Its Easy to Get In But Harder to Get Out Post Hospital Syndrome or PHS

Bad for your health?

When the Disease Management Care Blog was told by the intern, the hospital social worker, the VP for Medical Affairs or the family that an inpatient "was ready for discharge," it had a favorite test to see if it was really true.  The DMCB would walk into its patients room and ask her to do what she had easily done before she was admitted to the hospital: swing your legs out of bed, stand up and walk across the room.

The DMCB was impressed by how often elderly patients were unable to perform that simple but telling task.

Of course, the best approach was to not let the patient become that debilitated in the first place.  Thats the point of Harlan Krumholzs article on "Post-Hospital Syndrome" that was recently published in the January 10 New England Journal.

In it, Dr. Krumholz shares an important secret: being in the hospital can result in starvation, sleep deprivation, muscular deconditioning, confusion and myriad poly-pharmacy side effects.  In fact, its probably those issues, not the original medical problem that led to the hospitalization, that account for much of the infamous 20% 30-day readmission rate for Medicare beneficiaries.

Dr. Krumholz recommends that hospitals be more attentive to assuring better nutrition, provide a less noisy environment, promote early activity and keep the use of sedative, pain and hypnotic (i.e., sleeping pill) drugs to a minimum. The DMCB seconds that motion and suggests that many of its more savvy colleagues think of this as discharge planning that begins the minute the patient is admitted to the hospital.

And when patients are ready to go home, its not a matter of continuing outpatient treatment for the initial diagnosis.  These patients need comprehensive assessment and planning.  While the author doesnt come out and say it, the DMCB will: these patients need nurse-led care planning and management that addresses the full spectrum of needs that are too often ignored by hospital personnel in the rush to collect on the DRG and minimize length of stay.

Last but not least, the DMCB recommends adoption of the term "post-hospital syndrome" and wonders if it may not deserve the "PHS" acronym.

Anyone who has ever witnessed a previously well person be unable to stand up and walk will know exactly what it means.

Medicaid Disease Management No Impact on Emergency Room Utilization or Inpatient Costs for Enrollees with Diabetes

Regular readers of the Disease Management Care Blog know that Medicaid is coming. While many of the nations Governors have declined President Obamas invitation to run Medicaid the Affordable Care Act way, others have agreed to use the ACAs generous funding to enroll millions of their indigent citizens into this vastly expanded public insurance program.

"No problem!" says the disease management vendors.  For years, theyve been offering their services to state Medicaid programs and would be happy to expand their contracts.

Unfortunately, an article by Matthew Conti that was just published in the journal Health Services Research suggests that that may not be a good idea.  The articles title is Effect of Medicaid Disease Management Programs on Emergency Admissions and Inpatient Costs.  The only thing thats missing are the words "The Lack of Any" at the front of that sentence.
   
The article studied the impact of diabetes "opt-out" disease management on diabetic patients emergency room utilization and admissions in three states Medicaid programs: Washington (started in 2002), Texas (started in 2004), and Georgia (started in 2005).

These states with were compared to states without diabetes disease management.  These control states were selected on the basis of baseline Medicaid enrollment trends that were similar to the three study states. These control states were Hawaii, Kentucky, Massachusetts, Maryland, Maine, North Carolina, Nebraska, South Carolina and Tennessee.

To perform the comparison, Dr. Conti used the Agency for Health Care Research and Qualitys (AHRQ) National InPatient Sample (NIS) from the Health Care Cost and Utilization Project ("HCUP"). These databases contain patient-level and longitudinal hospital information on inpatient stays, including cost, payer, admission type (e.g., emergency, urgent and elective), age, gender, primary payer, and total charges. The span of data that was used went from 2000 through 2008.

A complicated pre-post "difference in differences" model was used to compare baseline vs. follow-up:

1) total inpatient charges/Medicaid enrollment (which averaged $430 per diabetic enrollee, with a 95% confidence interval of $265 to $700) and

2) emergency admissions/inpatient admissions (a ratio of 0.37 per admission with a standard deviation of plus or minus 0.12)  All Medicaid enrollees with diabetes were included in the analysis, whether or not they had been enrolled or opted out.  The author used this approach figuring that if a statewide disease management program enrolled up to a third of eligible persons with diabetes (that was the case in Texas), there should have been an observable impact on the entire population. Thats the approach favored by the Disease Management Purchasing Consortium.
 
