11.30.07
Posted in Uncategorized at 6:31 am by amit
PROVIDENCE, R.I., Nov. 29 (AP) — The chief of the neurosurgery department at Rhode Island Hospital has stepped aside while officials investigate three incidents in which surgeons operated on the wrong side of a patient’s head.
The chief, Dr. John A. Duncan, will see patients but will not run the department, a spokeswoman for the hospital’s parent company, Lifespan, said Thursday.
Since February, three brain surgeons at the hospital have operated on the wrong side of a patient’s head; the most recent incident was on Friday.
In two cases, the doctors did not realize the errors until after they had opened the skull.
An elderly man died in August a few weeks after a surgeon mistakenly operated on the wrong side of his head.
Dr. David R. Gifford, director of the Rhode Island Department of Health, said that an autopsy was pending but that the department believed that the man’s death was not connected to the surgery. In the other two cases, the patients are fine, the department has said.
The hospital was fined $50,000 this week, reprimanded and ordered to make a series of changes that include improved training and additional safeguards.
Rhode Island Hospital is the largest hospital in the state and serves as the teaching hospital for the Alpert Medical School at Brown University.
Permalink
Comments off
11.28.07
Posted in Uncategorized at 4:00 pm by amit
Okay - I haven’t tried this out, but I have to admit the demo looks pretty slick.
Patient Prompt emails, calls, or text messages your clients to remind them of their appointments, allows them to respond to confirm, and it does it all automatically. Reminder calls consume quite a bit of time for us these days, but I can’t imagine not doing them. This might be just the solution.
I’m not sure how patients would respond to the automated system. You can actually record your own message so that clients hear a familiar voice, but I still tend to lean more toward the full-service, “real person” approach from a service quality perspective. If you’ve tried it, or have any thoughts, leave a comment and let us know.
Permalink
Comments off
Posted in Uncategorized at 6:51 am by amit
Suicide is more common among older Americans than any other age group. The statistics are daunting. While people 65 and older account for 12 percent of the population, they represent 16 percent to 25 percent of the suicides. Four out of five suicides in older adults are men. And among white men over 85, the suicide rate 50 per 100,000 men is six times that of the general population.
Yet, says Dr. Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical Center in the Bronx, If you consider only major depression as the antecedent of elder suicide, youll miss 20 to 40 percent of cases in which there is no sign of mental illness.
Dr. Kennedy, who is also affiliated with Albert Einstein College of Medicine, recently directed a symposium in New York on preventing suicide in older adults, designed to alert both mental health and primary care practitioners to the often subtle signs that an older person may try to end it all.
The Warning Signs
In interviews, he and other symposium presenters noted that detecting suicidal impulses in older people often depended on the ability of family members and friends to recognize warning signs and act on them. According to Gregory K. Brown, a suicide specialist at the University of Pennsylvania, in studies of what preceded elder suicides, suicide ideation the wish to die or thoughts of killing themselves appears not to have been taken seriously. In 75 percent of cases, the suicide victims had told family members or acquaintances of their intention to kill themselves, Dr. Brown said.
Dr. Kennedy put it this way: This is not simply a doctors problem. We need to think of elder suicide more as a social problem and look out for individuals at risk.
Primary care practitioners are also crucial to suicide prevention among the elderly because older people, and especially older men, are unlikely to seek out and accept mental health services but are often seen by family doctors and nurses within days or weeks of a suicide. Among suicide victims 55 and older, 58 percent visited a general physician in the month before the suicide. In fact, 20 percent see a general physician on the same day and 40 percent within one week of the suicide.
While major depression is the main precipitant of suicide at all ages, social isolation is an important risk factor for suicide among the elderly. And older men, more so than older women, often become socially isolated.
Widowers are especially at risk because older men in the current generation tend to depend on their wives to maintain social contacts. When wives die, their husbands social interactions often cease.
Older males who live alone are an endangered species, Dr. Kennedy said particularly in states like Wyoming, Montana and Nevada, where the social distance is great and firearms are a part of the culture.
