Malingering: Why Healthcare Providers Continue to Keep their Heads inthe Sand

Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives such as avoiding work, obtaining financial compensation, evading criminal prosecution, avoiding military duty, or obtaining drugs (APA,1994). In layman’s terms, it is lying or significantly exaggerating in order to get something. 

Malingering is a major problem for the healthcare system and society because:

a) It decreases access to needed healthcare services (e.g., doctor appointments, diagnostic tests, therapy sessions) for patients with genuine health problems. This can delay diagnosis and reduce treatment onset and treatment effectiveness. 

b) It leads to billions of dollars in wasted health care resources for unnecessary doctor visits, diagnostic tests, and treatments (e.g., medications, therapy sessions). This leads to increased insurance premiums.

c) It leads to billions of dollars in wasted tax dollars towards fraudulent disability awards (e.g., Social Security Disability, military disability benefits). Disability and compensation benefits awarded through private workers compensation companies, no-fault insurance companies, and other private companies are a further cause of wasted funds and increased insurance premiums.

d) It leads to billions of dollars wasted in legal costs and settlements for companies defending themselves against fraudulent claims. Many companies opt to pay to settle a case rather than pay the larger cost of mounting a legal defense.

Malingering is a topic that I have spent a great deal of time writing about. For example, in August 2012, a book I co-edited on the topic was published. The title is Mild Traumatic Brain Injury: Symptom Validity Assessment and Malingering. One of the chapters provides suggestions to help physicians and non-neuropsychologist healthcare providers detect poor effort and symptom exaggeration that can be a result of malingering. In September 2012, I was interviewed for a story by amednews.com entitled, Detecting Deception: How to Handle a Malingering Patient, which aimed to raise physician awareness about the issue. I have continued to publish on this topic in peer reviewed academic journals and international lectures but have not written about it on my blog since 2011 and figured it was time for an update due to some recent developments.

As I showed in the opening chapter of my book with numerous tables, there has been a significant increase in publications (e.g., research articles, books) about malingering, in addition to legal cases mentioning the word. Thus, it is not as if healthcare providers, insurance companies, and government officials are unaware that the problem exists.

Despite this increased knowledge of the topic, in the most recent update of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), the word “malingering” has been removed from the index. The DSM-5 is a guide that many healthcare providers use to diagnose mental disorders. In DSM-5, malingering is no longer listed as an issue that needs to be ruled out when a patient is suspected of having a somatoform disorder (now called a “somatic symptom disorder”).

As it has traditionally been conceptualized, a somatoform disorder is a condition in which one develops physical symptoms in response to psychological distress. While these patients may exaggerate, the exaggeration is not done for external gain (e.g., to win a lawsuit). In reality, some patients malinger and have somatoform disorders but in some cases the distinction between the two is an important one to make. While malingering does remain in the text of DSM-V, it is buried within it on pages 726 and 727 and difficult to find even if you are specifically searching for it.

I do not believe that the omission of malingering from the index and other sections of the DSM-V was an accident. As I described in my December 2011 blog entry on this topic, there are many reasons why physicians and other healthcare providers are motivated to ignore the topic of malingering. These reasons include not wanting to deal with retaliatory false complaints lodged against them for exposing it, the uncomfortable nature of discussing the topic with the patient, extreme patient advocacy by healthcare providers, being overly trusting of patient self-report, and not wanting to cause the patient a loss of financial benefits.

While I still believe that these are reasons that healthcare providers often ignore malingering, there are additional reasons that all involve financial incentives…but this time for the healthcare provider. Specifically:

a) If a healthcare provider labels a patient as malingering, the insurance company will likely not pay for additional costly treatments and medical tests. That potentially can lead to losses of thousands to millions of dollars of treatment revenue. For example, hospitals make a great deal of money from diagnostic tests (e.g., magnetic resonance imaging), weekly therapy sessions, and pain medication injections.

b) Due to healthcare reform, hospitals will now receive more money from the government if they have higher patient satisfaction ratings. Identifying malingering results in lower patient satisfaction scores and would then lead to less money for the hospital.

c) Some healthcare providers may be knowingly contributing to malingering by signing off on fraudulent disability applications. This presumably involves some type of kickback fee for enabling the fraudulent claims.