The results?  No state with disease management had lower emergency room utilization or inpatient costs for their Medicaid enrollees with diabetes. The DMCB couldnt find a table with numbers, but the figures (which cant be reproduced without permission) show little impact over time.

What can readers conclude?  Assuming that, during the period of study, the three states Medicaid programs suffered from the programs endemic issues of underpayment to providers with a relative lack of access to primary care:

1. "Blanket" call-everyone telephonic disease management cannot make up for fee-for-service Medicaids shortfalls.  It remains to be seen if the ACAs revitalization of Medicaid will make up for this and increase the parallel impact of disease management. 

2) This also means that Medicaids experience with disease management cant be generalized to other types of insurance with better provider payment rates and patient access to care.

That being said, the DMCB has two concerns:

1. If the DMCB is reading this right, it appears all persons of any age with diabetes were included in the study, including Type 1 diabetics.  If thats correct, that could have also blunted the impact of any disease management program, since children are over-represented in Medicaid and the impact of remote telephonic coaching in Type 1 is widely viewed (even among the disease management vendors) to be ineffective.  Insulin-requiring kids need lots of face-to-face hands-on care.

2. The DMCB is unfamiliar with the three study states disease management programs, but if they were set up the "old fashioned way" to contact all persons with diabetes without the modern regard to future risk and "impactibility," then its little wonder that the programs failed.  State-of-the-art population health management tailors its programs by focusing on subsets of persons with chronic conditions that are most likely to benefit.  Any impact on emergency room use or inpatient charges for these patients would be lost in the data "noise" of everyone elses utilization.

Should Medicaid programs that are facing huge jumps in enrollment abandon Medicaid as a result of this study?  Based on this study, the DMCB doesnt think so.  The findings are interesting, but more research is needed.

Natural Ingredients for Hemorrhoids or Piles

Natural Ingredients for Hemorrhoids or Piles benefits often underestimated by most people. Hemorrhoids or piles is a disease where there is swelling in the anal canal us. Pain and discomfort when sitting or even defecating running very troubling us.

Many methods are used to cure this disease one way to surgical removal of hemorrhoids. There are also ways to use natural ingredients to cure this disease (depending on how severe your disease) or drugs at the Potent Hemorrhoids and Piles Obatwasir.biz. Heres a list of natural ingredients for Hemorrhoids or Piles

Ice cube

Ice cubes are often used as a pain reliever. Likewise with hemorrhoids, ice can reduce pain by hemorrhoids mengompresnya on the hemorrhoids.

Apple Vinegar

Apple vinegar can reduce the itching and burning caused by hemorrhoids and may help shrink swollen blood vessels.

Garlic

Garlic contains essential oils as anti-bacterial and anti septic substance is suitable for hemorrhoids. Puree garlic and apply on the hemorrhoids section (previously cleaned with soap formerly part hemorrhoids) wait a few minutes and wipe.

Mangosteen skin

Xanthones Mangosteen fruit contains compounds mainly in the skin of the mangosteen. Xanthones are known as anti-cancer, anti-inflammatory, anti-bacterial making it suitable for hemorrhoids. Now has a lot of health products available in the market mangosteen peel.

Aloe vera

Aloe vera is known to possess potent anti-inflammatory that can serve as a reduction pembekakan, burning sensation and inflammation that can reduce irritation to hemorrhoids. You can consume aloe to be processed into food or drink, or as a topical medication to put it on the hemorrhoids. But keep in mind for those who are allergic to aloe vera, as it can cause increased irritation.

Thats some natural remedies that you can use for hemorrhoids or piles, may be able to recover quickly. But not one you should first consult your hemorrhoids medicine about to get proper treatment.