Many men are poorly prepared for retirement, and dont know how to fill in the hours and maintain a sense of usefulness when they stop working. They often sit around watching TV, said Martha L. Bruce, a professor of sociology and psychiatry at the Weill Medical College of Cornell University in White Plains said.
And Dr. Kennedy said, After retirement a lot of older men start drinking heavily, a sign of increased aggression turned inward. He called heavy drinking or binge drinking a risk factor for suicide among the elderly.
A particularly vulnerable time may be after the diagnosis of a life-threatening disease like cancer. Older men who were recently discharged from the hospital are also at high risk, Dr. Kennedy said. They need to be periodically screened for depressed mood, loss of interest in life and thoughts of killing themselves.
Serious personal neglect is another warning sign; people can commit a kind of passive suicide by failing to eat, letting themselves become dangerously sedentary or not taking needed medication.
Dealing With Depression
Contrary to what many people think, depression is not a normal part of growing older. Nor is it harder to treat in older people. But it is often harder to recognize and harder to get patients to accept and continue with treatment.
Most people think sadness is a hallmark of depression, Dr. Bruce said. But more often in older people its anhedonia theyre not enjoying life. Theyre irritable and cranky.
She added: Many older people despair over the quality of their lives at the end of life. If they have a functional disability or serious medical illness, it may make it harder to notice depression in older people.
Family members, friends and medical personnel must take it seriously when an older person says life is not worth living, I dont see any point in living, Id be better off dead or My family would be better off if I died, the experts emphasized. Listen carefully, empathize and help the person get evaluated for treatment or into treatment, Dr. Brown urged. He warned that depressed older adults tend to have fewer symptoms than younger adults who are depressed.
The ideal approach, of course, is to prevent depression in the first place. Dr. Brown recommended that older adults structure their days by maintaining a regular cycle and planning activities that give them pleasure, purpose and a reason for living.
He suggested social activities of any type joining a book club or bowling league, going to a senior center or gym, taking courses at a local college, hanging out at the coffee shop.
Dr. Bruce suggests taking up a new interest like painting or needlework or volunteering at a place of worship, school or museum.
Dr. Brown notes that any activity the person is capable of doing can help to ward off depression and suicidal ideation. And he urges older people to talk to others about their problems.
Permalink
Comments off
11.27.07
Posted in Uncategorized at 4:30 pm by amit
As a new parent eight years ago, I swore never to buy a video game system, certain that my child would spend her leisure time reading and playing outside.
I recently remembered this vow while waiting in line for two hours outside the Nintendo store in Manhattan. Like hundreds of other parents, I was trying to get my hands on the Nintendo Wii, a popular video game system and one of the seasons hottest toys.
My conversion from video game critic to buyer is due in large part to some recent research showing that so-called active video games, like those played on the Wii, arent like the sedentary games played by the Atari generation. Far from creating couch potatoes, these games compel players to dance, jump and sweat.
While the active video games are clearly an improvement, excessive video game playing by kids is still cause for concern. Exposure to violent video game content is linked with aggression and antisocial behavior, and game playing has been shown to have a small but still measurable impact on time spent reading and doing homework for certain children.
Active video games are not a substitute for sports and outdoor play, but several studies show that the games can significantly increase a childs level of activity while playing indoors.
In one New Zealand study, researchers studying game use by 21 children showed that active video games produced about as much activity as walking, skipping and jogging, according to the report in August in Pediatric Exercise Science.
Some of the new active video games burn more calories than walking on a treadmill, the American Academy of Pediatrics reported last year in its medical journal. In that study, researchers at the Mayo Clinic in Rochester, Minn., measured how many calories kids burned in 15 minutes of watching television, walking on a treadmill, playing a traditional seated video game (Disneys Extreme Skate Adventure) or playing two active games. One of the active games, Dance Dance Revolution, requires players to follow steps using a dance pad, while Nicktoons Movin Jellyfish Jam uses the Sony EyeToy, which is controlled by body movements.
