higgins et al., 2010).

Use of the Wii has been found to improve leg strength in the elderly, which can help decrease falls in a safe, adaptable, and low cost manner (Clark and Kraemer, 2009; Jorgensen et al., 2013; Young et al., 2011). It is thus used to prevent falls in numerous rehabilitation programs (Taylor et al,. 2012) and to improve balance in other settings with the elderly (Williams et al., 2011) . Although the elderly enjoy the Wii Fit, not all studies have shown that it improves their balance (Franco et al, 2012). However, in older patients who have needed to wear a prosthesis for leg amputation, the Wii Fit it has been shown to improve balance confidence, to decrease reliance on assistive devices, and to increase energy efficiency when walking with the prosthesis (Miller at al, 2012). Importantly, the elderly, including those in long-term care facilities, enjoy playing the Wii for exercising, socializing, nostalgia, and competition, which enhances adherence to continuing its use (Brandt and Paniaqua, 2011) although some elderly prefer traditional therapy techniques (Laver et al., 2011). Although an initial attempt was made to use cognitive games on the Wii as a form of neuropsychological testing for the elderly, this idea never materialized into clinical practice, perhaps due to difficulties encountered by requiring physical interactions (Gamberini, et al., 2010).

EXERCISE, MEASUREMENT, AND SCIENTIFIC TESTING:

In times where it has become increasingly costly to cut medical costs, the Wii has been shown to provide a low cost, objective, valid, and reproducible way to measure standing and postural balance in adults (Clark et al., 2009 Jorgensen et al, 2013). The Nintendo Wii hand controllers have also been shown to be a portable and valid measure of running velocity (Clark et al, 2011a). The Wii remote controllers have also been used for the measurement of the angle of head posture (Kim et. al, 2012). Use of multiple Wii balance boards has been shown to be a reliable measure of weight bearing (Clark et al., 2011) and to improve weight bearing in athletes (McGough et al, 2012). The Wii remote has been used in functional magnetic resonance imaging (MRI) studies to track one or more moving points that can correspond to limbs, fingers or any other object whose position needs to be known (Modrono et al., 2011b).

The Wii Sports boxing game has been found to provide moderate to vigorous aerobic activity for exercise (Bosch et al., 2012). The Wii boxing game has been shown to involve more non-dominant upper extremity movement, energy expenditure, and heart rate than the Wii tennis or bowling games (Graves et al., 2008).

The Wii Fit has been shown to be an acceptable alternative to traditional moderately intense aerobic exercise in sedentary young adults (Douris et al., 2012). One problem with the Wii Fit is that the balance board scores it produces have been found to have poor reliability (consistency) within and between sessions and not to match up well with similar measures from other more established balance measurement systems (Wikstrom, 2012). However, others have found the Wii balance board to be reliable in measuring bodily sway in the elderly (Koslucher et al., 2012).

The handheld Nintendo DS system has been shown to be capable of integrating healthcare monitoring functions (e.g., heart monitoring signals, fall detection)  and transmit the information wirelessly to a separate location, allowing it to be used in an ambulance, nursing home, or general hospital (Lee et al., 2009; Lee et al., 2011). The Wii has also been used to show that men perform best at hunting games (navigation and shooting) but that men and women perform the same on gathering games (fine motor and visual search) (Cherney and Poss, 2008).

SURGICAL TRAINING:

Use of the Wii has also shown promise in predicting and improving basic laproscopic surgical skills in students and surgical trainees, particularly with the non-dominant hand (Badurdeen et al. 2010; Bokhari et al., 2010; Boyle et al., 2011; Middleton, et al, 2013). These benefits in enhancing laproscopic surgery skills have been replicated by others (Giannotti et al, 2013) and have also been shown for the PlayStation 2 when playing a gun arcade game (Time Crisis II) (Ju et al, 2012).

NINTENDO BASED INJURIES AND HAZARDS:


While the Nintendo Wii has had many positive benefits as it relates to healthcare, some negative impacts have been reported in the scientific literature. This includes a hand tendon rupture suffered by a community doctor after playing tennis on the Wii and striking a wall with her wrist and thumb while attempting a backhand motion (Bhangu et al, 2009). Even more dangerous was the case of a 55-year-old woman who sustained a large hemothorax (chest bleed) when playing tennis on the Nintendo Wii because she swung around too fast (Peek et al., 2008). A chest drain was inserted to drain out the blood and she was discharged home 5 days later.