As an example of healthcare providers enabling malingering, a large scheme was recently discovered in which about 1,000 people (mostly police and firefighters) defrauded the Social Security Administration (SSA) for disability benefits, claiming mental illness from the September 11th attacks. In this way, malingerers often prey on other’s sympathies and trust to try and avoid detection.  They know that it will be politically incorrect for anyone to challenge a disability claim based on terrorism exposure, particularly if they were in a trusted societal occupational role (e.g., cop, firefighter, corrections officer). 

It was a well-organized scheme in which people were coached on how to fail memory tests, how to  fake panic attacks, how to dress for appointments, and how to build a false medical record for about a year before applying for disability. The cost to society? 400 million dollars. And that is just for these 1,000 cases. That is a drop in the bucket compared to how much of this is taking place throughout the country.
How were they eventually caught? Instinctively, you may think that the doctors figured it out.

However, that was not the case. It finally took two Social Security Administration investigators to become suspicious of how it was that people documented as mentally  incapacitated were able to maintain a pistol license. It was a significant discrepancy between self-reported problems and real –world behaviors that did not make sense, which is common in malingering.  This led to monitoring of these people’s social media accounts and more in depth file reviews.  The review found that patients claiming total disability were pictured doing all sorts of activities that they should not have been able to do if their disability claims were accurate such as flying helicopters, riding motorcycles, and holding separate jobs. Reports from undercover agents and intercepted phone calls were the proverbial icing on the cake.

The Manhattan district attorney, Cyrus Vance, was quoted as saying about those indicted that “Their brazenness was shocking.” In a way, it does seem shocking at first. But when one stops to think about it, was their behavior really so shocking when they know that no health care provider will say they are malingering? It is unknown at this point if any of the health care providers actually knew of this scheme,  but one of the ringleaders indicted (Joseph Minerva) was allegedly specifically tasked with finding psychiatrists and psychologists to diagnose conditions that would lead to a determination of disability.

For Minerva to pull this off would require him to have done one of two things (or both): a) find healthcare providers who knew about the scheme and would write false notes in exchange for kickbacks, b) find healthcare providers who were naïve enough to believe everything presented to them. The latter would have also been laden with financial incentives due to an increased referral base.  It is significantly problematic that the healthcare providers in these cases were completely fooled by over 1,000 patients and that they presumably did not identify a single case themselves as malingering.

While some may say that it is easy to Monday morning quarterback these cases, the reality is that many of these malingering cases could have been detected by healthcare providers...if all they did was look. In fact, no field in healthcare has developed more sophisticated techniques to identify malingering than clinical neuropsychology, although techniques do exist in other fields. Utilizing healthcare professionals who use scientifically reliable and valid techniques to detect feigned mental disabilities is important because in these cases, the claimants decided to try to fake mental disabilities, not physical ones. It should also be noted that although some of these patients reportedly had genuine physical problems, that does not automatically translate to valid mental problems. However, malingerers will often use a valid condition in one area to try to gain credibility of a feigned disability in another area. As an example, the thought process of the malingerer goes something like this, “If my leg and arm were broken then surely I cannot be suspected of lying about having posttraumatic stress disorder.”

It is important to note that it was the field of clinical neuropsychology that raised the awareness of the SSA to the problem of malingering. Initially, due to numerous misconceptions, the SSA decided to no longer fund the use of techniques that can help identify malingering in a ruling on September 13, 2012. However, after consultation with national neuropsychological organizations, U.S. Senator Tom Coburn wrote a letter to the SSA urging reconsideration of this policy based on the weight of the current scientific evidence. The Social Security Administration responded that they would seek external expertise to evaluate their policy on tests that can help identify malingering when determining disability (Congressional Report No. A-08-13-23094, 2013). This recent scheme that was uncovered should provide further evidence that Senator Coburn is correct and that the use of such techniques should be funded by the SSA. Click here so see Senator Coburn’s interview on 60-minutes, where he goes into detail regarding the costs of malingering to society.

An additional recommendation that I and others in this area have is for healthcare providers to be afforded administrative and/or legal protections against complaints by identified malingerers, so long as the determination of malingering can be defended using currently accepted scientific standards. Until that happens (which may be never), patients who report mental disabilities in the context of a disability claim, litigation, compensation-seeking, seeking academic accommodations, seeking prescription drugs of potential abuse (e.g., pain killers, stimulants), who have a potential desire to avoid work, military service, school, or prosecution, should be required to undergo a comprehensive neuropsychological evaluation by an evaluator who uses scientifically reliable and valid malingering detection methods. The results of such evaluations need to be incorporated by other health care providers to reduce the financial burdens on the healthcare system and on society.