The EyeToy game burned about as many calories as walking on the treadmill, while dance pad users burned even more. The Mayo Clinic group is conducting a similar study of the Nintendo Wii.
Lorraine Lanningham-Foster, assistant professor at the Mayo Clinic, knows that the research into active video games will meet with skepticism. There are people who think, no matter how you repackage it, they are still video games and kids shouldnt be sitting down in front of the TV or a computer to play them, Dr. Lanningham-Foster said. But theyre not sitting down. Thats the whole aspect of these new games they are moving.
A recent Kaiser Family Foundation survey found that half of all 4- to 6-year-olds had played video games, and one in four played several times a week. Fisher-Price has introduced an active game system for 3- to 6-year-olds called the Smart Cycle. The cycle, the 13th most popular toy on Amazon.com, allows the child to control a video game by pumping the pedals.
The bigger worry for many parents isnt whether kids are getting enough exercise, but whether video games interfere with real sports activities and time with friends and family or distract children from academic pursuits.
Researchers from the University of Texas at Austin looked at how nearly 1,500 adolescents and teenagers, ages 10 to 19, spent their time, and compared the habits of video game players with nonplayers. (The data were collected in 2002 and 2003, before the new active games were popular.)
Over all, there were no significant differences between gamers and nongamers in the time they spent with parents and friends, or involved in sports or other active leisure activities, according to the report in July in The Archives of Pediatrics and Adolescent Medicine.
Among girls, video-game play had no effect on reading time. But for every hour a boy played a video game during the school week, he read just two minutes less than a boy who didnt play video games. Notably, nongaming boys didnt read much at all either spending only eight minutes a day with a book.
Video games didnt affect boys homework time. But girls who played video games during the week spent 13 fewer minutes on homework, representing about one-third less time, than nongamers. But the meaning of that finding is not clear, as high-academic achievers often spend less time on homework as well.
Researchers say far more study is needed to understand what type of children play video games and how time spent playing games affects other parts of their lives. The notion is, if kids werent watching TV and playing video games theyd be reading or outside running up and down a soccer field, says Elizabeth A. Vandewater, a co-author of the Texas study who is now a senior research health analyst at Research Triangle Institute, a social science group in North Carolina. Its not an even trade-off.
The American Academy of Pediatrics says children under 3 shouldnt spend any time in front of the television or video games. And parents who do buy active video games should still make sure that a childs overall media diet of computer use, television, videos and games does not exceed the academys recommendation of less than one to two hours a day.
As a parent, you still have to regulate and monitor what theyre doing, Dr. Lanningham-Foster said. It still boils down to limits.
E-mail: well@nytimes.com.
Permalink
Comments off
Posted in Uncategorized at 4:17 am by amit
THE FACTS
The aches and pains strike in the middle of the night for no apparent reason. For decades, doctors have dismissed them as normal signs of growing in small children, and said the pain was harmless.
Most textbooks attribute these growing pains to the stretching of leg muscles, caused by the rapid growth of bones.
But despite widespread acceptance of this claim, there is virtually no evidence that its true. Most studies have found instead that the pains which can affect nearly half of all children result from brittle bones and physical activity, in particular overuse from running, climbing and jumping during the day.
In 2005, for example, a study in The Journal of Rheumatology recruited 39 children with symptoms of growing pains and compared them with a control group. After ultrasound tests, the researchers found that the children in the pain group had decreased bone speed of sound a measure of bone strength and breakability suggesting that they suffered instead from a local overuse syndrome.
Other studies have had similar results, and some have also found that restless leg syndrome and other conditions are sometimes confused with growing pains. Researchers say that rather than dismiss the pains, parents can alert their pediatricians or try massages and a pain reliever.
THE BOTTOM LINE
Research suggests that growth spurts do not cause pain.
scitimes@nytimes.com
Permalink
Comments off
« Previous entries ·