Injuries while playing Nintendo are not unique to the Wii. In 2001, Dr. Johanna Wood documented the case of an 8-year-old child and his two friends who developed a blister in the middle of one of their hands due to overplaying the game, Mario Party, when rotating the central joystick with the palm of the hand.  Back in 1992, Bright and Bringhurst coined the term, “Nintendo elbow” in a 12-year-old boy with several days of right elbow pain, presumably from playing Nintendo alot. The problem resolved 9 days after stopping Nintendo play and use of ibuprofen. It was recommended that children support the elbow on a firm surface during Nintendo play. Nintendo elbow was preceded by “Nintendo neck” which was described in the scientific literature one year prior by Dr. David Miller. The term was coined after the author observed his son develop neck pain after 30 minutes of playing the hand-held Game Boy system. This was presumably caused by the position held while playing the game (hunched over, chin on the  chest, elbows bent, screen close to the face, while staring intently).

In 1990, the term “Nintendinitis” was used by Brasington  to describe thumb pain in a 35-year-old who pushed the Nintendo button repeatedly while playing. The term, “Nintendo epilepsy” was used the same year by Hart due to seizures that occurred in a 13-year-old girl after playing Super Mario Brothers for three hours with only a 10 minute break. The presumed cause was the shifting pattern of the video game image. Nintendo has also been associated with urinary accidents (Schink, 1991) and fecal accidents (Corkery et a., 1992) in children because they try to hold in bodily waste longer than they can due to not pausing the game.

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Herz NB, Mehta SH, Sethi KD, Jackson P, Hall P, Morgan JC. (2013, in press). Nintendo Wii rehabilitation ("Wii-hab") provides benefits in Parkinson's disease. Parkinsonism Relat Disord.

Higgins HC, Horton JK, Hodgkinson BC, Muggleton SB. (2010). Lessons learned: Staff perceptions of the Nintendo Wii as a health promotion tool within an aged-care and disability service. Health Promot J Austr. 21(3):189-95.

Holmes JD, Jenkins ME, Johnson AM, Hunt MA, Clark RA. (2013). Validity of the Nintendo Wii® balance board for the assessment of standing balance in Parkinson's disease. Clin Rehabil. 2013 Apr;27(4):361-6.

Howells BE, Clark RA, Ardern CL, Bryant AL, Feller JA, Whitehead TS, Webster KE. (2013). The assessment of postural control and the influence of a secondary task in people with anterior cruciate ligament reconstructed knees using a Nintendo Wii Balance Board. Br J Sports Med. 47(14):914-9.

Hsu JK, Thibodeau R, Wong SJ, Zukiwsky D, Cecile S, Walton DM. (2011). A "Wii" bit of fun: the effects of adding Nintendo Wii(®) Bowling to a standard exercise regimen for residents of long-term care with upper extremity dysfunction. Physiother Theory Pract. 27(3):185-93.

Huurnink A, Fransz DP, Kingma I, van Dieën JH. (2013). Comparison of a laboratory grade force platform with a Nintendo Wii Balance Board on measurement of postural control in single-leg stance balance tasks. J Biomech. 46(7):1392-5.

Koslucher F, Wade MG, Nelson B, Lim K, Chen FC, Stoffregen TA. (2012). Nintendo Wii Balance Board is sensitive to effects of visual tasks on standing sway in healthy elderly adults. Gait Posture. 36(3):605-8.

Jelsma J, Pronk M, Ferguson G, Jelsma-Smit D. (2013). The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy. Dev Neurorehabil. 16(1):27-37.

Jorgensen MG, Laessoe U, Hendriksen C, Nielsen OB, Aagaard P. (2013). Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 68(7):845-52.

Jørgensen MG, Laessoe U, Hendriksen C, Nielsen O BF, Aagaard P. (2013, in press). Intra-Rater Reproducibility and Validity of Nintendo Wii Balance Testing in Community-Dwelling Older Adults. J Aging Phys Act.

Ju R, Chang PL, Buckley AP, Wang KC. (2012). Comparison of Nintendo Wii and PlayStation2 for enhancing laparoscopic skills. JSLS.  16(4):612-8.

