Category Archives: Preventative Medicine

After working as a registered nurse in hospital settings for several years, Lindsey Herndon became a board-certified Family Nurse Practitioner a few years ago, shifting toward a holistic practice to pair with western medicine.

Herndon worked in Oregon for the past few years at a family practice where she embraced preventative healthcare, which is where she came up with the idea to open her own mobile business to offer both telehealth and mobile visits to patients homes.

Teaming up with local nurses and a business professional, Herndon launched BusyBee IV Hydration and Wellness, a mobile healthcare company offering traditional services akin to an urgent care, intravenous (IV) therapies, vitamin shots and Botox.

Instead of working more towards fixing the problem as it happens, weve shifted toward preventative healthcare so with the idea of IV, hydration and mobile urgent care, were taking that holistic approach to bring to the patient in the comfort of their own home, Herndon said.

With services treating a variety of ailments, ranging from respiratory infections to skincare to hangover relief, Herndon and her business partner, Megan Scameheorn, and her crew of registered nurses, Liz Gidley, Amy Bottomley and Meghan Neufeld, also offer group packages.

The Hangover Helper IV drip has become one of the most popular therapies, providing 1,000 ML of fluid, B complexes, magnesium, manganese, copper and selenium.

Customers often book IV therapy parties for events like birthdays, bachelor and bachelorette parties as a group activity before or after long weekends.

Its a fun experience for everybody, Scameheorn said We had a client who booked us for a birthday party, and she wanted to make sure everybody got hydrated when they went back to work and got their hangover cure.

In addition to hangover relief, another popular IV drip is the Worker Bee, which is geared toward athletes recovering from strenuous training and contains fluids and a variety of vitamins and minerals. The therapy is designed to address muscle soreness, fatigue and enhance athletic performances.

Other IV therapies include the Myers Cocktail, the Thirsty Bee and the Beeautiful, each containing fluids, vitamins and minerals geared toward general wellness, hydration and skincare.

Herndon and Scameheorn are working with event organizers to potentially set up a booth at the Whitefish Marathon and The Last Best Ride.

In addition to IV drips, Busy Bee offers vitamin shots containing B vitamins, Vitamin D, antioxidants, biotin and a Skinny Shot that helps reduce sugar cravings.

This is a town where people work hard and play hard and they need to feel good in order to operate well, Herndon said. So we have a holistic approach of doing urgent care, IV hydration and even aesthetics We treat the individual from the inside out so they can function and do the things they love to do.

For more traditional services, Busy Bee offers telehealth and in-home treatment for gastrointestinal issues, respiratory infections, urinary tract infections, COVID testing and earwax removal.

I think its really exciting to have the opportunity to promote wellness in our community outside of the hospital setting, Neufeld said.

For more information, visit http://www.busybee-iv.com.

Read this article:
Healthcare for the Busy Bee - Flathead Beacon

Connecticut has seen an upward trend in COVID-19 cases over the past few weeks. While it may be possible that this increase is due to the new Omicron subvariants BA.4 and BA.5, public health officials say that its too soon to tell.

Dr. Manisha Juthani, commissioner of Connecticuts public health department, said its unclear exactly how widely BA.4 and BA.5 are spreading in Connecticut or the degree to which the new subvariants are contributing to the states recent uptick in COVID-19 cases and test positivity rate.

Its hard to say that the slight rise that were seeing is related to (the subvariants) or not, she said. Are we seeing this rise because of that? It is possible. I just dont have enough conclusive evidence to say that its absolutely the reason why.

Juthani, who was previously an infectious disease specialist at Yale New Haven Health, said that while the states COVID-19 numbers are still lower than they were this spring, the upward trend is increasingly hard to deny.

I dont want to sound the alarm every few weeks and then people start tuning out any sort of alarms, she said. But what I can say is that we are going in that direction.

Connecticut, like every other U.S. state, does not determine the variant of each positive case of coronavirus. Instead, the state Department of Public Halth, and Centers for Disease Control and Prevention, work with scientists, universities, hospitals and diagnostic labs to collect representative samples of positive tests for variant determination. These results are used to generate prevalence models to help public health officials estimate which variants predominate in states and across regions.

