Overuse off Head CT Scans

AJM in the News: Overuse of Head CT Scans?

Are emergency room physicians over-prescribing head CT scans for atraumatic headaches?

The April 2012 of The American Journal of Medicine features research pointing to wide variability in the use of head CT scans.

A group of Harvard researchers hypothesized that there is a significant variation in physician head CT use even within a single facility, and they were right.

“Even after accounting for a number of factors associated with ordering behavior, we found that greater than 2-fold variability in head CT use still persists,” explains lead author Luciano M. Prevedello, MD, Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women’s Hospital, and Harvard Medical School.

The study looked at whether a head CT was performed in 55,281 patient visits to the adult-only emergency department at a large urban academic hospital throughout 2009. Patient variables included patient age, gender, severity of the emergency, emergency department location, and disease categorization. Physician-specific variables included years in practice and gender.

Overall, 8.9% of the visits generated head CT examinations. Rates per physician ranged from 4.4% to 16.9%.

Imaging has been identified as one of the key drivers of increased healthcare costs. Strategies to reduce such variation in head CT use may reduce cost and improve quality of care.

Several news outlets followed up on this story in the Journal.

Here is a link to the research study.
Variation in Use of Head Computed Tomography by Emergency Physicians

April 2012: Systemic Lupus

AJM's Editor-in-Chief Joseph S. Alpert, MD highlights new therapies for systemic lupus in the April 2012 issue of The American Journal of Medicine.

Work Life Balance: Establishing Work Life Boundaries

Now more than ever, it is hard to separate work from our home lives. The pressure to meet deadlines, goals and targets means many people have to bring our work home, and with the increase of technological advances, work also invades our home lives with work emails, text messages and the company website all accessible in our pockets.

The inability to leave work at work has people focused on work most of the day which creates emotional exhaustion, burnout and increased pressure and stress which then effects our physical health through heart attacks, obesity and lack of energy, to name a few.

But it is not only yourself who suffers; your family also feels the effects. Many partners and children often feel neglected and unloved through the lack of attention they receive due to too much time focused on work. All too often many people have lost their families due to this feeling of neglect.

So, I hear you ask, how can we balance life AND work without neglecting the family and meeting our work commitments? I believe what will make this challenge easier is to out in place clear boundaries that separate life and work and stick to them. I know it's easier said than done, but here are 5 tips on how to set these boundaries.

Prioritise

This is probably the most important step in helping to set the boundaries between work and home. By prioritising these parts of your life will make it easier to recognise where you need to put your focus. When work has demands on you such as meeting deadlines, working through important business times such as tax time or Christmas for people working in retail, you need to put work as a top priority. Explaining to your family that it is a busy time at work and that you need to spend more time working for a short period. You can then ask them to support you by allowing you to do this which will help your family to understand and prevent feelings of neglect. Likewise, when your family life needs a priority because of a death, illness or even just that big family holiday, communicating this to your employer or supervisor will help them to understand your needs and allow them to support you appropriately.

Transition

The transition from home to work and back again is the perfect opportunity to shift your focus so you can concentrate on where you need to be. This is to be done while travelling from one place to the other whether you're driving or on the bus/train. While going to work you can complete this transition by listening to the news, reading work documents (I don't recommend this while you're driving) planning or revising your to do list, anything that will help you to switch your mind from home to work. When you're leaving work to come home, the reverse applies. To switch your mind from work to home listen to enjoyable music, think about what you're going to do when you get home or even read a novel or your favourite book (again, not while driving, you could listen to an audio recording of this book). The benefit of going through this transitional period is that by the time you reach your destination, your mindset has already made that vital shift and you can put your focus where it needs to be.

"Turn off" on your days off

We have days off for a reason. Not only do they allow us to spend precious time with our family, they also allow us to recharge and rest. This is important as this resting and recharging is what prevents exhaustion and burnout. It is vital to our physical and emotional wellbeing. Too many people stay focused on work which prevents us from resting and emotionally connecting with our family. We need to "turn off" our work mind on our days off and be present to our home life. This involves changing your attitude. You need the attitude that work "Is not my problem" and that today "I don't care about work". This change of attitude is mentally changing priorities. To develop this change of attitude could take some time.

Turn off technology

With technology helping to blur the lines between work and home, it is vital that we don't let it invade our work or home life. The solution is as simple as turning it off. At home, turn off your work phone (better yet, leave it at work, why do you need it at home?), don't check work emails on your home computer don't use remote access technology which will put you virtually back in the office. Likewise, at work disable Facebook and Twitter, don't check your personal emails and turn your personal mobile off.