Keogh J WL, Power N, Wooller L, Lucas P, Whatman C.(2013, in press). Physical and Psychosocial Function in Residential Aged Care Elders: Effect of Nintendo Wii Sports Games. J Aging Phys Act.

Kim J, Nam KW, Jang IG, Yang HK, Kim KG, Hwang JM. (2012). Nintendo Wii remote controllers for head posture measurement: accuracy, validity, and reliability of the infrared optical head tracker. Invest Ophthalmol Vis Sci. 2012 Mar 15;53(3):1388-96.

Klompstra LV, Jaarsma T, Strömberg A. (2013). An in-depth, longitudinal examination of the daily physical activity of a patient with heart failure using a Nintendo Wii at home: a case report. J Rehabil Med. 45(6):599-602.

Laver K, Ratcliffe J, George S, Burgess L, Crotty M. (2011). Is the Nintendo Wii Fit really acceptable to older people? A discrete choice experiment. BMC Geriatr. 11:64.

Lee S, Kim J, Kim J, Lee M. (2009). A design of the u-health monitoring system using a Nintendo DS game machine. Conf Proc IEEE Eng Med Biol Soc. 2009:1695-8.

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McGough R, Paterson K, Bradshaw EJ, Bryant AL, Clark RA. (2012). Improving lower limb weight distribution asymmetry during the squat using Nintendo Wii Balance Boards and real-time feedback. J Strength Cond Res. 2012 Jan;26(1):47-52.

Meldrum D, Glennon A, Herdman S, Murray D, McConn-Walsh R. Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo Wii(®) Fit Plus. Disabil Rehabil Assist Technol. 2012 May;7(3):205-10.

Middleton KK, Hamilton T, Tsai PC, Middleton DB, Falcone JL, Hamad G. (2013, in press).Improved nondominant hand performance on a laparoscopic virtual reality simulator after playing the Nintendo Wii. Surg Endosc.

Miller CA, Hayes DM, Dye K, Johnson C, Meyers J. Using the Nintendo Wii Fit and body weight support to improve aerobic capacity, balance, gait ability, and fear of falling: two case reports. J Geriatr Phys Ther. 2012 Apr-Jun;35(2):95-104.

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Modroño C, Rodríguez-Hernández AF, Marcano F, Navarrete G, Burunat E, Ferrer M, Monserrat R, González-Mora JL. (2011). A low cost fMRI-compatible tracking system using the Nintendo Wii remote. J Neurosci Methods. 202(2):173-81.

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Peek AC, Ibrahim T, Abunasra H, Waller D, Natarajan R. (2008). White-out from a Wii: traumatic haemothorax sustained playing Nintendo Wii. Ann R Coll Surg Engl. 90(6):W9-10.

Pompeu JE, Mendes FA, Silva KG, Lobo AM, Oliveira Tde P, Zomignani AP, Piemonte ME. (2012). Effect of Nintendo Wii™-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial. Physiotherapy. 98(3):196-204.

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Tuesday, August 13, 2013

When Exercise Isn't Enough

Most health experts agree that the best way to approach weight loss is with a healthy diet, regular exercise and patience. Unfortunately, this doesn’t work for everyone. For some people, the faster they can lose weight the better—for their health! By now, it’s well known and universally accepted that obesity increases the risk of someone developing diabetes. Recent studies, however, have proven that obesity also increases a person’s risk of developing cancer.

According to the National Cancer Institute, obesity can lead to cancer in a variety of ways. One study, reported by the LA Times, says that obesity can seriously impact the microbes that live in a person’s “gut.” These changes cause the bacteria that live there to start producing chemicals that will damage a person’s DNA. This can then increase the likelihood of cancer taking hold.

Unfortunately, these changes can’t simply be undone by suddenly starting to eat a balanced diet. A person must actually lose weight and get them back down to a healthy weight range to reverse the changes that have been happening to them hormonally and on a cellular level. For some, this means taking drastic measures, like bariatric surgery.

According to Dr. Andrew Averbach, a bariatric surgeon based in Baltimore, the best way for some people to get back on track is to have a laparoscopic vertical sleeve gastrectomy. This procedure removes a huge chunk of the patient’s stomach, effectively turning the stomach into a tube or sleeve shape. Dr. Averbach says that the biggest benefit of the procedure is that it drastically reduces the amount of food a person can take in at one time. This, effectively, forces the patient to learn new (and healthier) eating habits.