Yale New Havens Clinical Virology Lab, which mostly tracks outpatient samples from Fairfield, New Haven and New London counties, indicates that new cases are being driven by variants BA.2, BA.4 and BA.5. Regionally, the CDC estimates that the majority (roughly 42%) of new cases in New England are caused by BA.5.

According to Connecticuts public health department, new cases are up statewide with higher concentrations in the high population corridor between Stamford, New Haven and Hartford. This is despite overall higher vaccination rates in those areas.

Hospital utilization is up in the same area according to the federal Department of Health and Human Services. This upward trend can be seen across New England and New York. Every New England state but Vermont has over 70% hospital utilization. Connecticut is in the middle portion of the pack at 75% utilization. Rhode Island leads at 91%.

BA.5 has been reported to be more transmissible and immune evasive than previous strains of the coronavirus. Several studies have demonstrated that both BA.4 and BA.5 are more able to escape antibodies than previous variants. This is true for monoclonal antibody treatments, antibodies from prior infection and antibodies from vaccination.

Because of this immune evasion reports are emerging of more rapid reinfections than before. A CDC study documented ten cases of reinfection within 90 days of prior infection with the Delta variant across four states.

There have been a series of variants over time that have shared a couple characteristics, said Mark Adams deputy director at The Jackson Laboratory for Genomic Medicine. One is increased transmissibility ... but increasingly they seem to be driven by the ability to escape prior immune protection from SARS-COV-2.

The upshot is that even though this variant is more infectious it is not clear that it causes more severe or unusual infections. A large-scale study from Qatar indicates that vaccination is still extremely (97%) effective at preventing the worst outcomes even if vaccinated people still get sick.

It can infect people who have been previously infected but they tend to get a very mild infection, said Dr. William Schaffner, a professor of preventative medicine at Vanderbilt University Medical Center.

While some reports have emerged about unusual symptoms, such as viral meningitis, its not clear that this is a function of the new strain or a function of more cases increasing the likelihood of documenting rare complications.

We have heard, anecdotally, stories of a variety of symptoms (and recurrent infections) said Schaffner. But it isnt clear if its long symptoms or relapse or recurrent infection.

Its also not clear yet whether this wave of BA.4/5 will cause hospital capacity issues locally like it did in Portugal earlier in the spring. Transmission, severe infection and hospital use are complicated to predict.

Its really hard to predict the number of infections and the number of hospitalizations, said Adams. He encouraged people to get boosted if they could.

Its a real benefit. All the studies show that vaccination and boosting reduce the severity of disease, said Adams. The difference might be smaller (with the new variants) but its not going to be nothing.

See the article here:
The COVID BA.4 and BA.5 subvariants are highly transmissible. Here's what else people in CT need to know. - CT Insider

The NHS plans to use drones to fly chemotherapy drugs to cancer patients in England to avoid the need for long journeys to collect them.

The devices will transport doses from Portsmouth to the Isle of Wight in a trial that, if successful, will lead to drones being used for similar drops elsewhere.

They will take 30 minutes to travel across the Solent, which will save patients on the island a three to four-hour round trip by ferry or hovercraft.

On Tuesday, Amanda Pritchard, NHS Englands chief executive, unveiled the move to help mark the 74th anniversary of the health services creation by the postwar Labour government.

Delivering chemo by drone is another extraordinary development for cancer patients and shows how the NHS will stop at nothing to ensure people get the treatment they need as promptly as possible, while also cutting costs and carbon emissions, she said.

The first drone deliveries will start shortly, NHS England said, subject to the outcome of the last of a series of test flights on Tuesday.

It plans to use the drones electrical vertical takeoff and landing aircraft to collect the medications from the Queen Alexandra hospital in Portsmouth and fly them to St Marys hospital on the Isle of Wight, where staff will collect and distribute them.