To Salt or Not to Salt That is the Question

Salt helps maintain the fluid in our blood cells and is used to transmit information in our nerves and muscles. It is also used in the uptake of certain nutrients from our small intestines. The body cannot make salt and so we are reliant on food to ensure that we get the required intake. Every cell in our body needs salt and our body relies on salt to aid in healthy bone density, proper circulation and stabilized blood sugar levels.

The main ingredient of iodized salt is sodium chloride, which is linked with hypertension (high blood pressure) and other medical disorders. Sodium chloride is acutely toxic in large amounts and could cause poisoning. 

Table Salt is a manufactured form of sodium called sodium chloride. While similar to naturally occurring rock, crystal, or sea salt, table salt merely mimics the taste of these elements.  Table salt is created by taking natural salt (or crude oil flake leftovers) and cooking it at 1200° Fahrenheit. Once the unprocessed salt is heated up to this temperature, it starts to lose the majority of the eighty important elements that naturally occur. Other naturally occurring forms of sodium, including sea salts and Himalayan salts, are harvested and dried in the sun. Natural salts are actually alkaline minerals that help keep us hydrated, balance our sodium-potassium ratios, as well as fill the body with powerful electrolytes. They also contain all of the trace elements needed for proper immune, thyroid and adrenal function. Natural salt also boosts the creation of digestive enzymes and juices that allow us to extract and assimilate other vitamins and nutrients from the food we eat. 
 

Harvesting Celtic Sea Salt

What Is In Table Salt?  

Commonly purchased iodized salts have synthetic chemicals added to them. These chemicals include manufactured forms of sodium, iodide, sodium bicarbonate, fluoride, anti-caking agents, toxic amounts of potassium iodide and aluminum derivatives.

The natural forms of important iodine are lost when salt is manufactured. Without this natural iodine, the thyroid is adversely affected, leading to growth and metabolism issues. Because of this, the chemical-based salt industry began to add synthetic forms of iodine to their products.

Other salts add things such as processed white sugar and toxic MSG (mono-sodium-glutamate). And what about the color of table salt? Salt found in the natural world is not usually white. Table salt has been bleached using harmful chemicals. And where does this salt come from? Much of it is the actual flaky residue, a by-product of oil digging. Crude oil extract is used to produce much of table salt commonly consumed.

Table salt causes blood pressure to rise rapidly because the blood is attempting to rapidly move the toxic elements away from the heart. Excessive ingestion of table salt causes unhealthy fluid retention. Many chronic imbalances such as diabetes, gout and obesity can be worsened or even partially caused by excessive intake of common table salt; kidney, thyroid and liver problems, the development of goiters, edema, hypertension, heart disease, strained elimination systems, muscle cramps, gout, stroke, heart failure, PMS, and even major nervous system disorders such as anxiety and depression are affected as well. Table salt is harmful to the circulatory, lymph and nervous systems. Processed salt is also highly addictive.

Hidden Salt

The sodium content listed on food packaging is misleading. The amount of salt in processed foods can be 2.5 times greater than the value quoted. Salt is added to food for many reasons including:

• Seasoning to enhance the taste of food and make bland food such as bread and pasta palatable
• Preservatives Even with the advent of refrigeration salt still plays a part in food hygiene
• Binding agent in processed meats
• Colour controller  makes food more attractive for us by, for example, enhancing the golden crust of a loaf of bread
• Texture aid improves tenderness in meat and gives an even consistency in cheese
• Fermentation control  makes a consistent product and reduces opportunity for harmful bacteria

It is the excessive consumption of processed foods containing high amounts of processed salt and the long term neglect of basic healthy habits that is questionable. 

Dialysis or hemodialysis

Health for human | Dialysis or hemodialysis is a blood-filtering process is done by machines. When and why should I do? Dialysis is usually performed on patients who experience kidney failure. So the process of blood Washing was done to replace the kidney function is already damaged.

The main functions of the kidney that filter the blood is dirty or blood that has been mixed by the rest of the bodys metabolism. The results of the filter was removed through the urine or urine. While the blood that has been filtered clean after last returned to the body. When the kidney was damaged, automated metabolic waste and water can not be removed from the body and when you reach certain levels of metabolic waste that can poison the body to cause tissue damage that can eventually cause death. So if you have kidney failure or kidney damage was blood washing process is required.