Losing weight isn’t always simply about the weight, though. For many, it is also about their self image. Weight loss—especially drastic weight loss like the sort brought about by bariatric surgery—can cause sagging skin, scars, and other issues. These problems might seem superficial but they can be major hazards for people who have struggled with obesity for a long time. Effectively, the person still looks obese even after they lose weight.

Unfortunately, while it stretches, skin doesn’t typically shrink, especially if it spends a prolonged period of time stretched out. This is why many people choose to undergo plastic and reconstructive surgery after they get down to a sensible weight. Not every plastic surgeon performs procedures related to weight loss correction.  Often weight loss surgery patients can get recommendations for plastic surgeons from their bariatric and gastronomic surgeons. For instance, patients of Dr. Averbach can ask him to recommend the top rated plastic surgeon in Baltimore to help their recovery from drastic weight loss.

When the outside of a person matches the inside of a person, he or she is more likely to maintain a dramatic weight loss—even if they came by it naturally.

Remember: even with surgery, weight loss takes time. A person does not automatically drop fifty pounds upon having bariatric surgery.  It will take a few months to get down to a healthy weight and to figure out how to eat (most patients already understand the “what” of a healthy diet) properly.

Still, where cancer is concerned: it’s better to only have to wait a few months to reduce your chances than a few years!

The above article is a guest blog entry.

Sunday, August 11, 2013

Drug Rehabilitation: MedFriendly's Newest Entry

On 8/10/13, MedFriendly, LLC, published a comprehensive online review on drug rehabilitation. Drug rehabilitation is a term for medical and/or psychological treatment of people who are dependent on mind-altering substances such as alcohol, prescription drugs (e.g., painkillers, sedatives), and street drugs (e.g., crack cocaine, heroin, or amphetamines). Detailed information is provided on various medical and psychological treatments.

The drug rehabilitation entry is the latest in hundreds of easy to understand entries available for free at MedFriendly.com. All entries on MedFriendly are written in an easy to understand format, with all complex terms defined within the same entry. This prevents the reader from needing to do extra research to understand what the writer is trying to convey. All entries are written on a single page, exposing the reader to fewer ads. Please share this link with others, bookmark MedFriendly and the MedFriendly Blog, and follow us on the MedFriendly Facebook and Twitter pages.

Saturday, August 10, 2013

When Fruits and Vegetables Kill

Fruits and vegetables can be a delicious and refreshing part of a healthy diet. However, just because fruits and vegetables are healthy and tasty does not mean that they cannot also be dangerous, particularly in young children.

FEATURED BOOK: Fresh Vegetable and Fruit Juices

In fact, in a recent study by the American Academy of Pediatrics, fruits and vegetables were listed as one of the top causes of non-fatal choking in children.While hard candy/other candy, meat, and bone were the most common causes of non-fatal choking, most parents realize the need to keep very young children away from such foods or to closely supervise their consumption at young ages. However, because fruits and vegetables are traditionally considered healthy, people do not always pay as close attention to the choking risk involved with their consumption.  Sometimes, these choking episodes can result in death.  This is particularly the case with raw fruits and vegetables because they are more difficult to chew.

Ten examples of deaths cause by fruit and vegetable choking include:

1). 13-month old baby dies after choking on raw orange fruit jelly cube given by parents.
2.) 10-month old baby dies after choking on an 8-mm piece of apple given in a nursery.
3.) 23-month old boy chokes to death after eating sticks of vegetables, including carrots.
4.) 5-year-old child dies 3 days after choking on a fruit gel snack.
5.) 21-month old child dies after choking on a grape.
6.) 2-year-old chokes to death on a carrot at a day school from the teacher’s tote bag.
7.) 3.5-year-old child chokes to death on a banana in school during snack time.
8.) 7-year-old chokes to death on plum pit during school lunch.
9.) 5-year-old girl dies after apparently choking on strawberries.
10.) 5-year-old  chokes to death on a grape in front of friends at an after school club.

The take home lesson is that fruits should be cut into small pieces prior to consumption, particularly by children (and the elderly).