Board certified neuropsychologists can be located at the American Board of Clinical Neuropsychology and the American Board of Professional Neuropsychology websites. Healthcare providers need to be reminded that they are supposed to be scientific-practitioners first (basing diagnoses and treatment planning on reliable and valid objective information) and to be patient advocates second. Unfortunately, for too many healthcare providers, patient advocacy has superseded the scientific method and now we are all paying the price...literally and figuratively.

Making the Switch to a Healthier Lifestyle

The following is a guest blog entry. 

I think it came to me about a year ago. I was sitting on the couch going over my finances. It didn't take me very long to realize that a great deal of my monthly earnings were going towards bad habits - cigarettes, alcohol, junk food, etc. The hit this was having on my wallet was nothing in comparison to what it was doing to my body, however. Still young, I had age on my side, but the lack of energy and slow accumulation of flab that came along with my lifestyle were beginning to rear their ugly heads.

Deciding to Make a Change

There's no getting around the fact that guilt can have a dramatic impact on life experience. As time went on, I began to feel increasingly bad each time I would go to the store for a pack of cigarettes or a case of beer. This was becoming no more than a raw habit, and I knew I needed to make a change. It started off slowly as I'd say to myself "maybe I'll only have one or two drinks tonight instead of going crazy like I normally do on a Friday."

I'd tell people that I was looking to make some changes in my life, but no one in my circle of friends really believed me. They all said that "moderation" is a tease and that the only way to really achieve my goals would be to quit everything altogether. I try to think that life is quite a bit less black and white than this, however, and it actually angered me that they felt this way. It was at that moment that I decided I was going to take control of my life and make the changes I wanted to see happen.

Setting Things Into Motion

One thing that I needed to make clear for myself was that I was going to have a way to track my progress, so I set up a spreadsheet and decided that each day I would journal about my goals and keep track of the changes I'd made. I had one column listing how much alcohol I'd allot myself in a given week and was determined to stick to it. I had a "notes" section that would allow me to list small changes that would inevitably make a huge difference in my overall health. I wanted to go to my spreadsheet as soon as I made the move to switch to an electronic cigarette or substitute fatty foods for organic fruits and vegetables. Being a detail-oriented person, it was essential that I had a way of tracking the changes I was making in my life, and it worked.

As time went on, I started taking on more and more tasks to help push my life in the right direction. Once I had changed my diet and quit smoking traditional cigarettes, I successfully lowered my alcohol intake and started going to the gym. I knew that if I didn't start slow with the latter that I would fall off quickly, so I stuck to 3x per week with the intention of ramping things up as time went on. Much to my delight, it took a mere few weeks until I was able to push this up to 4x per week and then 5x per week after that. It seemed as if the more I took my time with all of this, the faster I was seeing change.

The Takeaway

In the end, I realized that the one thing that was keeping me from living a healthier lifestyle was pretty easy to pinpoint; I needed a reason. It was my friends' doubts that really caused me to rise to the occasion, and I can't thank them enough today for the differences that one conversation made in my life.

MedFriendly Publishes the Most Comprehensive Entry on Stress Incontinence

On 12/4/13, MedFriendly, LLC, published the most comprehensive online review on stress incontinence. Stress incontinence is the most common form of urinary incontinence (involuntary or uncontrollable urine loss). It occurs when a physical movement or activity increases pressure inside the abdomen, which places involuntary pressure on the urinary bladder. Detailed information is provided on the causes of stress incontinence, diagnostic methods, treatment methods, and much more

The stress incontinence 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.

5 Tips to Help You Live Longer

Wouldn't it be great to spin back the hands of time and get an extended look at life? Well, although there may not be a way to go back in time, there is a way to extend it. Check out these five tips to help you live a longer and happier life.

Exercise More

Exercising not only promotes good physical health, it will also help you live longer.  Daily exercising is highly recommended, even if it is just a swift walk. It will reduce your risk of heart disease and promote the release of endorphins that perpetuate happiness.

A recent study shows that for every 1 minute of exercise you can extend your life up to 7 extra minutes. This is a small investment for something as valuable as time. So if you want to live a longer and happier life, then take the time to put fitness first.

Eat Better

Improving your diet is a fast and easy way to extend your life. Heart disease is the leading cause of death in America and is easily avoided by implementing a proper diet. There are several different kinds of diets, and each one can have its benefits. Here are a few healthy eating tips to consider when revamping your diet.