Learn to say no

This step is so simple yet is so hard for some people to do. We need to learn to say no when work places demands on us to blur the lines between work and life. Can you do overtime? No. Can you take this report home to complete? No. Likewise with home life, can you bring the kids to work? No. Saying no to unreasonable requests is not being uncooperative or not being a team player, it is simply being assertive, which is a healthy trait that we all should have.

10 Simple Tips To Help You Get Rid Of Stomach Fat Fast

Everyone wishes they had a flat, toned belly; especially since it's that time of year to get out your bathing suit. Most people don't know how to efficiently get rid of extra belly fat. However, giving up your favorite foods and performing non-stop crunches is not the way to go, although many people try.

You can get a fit and healthy tummy just by implementing a few small changes into your daily routine. The following 10 tips suggest how you can eliminate belly fat fast - just in time for a great summer!

1. Keep Yourself Hydrated With Plenty Of Fresh Water

It is essential that you give your body enough water to efficiently flush the bloat and toxins from your system, especially in the high summer heat. Drinking water equates to weight loss.

2. Eliminate Carbonated Soft Drinks From Your Diet

Whether you're drinking a regular soda or diet-soda, both are detrimental to your health. Not only do they dehydrate the body and add nutrition-less calories (regular soda), the carbonated bubbles will bloat your tummy. Try drinking Sassy Water instead of diet soda, regular soda or seltzer. It's a much better alternative.

3. Walk And Talk With A Friend

If you're going for a walk, why not ask a friend to join you? Studies show that an exercise buddy will prompt you to exercise much harder than if you were alone.

Plan a time when the two of you can get together for a weekly walking session, join a gym together, or start a neighborhood fitness group. Get as many people involved as you can. The more the merrier!

4. Reduce Salty Foods Like Pretzels Or Chips

Watch your intake of snacks/foods that contain a significant amount of salt such as pretzels or chips. Because these types of foods contain so much salt, your body will retain extra fluid. Salt is a contributing factor to water weight gain and a puffy, bloated appearance.

So, in order to get a slim, trim tummy - put down the pretzels and pick something less salty to eat instead.

5. Add More Foods Rich In Fiber To Your Diet

Amazingly, your tummy will carry nearly 4% less fat for every 10 grams of fiber you consume on a daily basis. Fortunately, there are easier ways to incorporate fiber into your diet than eating an entire box of Raisin Bran. For example:

Each of the following foods contain 10 grams of tummy-tightening fiber:
1 artichoke
2 cups of broccoli
2 apples
Half cup of pinto beans

6. Boxing Is A Great Way To Get A Flat Stomach

Try aerobic kickboxing or traditional boxing to tighten your tummy. They're not only beneficial for trimming your waistline, but also a terrific cardio workout as well. All those high kicks and forceful punches will impact your abdomen and get those muscles tighter than ever.

7. Work Your Abs By Cleaning Your House

Cleaning your house can be a drag. However, the good news is while you vacuum, you can work out your abs too. As you vacuum, concentrate on contracting your abs while pushing the vacuum back and forth.

8. Canoeing And Kayaking: Two Great Abdomen Workouts

Canoeing and kayaking both provide an invigorating abs workout. Both your upper and lower torso get quite a workout since both of these sports require continuous paddling. The muscles in your lower torso including your abs are constantly stretching, twisting, reaching and pulling for an extended period of time.

9. Avocado Is Beneficial In Stopping Belly Fat

Avocados are rich in monounsaturated fatty acids (MUFAs). Just half an avocado has 10 grams of valuable MUFAs, which stop blood sugar spikes that signal your body to store fat all around your tummy.

To prevent stomach fat, eat a quarter cup of avocado serving at a time.

10. How Alcohol Affects Belly Fat

Alcoholic beverages are notorious for raising cortisol levels, which send fat straight to the belly. In fact, it's widely known that alcohol will put belly fat on you quicker than anything else you can consume. In order to get rid of your stomach fat, you must drastically decrease your alcohol consumption.