In this dialysis renal function is replaced by a machine, the blood comes from blood vessels put into a small hose connected to the machine was called Dializer. In this Dializer blood would have done by membrane filtration, filter the results of this waste will be mixed with a solution called dialysate, and subsequently removed to be replaced by a new dialysate fluid. Then the blood that is filtered and clean re-inserted into the body. Although this process has such a function can only replace the kidney but normal renal function by 10% only.

For acute renal failure, dialysis is usually done while waiting for kidney function improved, whereas for chronic renal failure, should be done continuously, usually 3 times a week and each time the process takes approximately 3-5 hours. That must be considered is the cost that is large enough and have enough side effects such as low blood pressure, blood clots, infection, headache, nausea, vomiting, anemia, muscle cramps, and irregular heartbeat. Another alternative for patients with chronic renal failure is a kidney transplant if it does not want to do dialysis continuously, but the kidney transplant process is very complicated at all and certainly very costly, because it is to care and always keep your kidneys to stay healthy.

How to Get Male Baby or Female

How to Get Male Baby or Female - Male or female alike. The words we often hear from couples who are waiting for the arrival of baby. But sometimes in their hearts, there is a desire that can not be denied that they have no hope for children born to women or men. Can we design a child born as a male or female? Can!

The first attempt to do, of course pray and ask him directly on the Creator of Life. Alternatively, of course with the lawful efforts can and should do.

Every time ejaculation, normal male sperm release 2 to 5 sprays. In that duration, the sperm produced about 2 to 5 cc. Normal sperm per cc contains 60-200 million sperm. So every man ejaculates, 120 to 1 billion sperm has been removed from his body.

As we know, there are two genes in the sperm. Androsperma are also called gen Y and Gynosperma which we might call a gene X. Gen Y is the gene that allows us a mother pregnant with girls, whereas the gene X is the opposite. If husband and wife are equally dominant X gene was then the most likely, both will have a daughter. But if the father dominant gene Y and X genes of the mother then the chances of the children born are male. Nevertheless, it is counting logic that never beat the wonders of nature and power of God.

How to calculate the time of ovulation or peak fertility of a woman:

Known date of the beginning of the net of a woman every month, for example, every December 05.

Known date of the end of the net of a woman every month, for example, every December 27.

The formula: ((date each month) - (date of each month))/2 = n;

then n + date of the beginning of the net from a woman = time of ovulation or peak fertile period of a woman.

(27-05)/2 = 11; 05 + 11 = 16 - Every day to 16, from the net early on a woman is the culmination of a womans fertile period or ovulation

Characteristics of spermatozoa:

Androsperma, carrying the Y gene:

- Moving more slowly.

- More able to survive much longer (the average age of approximately 2 to 3 days).

- More resistant in the atmosphere of acid.

- No resistance in the atmosphere bases.

- Having a Specific Gravity (BJ) lighter.

Gynosperma, carries a gene X:

- Moving more nimbly.

- Life is shorter (average age approximately only 1 day only)

- No resistance in the atmosphere of acid.

- More resistant in the atmosphere bases.

- Having a Specific Gravity (BJ) is more severe.

If Men Want Children. If you are the spouse who wants a baby boy, there are tips from the results of a study that you can do. First, you should have intercourse at the time or the day before ovulation. Ovulation is when the release of eggs from the ovaries in a womans womb.

The next way is to moisten the vagina by a liter of water is first mixed with 2 (two) tablespoons of baking soda. Besides eating seafood and meat is also very helpful in this process. And most important of the above series of business is, the husband must remove sperm as close to the mouth of the uterus. This is expected to accelerate Gynosperma made their way to fertilize the egg.

If you want girl. If you are the couples who wanted girls, there are a few tips you can do. First look at the schedule of your intimate relationships. Perform an intimate relationship 2 days to 3 days before ovulation. The next step, prior to intercourse, the wife could wash the vagina with one liter of water mixed with one tablespoon of vinegar.