The drones weigh 85kg, have a wingspan of 5 metres and can carry up to 20kg. The scheme is the result of a partnership between NHS England and the technology company Apian.

This project marks a very important first step in the construction of a network of drone corridors connecting hospitals, pathology labs, GP surgeries, care homes and pharmacies up and down the country, said Alexander Trewby, Apians chief executive.

If the flights prove successful it will be much more convenient for the majority of cancer patients on the Isle of Wight who now have to travel to the mainland to receive their drugs.

Darren Cattell, the chief executive of the Isle of Wight NHS trust, stressed that we are still at a relatively early stage of drone use in healthcare but that drone could have radical and positive implications for both the NHS and for patients across the UK as well as the Isle of Wight.

Sajid Javid, the health secretary, said: I want England to become a world leader in cancer care and using the latest technology to deliver chemo by drone means patients will have quicker, fairer access to treatment no matter where they live.

Meanwhile, a study has found that reinviting patients every year to be screened for bowel cancer the UKs second biggest cancer killer could speed up diagnosis and save lives.

Although the proportion of people taking up the NHSs invitation to get screened has risen to 67%, bowel cancer has the lowest participation rate of all the health services screening programmes.

New research by Sheffield University showed that sending people a new home testing kit every year until they return one could prompt 13.6% more people to do so.

The study was funded by Cancer Research UK (CRUK) and is published in the journal Preventative Medicine.

Sign up to First Edition, our free daily newsletter every weekday morning at 7am BST

Michelle Mitchell, CRUKs chief executive, said: Screening is an effective way of catching cancer early and saving lives, but not everyone engages equally, and this contributes to health inequalities across the UK.

This study shows that sending yearly test kits to those who dont complete them could help close this gap and save lives.

The test used, the faecal immunochemical test, better known as the FIT test, looks for traces of blood in someones faeces. At the moment everyone in England aged 60-74 who is registered with a GP is sent one every two years. However, the government has pledged to expand the programme to 50- to 59-year-olds and the NHS has begun inviting 56 and 58-year-olds for screening.

Genevieve Edwards, the chief executive of Bowel Cancer UK, said: We know that once someone has taken part in bowel cancer screening, theyre more likely to do so again. So it will also be vital to increase investment in endoscopy and pathology staff and equipment, to match an increase in demand for prompt follow-up tests.

View post:
NHS to test using drones to fly chemotherapy drugs to Isle of Wight - The Guardian

Background

Smoking, obesity, and being below a healthy body weight are known to increase all-cause mortality rates and are considered modifiable risk factors. The purpose of this study is to assess whether adding these risk factors to a validated geriatric inpatient mortality risk tool will improve the predictive capacity for hip fracture patients. We hypothesize that the predictive capacity of the Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) tool will improve.

Between October 2014 and August 2021, 2,421 patients >55-years-old treated for hip fractures caused by low-energy mechanisms were analyzed for demographics, injury details, hospital quality measures, and mortality. Smoking status was recorded as a current every-day smoker, former smoker, or never smoker.Smokers (current and former) were compared to non-smokers (never smokers).Body mass index (BMI) was defined as underweight (<18.5 kg/m2), healthy weight (18.5-24.9 kg/m2), overweight (25.0-24.9 kg/m2), or obese (>30 kg/m2). The baseline STTGMA tool for hip fractures (STTGMAHIP_FX_SCORE) was modified to include patients BMI and smoking status (STTGMA_MODIFIABLE), and new mortality risk scores were calculated. Each models predictive ability was compared using DeLongs test by analyzing the area under the receiver operating curves (AUROCs). Comparative analyses were conducted on each risk quartile.