Alternative To ED Drugs - Why These Remedies Have Skyrocketed

When Viagra and similar pill products became available it did seem like the answer to men's prayers. But in curing one issue, it can then create others. It makes sex physically possible, however an increasing number of women are unhappy with the effect these type of drugs are having on their relationships.
Erectile dysfunction also known as ED or impotence is the inability to achieve or to maintain an erection for satisfactory sexual intercourse. Erections problems can mainly stem from poor blood flow to the penis, poor diet, drinking too much alcohol, being too tired or stressed.
The most common asked question about an ED drug is: "Does it work?" The next is "How safe is it?" Then "How much will it cost me?"
Are These Little Blue Pills So Marvelous?
Pills can have many side effects and may not be advisable to take, especially if men are under other medications. It is essential to read instructions and caution notices on the packaging of these drug products. Medication drugs are relatively expensive and more of a quick fix solution for men. They don't really solve erection problems in the long runs they do not tackle the root cause of the ED issue.
What Men Think...
Many men are not convinced ED pills will work, or are completely safe. Many men have a family to support and cannot afford to be paying for ED medications on an on-going basis. Men decide that they do not want to waste time in taking pills that will not help their problem in the long-term. Many have switched over to more natural non-drug alternative such as using vitamins and herbs for erectile dysfunction. Many men are in fact surprised at all the natural options for treating erectile dysfunction and find they will be able to boost circulation levels by 30% using these natural treatments.
However, most men will search for help in men's health in Google and men's health forums; millions of web pages offering products that will surely solve ED problems will show up. Men report that they can waste a lot of time and money on some gadgets and pill products and that these were not an effective solution to this problem.
A Natural Alternative
The popularity of natural remedies for erectile dysfunction has skyrocketed over the past few years. Instead of taking chemical drugs to cure erectile dysfunction, men are using ED remedies instead. They're all natural, healthy, and provide more benefit to you in the long-run. The good news is that scientific evidence supports the use of natural remedies for erection issues. A good alternative to erectile dysfunction drugs is Ginkgo Biloba. This herb can provide men with many benefits. It works by enhancing blood flow to the manhood and appears to be free of any unwanted side effects.

If you are looking to stop your erectile dysfunction permanently and start having hard erections by tonight, Click Here to read our featured story of how one man cured himself within a few days using a 3-hour natural home remedy to cure his erectile dysfunction. The sooner you treat this condition the natural way, the sooner you can start enjoying the tremendous benefits of a great sex life! If you are looking for the most effective erectile dysfunction remedies this Free ED Guide will help you to put an end to ED. The free guide will include information on the best alternative to erectile dysfunction drugs including natural treatment options.

Too Many Clots for Comfort

In instances of rare disease, clinical suspicion plays a critical role in preventing delays in diagnosis that can lead to unwanted complications and disease progression.

A 41-year-old woman presented to an outside medical facility with 4 days of progressive dry cough, fever of 101°F, fatigue, myalgias, and mild exertional dyspnea. After a chest x-ray showed left lower-lobe consolidation with parapneumonic effusion, she was admitted for treatment of pneumonia. Computed tomography imaging of the abdomen performed to evaluate the cause of abdominal pain and distention revealed hepatosplenomegaly and moderate ascites. Thoracentesis demonstrated exudative pleural effusion, and a left chest tube was placed for drainage. A left subclavian central venous line was placed after attempts to install a left internal jugular line failed. The abdominal distention and pain continued to worsen, however, and the patient was transferred to our hospital for further evaluation on day 10 of admission.

The patient's medical history was additionally notable for mild jaundice over the previous year, with simultaneous onset of intermittent brown-colored urine; 4 years of generalized fatigue; 4 miscarriages; and a normal birth after progesterone treatment.

To read this article in its entirety, please visit our website.

-- Bibhu D. Mohanty, MD, Carlos M. De Castro, MD

This article originally appeared in March 2012 issue of The American Journal of Medicine.

How To Determine Your Real Estate Investment Strategies

You have heard it said that this is the best time to buy a home or an investment property with the housing slump and this economy. Sure this is absolutely the best time now to take advantage of this real estate market. But the question on your mind if you are not a seasoned investor, is - how do you go about making sure you are able to get a great deal?

When purchasing real estate as an investment or your own personal residence, it is no laughing matter. There are pitfalls involved that sometimes even cost the season investor money. So with all your preparation to invest in real estate, what is the best way for you to make sure that it is a winning outcome for you? How do you make sure you are getting the best real estate deal during these recession times?

Great questions. We all understand that everyone is different. This is true whether we are talking about personalities, lifestyles, personal preferences or investment strategies. What works for one person may not be the best investment strategy for the next, because how, where, why, and what you invest in are all personal decisions. One thing is for certain, if you are looking for the best form of investment in the real estate arena, then you can join some of the wealthiest investors who specialized in a closely guarded investment secret known as Tax Lien Certificate and Tax Deeds Investing. The good news is that when it comes to investing in tax lien certificates and tax deeds, there are dozens of ways you can profit.