This solution was not harmful. Acid in the vinegar water solution is useful for disabling Androsperma who played a major role to form male genes. In addition, the candidate should spend sperm dad does not like the way the above, but rather take the distance to the mouth of the uterus. This method allows to get a baby girl. Consuming acid foods such as yogurt, fruit with a sour taste, fresh vegetables and nuts also help the process.

But once again do not forget, the human effort. Likewise Allah who have a plan.

source: ruly.blogdetik.com

Have Knee Pain When Walking Up or Down Stairs Learn About Chrondromalacia and Knee Pain Treatment

If you have knee pain when you walk up or down stairs, you might be suffering from chrondromalacia. Also known as patellafemoral pain syndrome, chrondromalacia often occurs without a specific traumatic event. The pain of chrondromalacia is sometimes compared to a toothache and it is often present when you stand up after sitting in a chair for a while.

Chrondromalacia of the patella is a common cause of knee pain, especially among women. While it sometimes happens following some type of traumatic event involving a hard hit to the knee, more typically, it happens over time when the kneecap becomes agitated or starts to wear out.

Knee pain treatments for those suffering from chrondromalacia does not typically involve surgery. The preferred approach for addressing patellofemoral pain is physical therapy combined with the use of shoe orthotics that provide stable support for the arches and feet.

Because the knee pain caused by chrondromalacia is often caused by body geometry that places increased pressure on the kneecap which over time leads to knee pain, the treatment focuses on altering the position of the leg to lessen the pressure on the knees.

While foot positioning is corrected by orthotics, strengthening exercises are also recommended for the muscles around the knees, especially those near the kneecap on the inner thigh.

Closed chain exercises, or exercises where a persons foot moves in a predetermined space so that it does not shift around, is helpful. Examples of closed chain exercises include activities like bike riding, mini squats and leg presses. A trained physical therapist can provide an exercise regimen that includes a variety of closed chain exercises to help strengthen the hips, legs, and knees in order to treat the condition.

Surgery is sometimes recommended by an orthopaedic surgeon to treat chrondromalacia in order to clean the undersurface of the patella or kneecap. This type of orthopaedic surgery can be conveniently done as an outpatient procedure using an arthroscope. Knee replacement surgery may be recommended in more extreme situations when damage to the undersurface of the patella has progressed to the point where the cartilage is worn out and exposed bone is evident.

Typically if you are suffering from knee pain including chrondromalacia or an ACL injury, you can find a successful knee pain treatment by consulting your orthopaedic physician. In many cases, before considering knee surgery, there are a number of non-surgical treatment options for you to consider. Often a combination of exercises, physical therapy, and orthotics will provide effective knee pain treatment.

Article by : Stacie L. Grossfeld, MD

Article Source : Have Knee Pain When Walking Up or Down Stairs? Learn About Chrondromalacia and Knee Pain Treatment

To ensure that diabetes or Diabetes Mellitus

Health for human | To ensure that diabetes or diabetes mellitus that is the presence of symptoms of diabetes include frequent urination, drinking lots, lots of eating, and was followed by decreased body weight and blood sugar in check when / without fasting is> 200 mg% or it could be the onset of symptoms such as itching, tingling, blurry eyes, wounds difficult to heal, the body feel sluggish but accompanied with fasting blood sugar> 126 mg% and blood sugar 2 hours after eating> 200 mg%.

For example this guy after checking the sugar content is still within normal limits, mean there are other causes that make frequent urination, other possible causes are the most common urinary tract infections, may also occur diuretics or hormonal disorders referred to as Diabetes Incipidus, and other causes are muscle-bladder muscle buffer that has begun to weaken.

If after checking the result was fasting blood sugar 220 mg%, most likely this man was hit by diabetes. And what is the treatment?

Treatment of diabetes is quite complex because it includes meal planning, regular exercise, and medication regularly.
In the pancreas gland function was good or just a mild disorder, it could just do a treatment with diit tight, but this must be followed by regular blood sugar checks for memonitoringnya. Because if this diit off guard just a little blood sugar can rise again.

To monitor blood sugar levels is best is by examination of HbA1c every 3 months, due to the high level of accuracy. Regarding the fruit be eaten is not too sweet fruit such as papaya, tomato, melon, pear, barking, watermelon, banana and so on.