A comparison of smokers versus non-smokers demonstrated that smokers experienced higher rates of inpatient (p = 0.025) and 30-day (p = 0.048) mortality, myocardial infarction (p < 0.01), acute respiratory failure (p < 0.01), and a longer length of stay (p = 0.014). Comparison among BMI cohorts demonstrated that underweight patients experienced higher rates of pneumonia (p = 0.033), decubitus ulcers (p = 0.046), and the need for an intensive care unit (ICU) (p < 0.01). AUROC comparison demonstrated that STTGMA_MODIFIABLEsignificantlyimproved the predictive capacity for inpatient mortality compared to STTGMAHIP_FX_SCORE(0.792 vs. 0.672, p = 0.0445). Quartile stratification demonstrated the highest risk cohort had a longer length of stay (p < 0.01), higher rates of inpatient (p < 0.01) and 30-day mortality (p < 0.01), and need for an ICU (p < 0.01) compared to the minimal risk cohort. Patients in the lowest risk quartile were most likely to be discharged home (p < 0.01).

Smoking, obesity, and being below a healthy body weight increase the risk of perioperative complications and poor outcomes. Including smoking and BMI improves the STTGMAHIP_FX_SCOREtool to predict mortality and risk stratify patient outcomes. Because smoking, obesity, and being below a healthy body weight are modifiable patient factors, providers can counsel patients and implement lifestyle changes to potentially decrease their risk of longer-term poor outcomes, especially in the setting of another fracture.For patients who are former smokers, providers can use this information to encourage continued restraint and healthy choices.

The worldwide population is aging. The World Health Organization (WHO) predicts that by 2030, one in six people will be 60 years old or older [1]. This trend toward an older population carries with it a higher risk of falls or accidents with subsequent orthopedic injuries. For example, the 2016 National Trauma Database found that patients older than 55 years of age comprised 42.6% of overall trauma and 57.6% of the deaths associated with these traumas [2]. Hip fractures, in particular, carry high rates of morbidity and mortality in the geriatric population [3]. Associated factors for poor outcomes in these patients include age, male gender, the presence of comorbidities, delayed time to surgery, and baseline ambulatory status [4,5]. As age, and to a certain degree, comorbidities are non-modifiable risk factors, it is important to consider factors that can be modified to lower a patients risk.

Body mass index (BMI) and smoking status are two such modifiable risk factors. Literature regarding the association of BMI and mortality or morbidity risk following hip fracture is divided. Despite an apparent obesity paradox, with obese patients having a lower risk of mortality, several studies have found contrasting results where obese, super-obese, and very underweight patients have higher rates of poor outcomes and mortality [6-9]. Similar to BMI, current research has demonstrated smoking to be associated with worse perioperative outcomes and higher rates of mortality following surgery [10-13]. Tobacco smoking is the leading cause of premature mortality that can be adjusted through behavioral changes, regardless of tobacco amount, as Qin et al. reported that even light smoking, that is, one to two cigarettes a day, can increase a patients all-cause mortality [14-16]. In former smokers, understanding the increased mortality risks is important to be able to provide preventative medicine and help these patients to remain smoke-free.

As hip fractures carry a significantly high rate of morbidity and mortality at baseline, it is important to consider strategies to decrease a patients mortality risk. Addressing and understanding modifiable risk factors is one way providers can intervene to improve outcomes. The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated inpatient mortality risk assessment tool for middle-aged and geriatric patients 55 and older who sustain different orthopedic trauma injuries [17]. The original STTGMA tool utilized clinical data available at the time of arrival to the emergency department (ED) to calculate a mortality risk score. Variables included in the original STTGMA tool were a patients age, injury details, Glasgow Coma Scale (GCS) score, and comorbidity profile as defined by the Charlson Comorbidity Index (CCI) [17]. Since STTGMAs inception, the model has evolved to include additional variables such as a patients baseline ambulatory status, American Society of Anesthesiologists (ASA) score, and their coronavirus disease 2019 (COVID-19) status on hospital admission [18-20].

The purpose of this study is to determine whether the inclusion of two additional modifiable clinical variables, BMI and smoking status, would further improve the predictive capacity and risk stratification regarding inpatient mortality for geriatric and middle-aged patients treated for hip fractures. We hypothesize that the addition of these modifiable risk factors will improve predictive capacity.