• Minimize Gluten in your diet- Gluten; found in wheat, barley, and other grains, is an inflammatory food that agitates your intestines. Many people are actually unknowingly allergic to gluten.

• Increase the intake of fruits and vegetables. Fruits and vegetables are filled with healthy fibers and antioxidants. They can even help to lower the risk of heart disease by up to 76 percent.

• Monitor your fat intake. The kinds of fat you chose to put into your body can play a large role in your well-being. You should lower your intake of trans fat and substitute it for omega-3 fish oil when possible.
Your diet plays a huge role in the quality and length of your life. It can reduce the likelihood that you'll contract major diseases and perpetuate a healthy and happy lifestyle that will add several years to your life.

Get Enough Rest

Although you may think that a lot of sleep means less time living, it is actually proven that a substantial amount of quality sleep can help you live longer.

There are several studies that suggest anywhere between six and nine hours each night is ideal. There is no specific time frame, rather it suggests that you shouldn't hit the snooze button. That time when you wake up naturally is when you should start your day.

One of the best ways to improve your sleeping habits is to schedule an earlier bedtime and stick to it. After some time you will begin to fall into a sleep cycle that will become second nature. Not only is the quantity of sleep important, but you should also consider the quality of sleep. Once you improve the quality of sleep you will be on your way to a longer and happier life.

Drink Moderately

In small doses alcohol can actually provide health benefits. One study suggests that there is a tie between moderate drinking and a healthy heart. However, the keyword is moderately.

Drinking heavily can lead to obesity, dependency, abuse, and even depression. However, when practiced responsibly there are some very real health benefits to drinking. It can reduce blood pressure, decrease blood clotting, and even increase good cholesterol while eliminating bad cholesterol. So if you are someone who enjoys drinking, practice moderation and it can actually help you live longer.
Reduce Your Stress

There are several studies conducted proving that reducing stress in your life will help you live longer and more fulfilled. Having an active sexual life can be one of the easiest and more enjoyable ways to accomplish this. It can lead to lower blood pressure and protect against stroke or heart disease.

Being optimistic is another way to ease stress. People who exhibit more positivity actually have a 50 percent decrease in risk of early death compared to those who are pessimistic. In order to help improve the quality and longevity of your life, reduce the stress.

There is no hiding the fact that many people would do anything they could to live longer. Many people even devoted their life in the search of the Fountain of Youth, said to ensure invincibility. Although, these tips won't give you invincibility, they can help extend your life and improve the overall quality of it.

Author Bio:
Writer Molly is a prolific writer who spends all her time on the Internet writing about everything that fancies her. She is a well sought after guest writer who can write across all niches including, but not limited to, tech, gadgets, travel, finance, education, health, etc. You can find her on Twitter as @WriterMollyP.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

REFERENCES:

Badurdeen S, Abdul-Samad O, Story G, Wilson C, Down S, Harris A. (2010). Nintendo Wii video-gaming ability predicts laparoscopic skill. Surg Endosc. 24(8):1824-8.

Baltaci G, Harput G, Haksever B, Ulusoy B, Ozer H. (2013). Comparison between Nintendo Wii Fit and conventional rehabilitation on functional performance outcomes after hamstring anterior cruciate ligament reconstruction: prospective, randomized, controlled, double-blind clinical trial. Knee Surg Sports Traumatol Arthrosc. 21(4):880-7.

Berg P, Becker T, Martian A, Primrose KD, Wingen J. (2012). Motor control outcomes following Nintendo Wii use by a child with Down syndrome. Pediatr Phys Ther. 2012 Spring;24(1):78-84.

Bhangu A, Lwin M, Dias R. (2009). Wimbledon or bust: Nintendo Wii related rupture of the extensor pollicis longus tendon. J Hand Surg Eur Vol. 34(3):399-400.

Bokhari R, Bollman-McGregor J, Kahoi K, Smith M, Feinstein A, Ferrara J. (2010). Am Surg. Design, development, and validation of a take-home simulator for fundamental laparoscopic skills: using Nintendo Wii for surgical training.76(6):583-6.

Bosch PR, Poloni J, Thornton A, Lynskey JV. (2012). The heart rate response to nintendo wii boxing in young adults. Cardiopulm Phys Ther J. 23(2):13-29.

Boyle E, Kennedy AM, Traynor O, Hill AD. (2011). Training surgical skills using nonsurgical tasks--can Nintendo Wii™ improve surgical performance? J Surg Educ. 68(2):148-54.