Related blog entries:  

1. How Fruits and Vegetables Killed Steve Jobs
2. Exercise & Eat Fruits & Veggies All You Want: You're Still Going to Die
3. Michael Clarke Duncan Turns Vegetarian, Loses Weight, and Dies of a Heart Attack 

Friday, August 02, 2013

Why Ariel Castro is a Monster and a Psychopath

On 8/1/13, Ariel Castro received a life sentence for his role in abducting and torturing three girls for over a decade in filthy conditions while restrained to poles with chains. Casrto had the opportunity to speak in the courtroom and his words were completely consistent with him being a monster and a psychopath (also known as a sociopath).

Psychopathy and sociopathy are more colloquial terms for what is technically referred to as antisocial personality disorder (APD).

Suggested Book: Without Conscience: The Disturbing World of the Psychopaths Among Us

In the Diagnostic and Statistical Manual of Mental Disorders (now in its newly published 5th edition), APD is defined as a pervasive pattern of disregard for and violation of the rights of others since the age of 15 as indicated by three or more of the following items below. Examples of how Castro meets these criteria are also listed:

1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest. Castro examples: Child abduction, assault, murder of unborn children.

2. Deceitfulness as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. Castro examples: Lying to his family and neighbors repeatedly about his whereabouts, why his house had so many restricted areas, and who the child was that he fathered with one of the abductees. 

3. Impulsivity or failure to plan ahead. Castro example: He stated today that he impulsively abducted the girls. 

4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. Castro example: Abuse not only to the three people he abducted but also to his ex-wife and children.

5. Reckless disregard for safety of self or others. Castro example: Reckless disregard for the abductees and for the child he fathered by having the child delivered in an empty child pool and never providing her medical care. 

6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. Castro example: Repeated problems at his bus driver job in which he admitted during his statement that he was trying to get himself fired.

7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. Castro example: His statements today reveal a lack of remorse as noted below. It is important to note that lack of remorse should not be confused with statements of remorse. Some psychopaths may say the words “I’m sorry” but do not actually mean it as revealed by their actions.

In Castro’s statement, a few themes emerged.

1. Reversing the victim role: The very first point Castro made was to paint himself as the victim due to a prior history of abuse. It was a manipulative attempt to take away from the three main victims in this case -- the girls he abducted. He repeatedly referred to himself as an addict, akin to an alcoholic, and sometimes did so with an aggressive demeanor. In fact, by watching his aggressive mannerisms, it is very easy to see how this is someone who could quickly become abusive. In addition, in what amounted to an illogical attempt to gain sympathy, he states that he cannot handle being labeled as a monster because he used to be a musician. Another bizarre attempt to make people feel bad for him was when he lamented how hard it was for him to “juggle” being a bus driver and come home to his “situation,” as if this is the same thing as juggling a job and coming home to make dinner for the kids.

2. Externalizing of behavior: This means that he blamed his behavior as caused by factors beyond his control, such as an abuse history and adult rated material which he claims made him impulsive. This is related to the victim role portrayal and his insistence that he is not a monster but that he is sick. The two are not mutually exclusive.

3. Attempts to hurt the victims: Knowing that the victims must be hurting inside, Castro goes out of his way to point out that he is a happy person inside. He also explicitly attacked the victims of being promiscuous with him and before they met him. This was an attempt to publicly embarrass them with personal information. He also pointed out that no one seemed to care about Michelle Knight when she went missing to make her hurt even more.

4. Attempts to blame others:
In addition to blaming the victims he abducted, he also blamed his now deceased ex-wife who he assaulted by blaming her for not quieting down and putting her hands on him. He blamed Amanda Berry for getting into his car without knowing who he ways, but leaving out that she was a young child and that he lured her in. He also blamed the FBI for letting the girls down by not questioning him and stopping him sooner. This was also a way to tell the authorities that he outsmarted them and is a way for him feel powerful over them, which is a driving need of psychopaths. He also called one of the family impact statements uncalled for, despite realizing practically anything a family member would say to him given his behaviors would be called for.