This is a retrospective cohort study. An Institutional Review Board-approved trauma database was queried for all patients aged 55 and older who sustained a low-energy hip fracture (low energy defined as a fall from standing or from a height of fewer than two stairs) between October 2014 and August 2021. All patients were treated at one urban academic medical center. Fracture patterns included in our analysis were subtrochanteric, femoral neck, or intertrochanteric hip fractures [AO Foundation/Orthopaedic Trauma Association fracture classifications: 31A, 31B, 32(A-C)].Patients were excluded if they were younger than 55 years old or had a high-energy mechanism of injury.

Each patients chart was reviewed for demographics that included age, BMI, gender, smoking status, baseline ambulatory status, and comorbidities using CCI. Smoking status was recorded as a current every-day smoker, former smoker, or never smoker. On a pre-study analysis, as current and former smokers were found to have no differences in complication, hospital quality, or mortality rates, these patients were grouped for analysis. Therefore, patients were considered smokers if they were current or former smokers. BMI was defined as underweight (<18.5 kg/m2), healthy weight (18.5-24.9 kg/m2), overweight (25.0-24.9 kg/m2), or obese (>30 kg/m2). Injury presentation variables collected were GCS scores and Abbreviated Injury Severity scores (AIS) for both the Head/Neck (AIS H/N) and Chest (AIS C).

Hospital quality measures collected were the length of stay (LOS) in days, the need for admission to the Intensive Care Unit (ICU), and discharge home (home was defined as either home independently or home with a health service). Mortality measures collected included inpatient and 30-day mortality. Inpatient complications recorded during each patients admission included sepsis/septic shock, pneumonia, deep vein thrombus/pulmonary embolism (DVT/PE), myocardial infarction (MI), acute renal failure/acute kidney injury (AKI), stroke, surgical site infection (SSI), decubitus ulcer, urinary tract infection (UTI), acute respiratory failure (ARF), anemia, and cardiac arrest.

Patients were initially grouped based on their smoking status, smokers (current and former) versus non-smokers (never smokers), and BMIs. Comparative analyses were conducted between each of these cohorts.For each patient, the baseline STTGMA score for hip fractures (STTGMAHIP_FX_SCORE) was calculated. The model was then adapted to include a patients BMI and smoking status (current every-day smoker, former smoker, or never smoker). A new mortality risk score, STTGMA_MODIFIABLE, was calculated for each patient. The predictive ability of each model was then compared using DeLongs test to assess the area under the receiver operating curves (AUROCs). Then, patients were stratified into risk quartiles based on their new respective STTGMA_MODIFIABLE mortality risk scores. Comparative analyses were conducted on each risk quartile to assess the efficacy of the new BMI and smoking status factors.

The following statistical tests were used as appropriate: Mann-Whitney U tests, chi-square tests, independent-sample t-tests, and analysis of variance (ANOVA). All statistics were calculated using SPSS Version 25 (IBM Corp., Armonk, NY, USA). The significance for this study was defined with an alpha of 0.05.

In total, 2,421 patients met the inclusion criteria. Characteristics for the total cohort were as follows: 69% of patients were female, the mean age was 80.7 10.2 years, mean BMI was 24.17 4.94 kg/m2, median GCS score was 15 (interquartile range (IQR): 0), mean CCI was 1.49 1.73, mean AIS Head/Neck was 0.03 0.27, and mean AIS Chest was 0.02 0.19.The majority of patients were White (71.71%). At baseline, most patients were community ambulators (67.91%), while 28.17% of patients were household ambulators, and 3.92% were non-ambulatory (Table 1).

An initial comparison of the current versus former smoker cohorts demonstrated that there were no differences in complication risk, hospital quality measures, or mortality outcomes (p > 0.05 for all). Subsequently, former and current smokers were grouped for further analysis. When comparing the smoker versus non-smoker cohorts, patients who were currently smoking or had a history of smoking experienced higher rates of inpatient (2.85% vs. 1.52%, p = 0.025) and 30-day (5.60% vs. 3.88%, p = 0.048) mortality. They also had higher rates of MI (2.01% vs. 0.76%, p < 0.01) and ARF (6.98% vs. 3.39%, p < 0.01), and had a longer inpatient LOS (in days: 6.82 4.83 vs. 6.28 4.17, p = 0.037) (Table 2).