Here Are 3-Great Ways To Profit With Tax Liens And Deeds:

1. For the investors just looking for a quick buck;this is a surefire way to create a secondary, passive income that supplements their primary source of income. This type of investor might also want to eventually quit his/her day job and go into tax lien certificate or tax deed investing as a business venture that pays the expenses and then some.

2. For the investors searching for retirement security; many people, particularly those who are approaching the second half of their lives, prefer to invest in tax lien certificates or tax deeds as a way to save for their retirement. They might want to use their self-directed IRA accounts as a way to finance their purchases, placing the profits back into the IRA so that it becomes a very healthy and rapidly growing nest egg.

3. For the investors looking for rental income; some investors enjoy the thought of earning a monthly rental income that they can use for whatever purpose suits them at the moment. This type of investor may want to purchase tax deed properties and rent them out or they may simply stick to tax lien certificates and go for the sure, but slower profits.

Utility of Electronic Notifications

Notifications Received by Primary Care Practitioners in Electronic Health Records: A Taxonomy and Time Analysis

Primary care providers receive large numbers and types of asynchronous electronic medical alerts daily and spend an estimated 50 minutes of daily non-face-to-face time processing them.

Abstract

Background
Asynchronous electronic health record (EHR)-based alerts used to notify practitioners via an inbox-like format rather than through synchronous computer “pop-up” messages are understudied. Our objective was to create an asynchronous alert taxonomy and measure the impact of different alert types on practitioner workload.

Methods
We quantified and categorized asynchronous alerts according to the information they conveyed and conducted a time-motion analysis to assess practitioner workload. We reviewed alert information transmitted to all 47 primary care practitioners (PCPs) at a large, tertiary care Veterans Affairs facility over 4 evenly spaced 28-day periods. An interdisciplinary team used content analysis to categorize alerts according to their conveyed information. We then created an alert taxonomy and used it to calculate the mean number of alerts of each type PCPs received each day. We conducted a time-motion study of 26 PCPs while they processed their alerts. We used these data to estimate the uninterrupted time practitioners spend processing alerts each day.

Results
We extracted 295,792 asynchronously generated alerts and created a taxonomy of 33 alert types categorized under 6 major categories: Test Results, Referrals, Note-Based Communication, Order Status, Patient Status Changes, and Incomplete Task Reminders. PCPs received a mean of 56.4 alerts/day containing new information. Based on 749 observed alert processing episodes, practitioners spent an estimated average of 49 minutes/day processing their alerts.

Conclusions
PCPs receive a large number of EHR-based asynchronous alerts daily and spend significant time processing them. The utility of transmitting large quantities and varieties of alerts to PCPs warrants further investigation.

To read this article in its entirety, please visit our website.

-- Daniel R. Murphy, MD, MBA, Brian Reis, BE, Dean F. Sittig, PhD, Hardeep Singh, MD, MPH

This article originally appeared in February 2012 issue of The American Journal of Medicine.

Pregnancy and Stiff Person Syndrome

Stiff person syndrome is an uncommon disorder characterized by fluctuating, progressive muscle stiffness, contractions, rigidity, and spasm usually involving the axial muscles.1 Although the cause is unknown, it has been reported to be frequently associated with autoimmune conditions such as diabetes mellitus, pernicious anemia, thyroiditis, and vitiligo. Three different forms of stiff person syndrome are recognized: autoimmune, paraneoplastic, and idiopathic.2

The autoimmune form of the disease accounts for approximately 60% of the cases and is associated with circulating anti-glutamic acid decarboxylase antibodies.3 These antibodies target gamma aminobutyric acidergic neurons and their nerve terminals and are detectable in the serum. The other 40% rely on clinical testing and history for diagnosis4 because there are no consistent characteristic serologic or image abnormalities.

Case Report
A woman (gravida 3 para 2) at 10 weeks' gestation presented to the triage area with several days of progressive muscle stiffness, body spasms, rigidity, and disabling axial muscle pain.

To read this article in its entirety, please visit our website.

-- George Amyradakis, MD, S.J. Carlan, MD, Amanpreet Bhullar, MD, Julie Eastwood, RN

This article originally appeared in March 2012 issue of The American Journal of Medicine.