5. Minimization of his behaviors: The best example of this was the comment that “I simply kept them there without being able to leave.” He forgot to add…for over 10 years and by using chains. He also repeatedly used the word “just” as a way to minimize behaviors as in he “just” acted on his urges. He also said that he could not have possibly tortured any of the girls because he sees that they are trying to get on with their lives and that if he tortured them they would not be able to do this so quickly.

6. Denial of reality: All of the prior examples can fall under this general theme, but the highlight of his denials came when he claimed not to be a violent person and a family man who tried to raise the daughter he fathered with one of his victims the right way. He described her living locked in a house for most of her life (6 years) as a “normal life” and stated that there was a lot of harmony in the home.

Thursday, July 25, 2013

Red Blood Cells: Most Comprehensive Entry Published by MedFriendly

On 7/25/13, MedFriendly, LLC, published the most comprehensive online review of red blood cells on the internet. Red blood cells are cells that circulate in the blood that specialize in delivering oxygen to the body’s tissues. Comprehensive topics are covered such as how red blood cells are made and reasons for high and low red blood cell counts.

The entry is also written in an easy to understand format which will be helpful for older individuals and their families who are trying to learn about this important cell that is routinely tabulated during routine blood tests.

The red blood cell entry is the latest in hundreds of easy to understand entries available for free at MedFriendly.com. All entries on MedFriendly are written in an easy to understand format, with all complex terms defines within the same entry. This prevents the reader from needing to do extra research to understand what the writer is trying to convey. All entries are written on a single page, exposing the reader to fewer ads. Please share this link with others, bookmark MedFriendly and the MedFriendly Blog, and follow us on the MedFriendly Facebook and Twitter pages.

Monday, July 15, 2013

What Is Equine Facilitated Psychotherapy?

Animal therapy is a growing aspect of treating psychological conditions with our furry (and sometimes not-so-furry) pets and friends. One growing trend in animal treatments is equine therapy, the use of horses to help psychological issues, developmental challenges, or emotional growth in patients.

Riding on a horse, even if it is only infrequently, allows a patient to develop a bond with the animal that creates confidence, trust, social skills, and self-value that may have been difficult to foster using traditional therapy. Equine facilitated psychotherapy is a common method of treatment for many conditions.

What But A Horse, Of Course

What makes a horse such a helpful companion to development and therapy? Horses are different than other pet therapy animals like dogs: though both are social animals, dogs are eager to please while horses are much more aloof. Horses respond to commands, but do not do so in ways that a human would expect: yelling or clapping or whistling does not do much to stir them, leaving patients with the lesson that not all problems in life can be overcome with yelling. Rather, horses obey commands when they trust the person giving them, creating a lesson with patients about the need to trust on both sides of a relationship, even if one is giving more commands than they receive.

Activities

One of the first lessons that a patient will learn with equine therapy is how to get your horse to come over to them without actually touching the animal. This can be used for patients with social anxieties or who need to develop a sense of confidence; it is a common exercise at a drug rehab facility on a horse ranch.  The students who can figure out how to cajole a horse and come to their side will then learn how to lead a horse out of its pasture, and finally how to ride it.

Ride On

One of the great moments in equine facilitated psychotherapy is where a horse allows a patient to ride. This can be an exhilarating experience for a patient, since getting around by horse is so different than a bicycle or car. Riding a horse requires a patient to develop a connection, minimizing their feelings of isolation while giving them a new perspective of teamwork and cooperation. Since the horse is a steady and methodical animal, it works to increase a patient's impulse control and patience as they learn how to ride.

The above entry is a guest blog entry.

Friday, July 12, 2013

How Do Energy Healing Techniques Work?

Energy healing is a holistic approach to healing and health. Healers believe that physical and emotional health problems can be treated with directing healing energy to the person. Most healers use energy healing techniques that involve transmitting energies through their hands, sometimes by placing the hands on the person and sometimes holding the hands just above the body.

Types of Energy Healing

Energy healing techniques include spiritual healing, Reiki and other methods, but all are based on similar principles. The theory behind energy healing is that there is a natural life energy that flows in everyone, and when that energy is blocked, illnesses can result. The job of the healer or the Reiki practitioner is to direct energy from a higher source to the client. Some practitioners talk about universal life energy and some talk about divine energy. In all cases the healer is said to connect to this universal life energy and transmits it to the client.

What Happens in a Session?

