May 18th, 2009 by GruntDoc in Better Health Network, Humor
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Fort Worth soldier’s, um, boxers make him famous | Fort Worth | Star-Telegram.com
Army Spec. Zachary Boyd, a 2007 graduate of Keller Central High School, was in his sleeping quarters this week when the Taliban attacked in the rugged mountains of eastern Afghanistan. Boyd rushed to a defensive position clad in his helmet, vest and boxers — the pink ones decorated with the “I Love NY” slogan.
Dude’s from Fort Wort. “I Love NY” Boxers. Geez.
Thank you for your service. Get some Texas undies.
*This blog post was originally published at GruntDoc*
May 18th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network
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I’ve previously written about what face-to-face smoking cessation services typically do, largely based on my own experience. However, while at the SRNT annual conference I met two Smoking Cessation Advisors working in Lancashire, England who appeared to have a successful service, so thought it worth sharing some of their information.
Jan Holding and Eileen Ward manage a UK National Health Service (NHS) Stop Smoking Service in Lancashire in the north of England. Both are nurses by training and many of the 14 staff providing the treatment have primarily a nursing background. Their service sees around 450 new clients per month (i.e. over 5000 new clients per year). Services are provided at “community sessions” at various locations all over their catchment area, and clients are given their own hand-held record which they keep, and take with them to sessions, enabling them to attend whichever community location suits them at the time. While clients can make scheduled appointments, the service is also flexible, allowing clients to “drop-in” to community sessions without an appointment. Although some initial assessment sessions take place in a group format, most of the sessions are delivered in a one-to-one format via a relatively brief discussion with a smoking cessation advisor. These community sessions often take place in a large community room from 4pm to 8 pm in the evening, with multiple types of services being provided in the same room at the same time at different corners (e.g. initial assessments in one corner, prescribing of varenicline in another, and nicotine replacement therapy in another). It is not uncommon for around 200 clients to attend a single community session.
Clients are frequently encouraged to use NRT prior to quitting smoking (about half do this) and usually use more than one smoking cessation medicine (more than half do). Nicotine replacement therapy is provided via a voucher system requiring either no cost to the client, or just a co-pay (around $10 USD).
The service runs 6 days per week and includes evening sessions, and aims to reduce most of the usual barriers to entering treatment. Their “3 As” approach emphasizes “Accessibility, Availability and Adaptability”. They also specifically try to develop smoking cessation advisors who are passionate about their role, have a positive attitude to the importance of quitting smoking, and are therefore very committed to that work, as well as being knowledgeable about it.
My understanding is that the quit rates at this service are pretty good. But perhaps the best testimony to its success is the fantastic volume of clients who attend…..largely influenced by positive word-of-mouth via other clients. The success of this service reminds us that there isn’t just one way to do it, that all smoking cessation counselors and systems may need to be flexible and adaptable in order to help as many smokers to quit as possible.
For further information on what a smokers’ clinic does, see: What does a tobacco treatment clinic do?
This post, Smoking Cessation Programs: Lessons From The UK, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
May 18th, 2009 by KevinMD in Better Health Network
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Paying physicians via capitation was soundly rejected by patients when it was tried in the HMO era a decade ago.
Massachusetts is trying again. According to a state commission, they recommend “replacing fee-for-service with a system that would use a single payment to cover most of a person’s care for an entire year.”
The last time this was tried, patients rebelled as it was perceived that there was a financial incentive for doctors and insurers to deny care. And they were right. Bluntly put, it’s the only way to control health care spending.
Some are skeptical that Capitation Version 2.0 will work. Hospital CEO Paul Levy feels that doctors and hospitals will be at risk of being caught in the middle: “You also need to let the public know what the new environment will be for their care so doctors and hospitals are not caught in the middle, the way it happened during the last experiment with managed care. If the Commission does half the job in its recommendations and leaves the rest to be fixed in the future, it will leave us will a lot of unintended consequences and will undermine the good that might otherwise come from a new payment scheme.”
Health insurer CEO Charlie Baker echoes my skepticism about whether patients will accept the implications of this new model. In addition to the fear that doctors will be incentivized to withhold care, patients will also worry about a possible “restriction on their ability to see any physician they wanted to see.”
But, the bottom line is that saying “no” is the only way to control costs. Whether patients will accept that fact will determine whether these payment reforms will be successful.