Brandt K, Paniagua MA. (2011). The use of Nintendo Wii with long-term care residents. J Am Geriatr Soc. 2011 Dec;59(12):2393-5.

Brasington, R. Nintendinitis. N Engl J Med 1990; 322:1473-1474.

Brichetto G, Spallarossa P, de Carvalho ML, Battaglia MA. (2013).The effect of Nintendo(R) Wii(R) on balance in people with multiple sclerosis: a pilot randomized control study. Mult Scler. 19(9):1219-21.

Bright DA, Bringhurst DC. (1992). Nintendo elbow. West J Med. 156(6):667-8.

Cherney ID, Poss JL. (2008). Sex differences in Nintendo Wii performance as expected from hunter-gatherer selection. Psychol Rep. 102(3):745-54.

Clark R, Kraemer T. (2009). Clinical use of Nintendo Wii bowling simulation to decrease fall risk in an elderly resident of a nursing home: a case report. J Geriatr Phys Ther. 32(4):174-80.

Clark RA, Bryant AL, Pua Y, McCrory P, Bennell K, Hunt M. (2010). Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance.Gait Posture. 31(3):307-10.

Clark RA, Paterson K, Ritchie C, Blundell S, Bryant AL. (2011). Design and validation of a portable, inexpensive and multi-beam timing light system using the Nintendo Wii hand controllers. J Sci Med Sport. 14(2):177-82.

Clark RA, McGough R, Paterson K. (2011b). Reliability of an inexpensive and portable dynamic weight bearing asymmetry assessment system incorporating dual Nintendo Wii Balance Boards. Gait Posture. 2011 Jun;34(2):288-91.

Douris PC, McDonald B, Vespi F, Kelley NC, Herman L. Comparison between Nintendo Wii Fit aerobics and traditional aerobic exercise in sedentary young adults. J Strength Cond Res. 2012 Apr;26(4):1052-7.

Ferguson GD, Jelsma D, Jelsma J, Smits-Engelsman BC (2013). The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit training. Res Dev Disabil. 34(9):2449-61.

Franco JR, Jacobs K, Inzerillo C, Kluzik J. (2012). The effect of the Nintendo Wii Fit and exercise in improving balance and quality of life in community dwelling elders.Technol Health Care. 2012;20(2):95-115.

Fung V, Ho A, Shaffer J, Chung E, Gomez M. (2012). Use of Nintendo Wii Fit™ in the rehabilitation of outpatients following total knee replacement: a preliminary randomised controlled trial. Physiotherapy. 2012 Sep;98(3):183-8.

Gamberini L, Cardullo S, Seraglia B, Bordin A. (2010). Neuropsychological testing through a Nintendo Wii console. Stud Health Technol Inform. 154:29-33.

Giannotti D, Patrizi G, Di Rocco G, Vestri AR, Semproni CP, Fiengo L, Pontone S, Palazzini G, Redler A. (2013). Play to become a surgeon: impact of Nintendo Wii training on laparoscopic skills. PLoS One. 8(2):e57372.

Gordon C, Roopchand-Martin S, Gregg A. (2012). Potential of the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy in a developing country: a pilot study. Physiotherapy. 98(3):238-42.

Graves LE, Ridgers ND, Stratton G. (2008). The contribution of upper limb and total body movement to adolescents' energy expenditure whilst playing Nintendo Wii. Eur J Appl Physiol. 104(4):617-23.

Griffin M, McCormick D, Taylor MJ, Shawis T, Impson R. (2012). Using the Nintendo Wii as an intervention in a falls prevention group. J Am Geriatr Soc. 2012 Feb;60(2):385-7.

Hart, EJ. Nintendo epilepsy. N Engl J Med. 1990 May 17;322(20):1473.

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.

Lee S, Kim J, Lee M. (2011). The design of the m-health service application using a Nintendo DS game console. Telemed J E Health. 17(2):124-30.

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.

Miller DL. (1991). Nintendo neck. CMAJ. 145(10):1202.

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.

Neil A, Ens S, Pelletier R, Jarus T, Rand D. (2013). Sony PlayStation EyeToy elicits higher levels of movement than the Nintendo Wii: implications for stroke rehabilitation. Eur J Phys Rehabil Med. 49(1):13-21.

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.

Schink JC. (1991). Nintendo enuresis. Am J Dis Child. 145(10):1094.

Shih CH, Chang ML, Shih CT. (2010a). A limb action detector enabling people with multiple disabilities to control environmental stimulation through limb action with a Nintendo Wii Remote Controller.Res Dev Disabil. 31(5):1047-53.