Clients often describe feelings of warmth or relaxation during a healing session. Many people feel the energy as heat that radiates from the practitioner's hands. Most clients feel relaxed and peaceful after the treatment, and many say they have slept better than for a long time. Even animals react to healing, and Reiki healing has been especially popular when treating domestic pets. Reiki can be used to help animals that are nervous or tense, and it can be used together with veterinary medicines and treatments.

How to Become a Healer

Different practitioners learn their energy healing techniques in different ways. Some people recognize their own healing abilities early on in life, and some start to learn healing later. Some work as full-time energy healing practitioners, and others give occasional treatments to family and friends.

To become a Reiki practitioner you will need to study with a Reiki Master Teacher. The master helps you to connect to the universal Reiki energy in a process called "attunement". The student always works together with the master over a period of time to discover his or her healing abilities and to tune into the energies.

Reiki healing and energy healing are used to relieve stress and tension, to bring relief to emotional imbalances, and to speed up the body's natural healing abilities in many other conditions. Healers do not claim to treat illnesses or to provide medical services. However they can often provide healing and comfort while the patient is receiving medical treatment.

The above entry is a guest blog entry.

Thursday, July 11, 2013

Types of Urinary Incontinence and Treatments

Urinary incontinence is a condition where the bladder is unable to store liquids, resulting in involuntary urination. Urinary incontinence occurs in both genders, but it is more common in women. There are several types of urinary incontinence, and they all have different causes and treatments.

Types of Urinary Incontinence

Stress Incontinence

Stress incontinence occurs when there is pressure, or stress, on the bladder that causes small amounts of urine to leak. This stress can occur with exercise, sneezing, and even laughter. Stress incontinence is usually caused by weak pelvic floor muscles. The pelvic floor muscles can be weakened by age and childbirth, as well as certain medications.

Urge Incontinence

Urge Incontinence is characterized by a sudden, urgent need to urinate. Urge incontinence could cause large amounts of urine to leak, and sometimes the urge is so sudden that it's impossible to get to the bathroom in time. Urge incontinence is usually caused by nerve damage or by damage to the bladder muscles. Neurological diseases, such as Parkinsons, and long-term drug and alcohol abuse can contribute to the nerve damage that causes urinary incontinence.

Overflow Incontinence

Overflow incontinence occurs when you can't empty your bladder properly causing it to leak, or overflow, when it fills up again. This form of incontinence is more common in men, and can cause varying amounts of urine to leak from the bladder. Overflow incontinence can be caused by an enlarged prostate, weak bladder muscles, and tumors or other structures, blocking the flow of urine.

Functional Incontinence

Functional incontinence occurs when an external influence prevents someone from going to the bathroom in time. These external influences could include mobility issues, impaired motor skills, or mental and cognitive issues. This type of incontinence does not directly affect the bladder, and can involve a variety of ancillary factors including arthritis and traumatic brain injury.

Treatments for Urinary Incontinence

Stress Incontinence

Treatments include exercises to strengthen the pelvic floor muscles with Kegel exercises or weights,  pessaries that help reduce leakage, and biofeedback monitors. Cases of extreme pelvic floor weakness could require surgery to reposition the bladder.

While the incontinence is active, patients can wear incontinence pads to trap minor leakage. Incontinence pads are similar to menstrual pads but they are designed specifically to deal with the moisture and odor associated with urine. If the leakage is heavy, or it the patient suffers from more than one type of incontinence (or mixed incontinence) adult diapers might be necessary.

Urge Incontinence

Urge incontinence is usually treated with medications that prevent the bladder spasms that cause the immediate urge to go. Lifestyle fixes, like bladder training and timed voiding, can be used in conjunction with the medication. Bladder training involves keeping track of when the urge hits and attempting to avoid situations that might cause a spasm. Timed voiding is intentionally emptying the bladder before it has a chance to spasm. As with stress incontinence, patients can wear incontinence pads or adult diapers to avoid soiling their clothing.

Overflow and Functional Incontinence

In some cases, treating the underlying condition – such as removing an enlarged prostate – can correct the condition. If muscle or nerve damage is the issue, surgery or medication could be the solution. For patients with mobility or memory issues, bladder training and timed voiding can help. In either case, protecting the clothing with pads or diapers can have positive psychological effects.

The above entry is a guest blog entry.