*This blog post was originally published at KevinMD.com - Medical Weblog*
May 18th, 2009 by Dr. Val Jones in True Stories
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Can anyone tell me what this is? (I’ll post the answer in the comments section).
Film Credit: Dr. Michael Armento
May 17th, 2009 by DrRob in Better Health Network
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Before you get too “conspiracy theory” on me, let me assure you that I am not going to talk about how the influenza virus pandemic is the work of terrorists (unless the Napoleon and Snowball are trying to take over our farm). I am also not suggesting that children are terrorists (although some do raise my suspicion).
The virus that brought such worry and even panic seems now to be “fizzling out” and people are now questioning if the authorities and the press overreacted to the threat. Will this be a replay of the “boy who cried wolf” and have us complacent when a real threat comes? One writer questioned if the flu “overreaction” was “more costly than the virus itself.“ Another article cites an Australian professor (of what, the article did not say) who stated that “the country would be better off declaring a pandemic of some of the real health problems it has, like diabetes and obesity.”
The real din, however is in the countless letters to the editor and calls to radio talk-show hosts mocking the “alarmism” put forth by the WHO and others about this flu. This does appear to be in the minority, as one poll said that 83% of Americans were satisfied with the management of the outbreak by public authorities. Still, I suspect the volume of the dissent and sniping at the non-serious nature of the pandemic so far will only increase over time. The number of people who know better than public health officials will multiply.
This pandemic is a catch-22 for public health officials, as an excellent article on the subject states:
The irony is that the overreaction backlash will be more severe the more successful the public health measures are. If, for example, the virus peters out this spring because transmission was interrupted long enough for environmental conditions (whatever they are) to tip the balance against viral spread, CDC and local health officials will be accused of over reacting.
Which brings me to the connection to terrorism. If public authorities somehow thought there was a 10% chance that New York City would be hit with another major terrorist attack, how big should their reaction be? If they suspected that there was a reasonable probability, say 5%, that the subways would be flooded with sarin gas, should they shut them down? I would certainly hope they wouldn’t leave that many people open to the chance of death.
And what is the best outcome? The best outcome is that this is an overreaction. The best outcome is that the terrorists, in fact, have reformed and are instead joining the Professional Bowling tour. I would welcome this outcome (not to mention the exciting infusion of young talent to the tour). The problem is, the officials have no idea how it will play itself out. Truth be told, since 9/11, there have not been any major terrorist attacks in the US. Does this mean that the money spent on the department of homeland security has been wasted?
As a pediatrician, I am very accustomed to overreaction. If you bring in your 20 day-old child to my office with a fever of 102, I will do the following:
- Admit them immediately to the hospital
- Draw blood tests looking for serious infection
- Check a urinalysis to make sure there isn’t an infection (using a catheter to get the sample)
- Start IV antibiotics as soon as possible
- Perform a spinal tap to rule out meningitis.
This seems a little over-the-top, doesn’t it? The child just has a fever! The problem is that children this age with a fever caused by a virus look identical to those who have meningitis. By the time their appearance differentiates, it is too late. This forces me to do the full work-up on every infant with fever and treat each one as if they have meningitis or some other serious infection. I do this despite the fact that the cases of meningitis are far outnumbered by that of less serious problems.
If this is your child, don’t you want me to do that?
Knowing what we know about pandemics, the same caution was, in my opinion, absolutely the right thing to do. If the virus turns out to be nothing serious, hallelujah. I don’t want my patients (or family members) dying at the rate that some of the previous H1N1 viruses caused. I want this to be a lot of worry for “nothing.” Please let it be so.
But I still don’t think it is time to relax. As one commenter on an earlier post I wrote about this pandemic stated:
It’s still a bit early to relax. The 1918 flu went around first in the spring and was very mild – kinda like this. Then it came back in the fall after incubating and mutating and was a killer.
I think the CDC and WHO probably will be concerned about this until next year, at least. Just to be on the safe side.
Remember that that flu, which was mild in the spring, went on to kill 20-100 million people.
For this reason, I hope the voices of reason win out over the armchair quarterbacks that don’t have to make these decisions that could mean the life or death of millions. Will you tell me that evacuating the NY subways wouldn’t be a good thing on the threat of Sarin gas? Would you criticize me for “overreacting” if your infant with a fever turned out to just have an upper respiratory infection? I hope not.
If you would, then that gives us ample reason to ignore your opinions on how this flu was handled.
*This blog post was originally published at Musings of a Distractible Mind*