Shih CH, Shih CT, Chu CL. (2010b). Assisting people with multiple disabilities actively correct abnormal standing posture with a Nintendo Wii balance board through controlling environmental stimulation.  Res Dev Disabil. 31(4):936-42.

Shih CH. (2011). A standing location detector enabling people with developmental disabilities to control environmental stimulation through simple physical activities with Nintendo Wii Balance Boards. Res Dev Disabil. 32(2):699-704.

Shih CH, Chung CC, Shih CT, Chen LC. (2011). Enabling people with developmental disabilities to actively follow simple instructions and perform designated physical activities according to simple instructions with Nintendo Wii Balance Boards by controlling environmental stimulation. Res Dev Disabil 32(6):2780-4.

Shih CH, Chang ML.(2012). A wireless object location detector enabling people with developmental disabilities to control environmental stimulation through simple occupational activities with Nintendo Wii Balance Boards. Res Dev Disabil. 33(4):983-9.

Shih CH, Wang SH, Chang ML, Shih CH. (2012a). Enabling people with developmental disabilities to actively perform designated occupational activities according to simple instructions with a Nintendo Wii Remote Controller by controlling environmental stimulation. Res Dev Disabil. 33(4):1194-9.

Shih CH, Chang ML, Mohua Z. (2012b). A three-dimensional object orientation detector assisting people with developmental disabilities to control their environmental stimulation through simple occupational activities with a Nintendo Wii Remote Controller. Res Dev Disabil. 2012 Mar-Apr;33(2):484-9.

Shih CH, Chen LC, Shih CT. (2012c). Assisting people with disabilities to actively improve their collaborative physical activities with Nintendo Wii Balance Boards by controlling environmental stimulation. Res Dev Disabil. 33(1):39-44.

Shih CH, Shih CJ, Shih CT. (2011a). Assisting people with multiple disabilities by actively keeping the head in an upright position with a Nintendo Wii Remote Controller through the control of an environmental stimulation. Res Dev Disabil. 2011 Sep-Oct;32(5):2005-10.

Shih CH, Yeh JC, Shih CT, Chang ML. (2011b). Assisting children with Attention Deficit Hyperactivity Disorder actively reduces limb hyperactive behavior with a Nintendo Wii Remote Controller through controlling environmental stimulation. Res Dev Disabil. 32(5):1631-7.

Sparrer I, Duong Dinh TA, Ilgner J, Westhofen M. (2013). Vestibular rehabilitation using the Nintendo® Wii Balance Board -- a user-friendly alternative for central nervous compensation. Acta Otolaryngol. 133(3):239-45.

Synnott J, Chen L, Nugent C, Moore G. (2012). WiiPD - Objective Home Assessment of Parkinson's Disease using the Nintendo Wii Remote. IEEE Trans Inf Technol Biomed.

Taylor MJ, Shawis T, Impson R, Ewins K, McCormick D, Griffin M. (2012). Nintendo Wii as a training tool in falls prevention rehabilitation: case studies. J Am Geriatr Soc. 60(9):1781-3.

Wikstrom EA.(2012). Validity and reliability of Nintendo Wii Fit balance scores. J Athl Train. 47(3):306-13.

Williams MA, Soiza RL, Jenkinson AM, Stewart A. (2010). EXercising with Computers in Later Life (EXCELL) - pilot and feasibility study of the acceptability of the Nintendo® WiiFit in community-dwelling fallers. BMC Res Notes. 3:238.

Williams B, Doherty NL, Bender A, Mattox H, Tibbs JR. (2011). The effect of nintendo wii on balance: a pilot study supporting the use of the wii in occupational therapy for the well elderly. Occup Ther Health Care. 25(2-3):131-9.

Wood DJ. (2001). The "How!" sign--a central palmar blister induced by overplaying on a Nintendo console. Arch Dis Child. 84(4):288.

Yohannan SK, Tufaro PA, Hunter H, Orleman L, Palmatier S, Sang C, Gorga DI, Yurt RW. (2012). The utilization of Nintendo® Wii™ during burn rehabilitation: a pilot study. J Burn Care Res. 2012 Jan-Feb;33(1):36-45.

Young W, Ferguson S, Brault S, Craig C. Assessing and training standing balance in older adults: a novel approach using the 'Nintendo Wii' Balance Board. Gait Posture. 33(2):303-5.