Comparison among BMI cut-off cohorts demonstrated that underweight patients experienced higher rates of pneumonia (p = 0.033), decubitus ulcers (p=0.046), and need for the ICU (p < 0.01) (Table 3).

When comparing each risk scores respective AUROC, STTGMA_MODIFIABLE was found to improve the predictive capacity for inpatient mortality compared to STTGMAHIP_FX_SCORE (0.792 vs. 0.672, p = 0.0445) (Figure 1).

Regression weighting showed a coefficient of 0.337, with current smokers having the greatest absolute effect size (current every-day smoker = 1.011, former smoker = 0.674). While our other study findings demonstrate being below a healthy body weight increases the risk of inpatient mortality, BMI had a regression coefficient of 0.116, suggesting that a very high BMI is more strongly positively correlated with a higher risk of inpatient mortality. While this demonstrates statistically that a higherBMI positively correlates with a higher risk of inpatient mortality, our additional study findings demonstrate being below a healthy body weight similarly increases the risk of inpatient mortality.

When comparing risk quartiles for STTGMA_MODIFIABLE, multiple outcomes had significance. For mortality, patients in the highest risk quartile (STTGMA score >2.50%) experienced the highest rates of both inpatient (p < 0.01) and 30-day (p < 0.01) mortality. Patients in the highest risk cohort similarly experienced a longer inpatient LOS (p < 0.01), higher rates of sepsis (p < 0.01), pneumonia (p < 0.01), DVT/PE (p = 0.015), MI (p = 0.032), AKI (p < 0.01), ARF (p < 0.01), anemia (p < 0.01), cardiac arrest (p < 0.01), need for ICU level of care (p < 0.01), and were the least likely to be discharged home (p < 0.01) (Table 4).

The purpose of this study was to assess if the addition of various modifiable risk factors, a patients BMI and smoking status, to a validated inpatient mortality risk assessment tool improved the models predictive capacity and ability to effectively triage geriatric and middle-aged patients treated for hip fracture. This study demonstrates that the addition of these modifiable risk factors provided an improved predictive model. This improved mortality risk model will help guide treatment decisions and provide valuable prognostic information to discuss expectations surrounding patients injuries and potential outcomes with patients and their families.

This study demonstrated that patients who are either current smokers or have a history of smoking are at a higher risk for perioperative complications and potentially worse outcomes. While the higher mortality rate cannot be linked solely to a patients smoking status, the higher mortality rates found in our study align with those reported in the literature [11,12].The higher rates of MI and ARF seen in smokers can be expected as well due to the well-documented cardiovascular and pulmonary diseases found in patients secondary to smoking history [21,22]. Longer hospitalizations may also be attributed to the higher complication rates as patients in the smoker cohort required extended hospital stays to improve their health status before discharge. Similarly, these patients had worse baseline statuses prior to the injury, potentially necessitating a longer inpatient course. In addition, it is well documented in the literature that smoking delays wound healing [23-25]. For patients who required surgery as a part of their treatment for hip fracture, it is possible that they needed a longer time to heal due to the detrimental wound healing effects caused by smoking. While in our study, the rate of decubitus ulcer was higher in the smoker cohort, it was not significant. This may be due to the size of our patient cohort; given a larger patient cohort, we may have seen higher rates of decubitus ulcers. In addition, we did not capture the rate of wound infections which could also impact LOS. While the causes of the higher perioperative and mortality rates are multifactorial, smoking likely played a role. Smoking cessation has been proven to improve underlying cardiovascular and pulmonary health [26]. Providers may use this knowledge to counsel patients on the importance of both smoking cessation and/or continuing to remain smoke-free.

This study also demonstrated that patients who are underweightare at a higher risk for perioperative complications and potentially worse outcomes. Patients with a BMI of less than 18.5 kg/m2 were found to be at higher risk for pneumonia, decubitus ulcers, and the need for the ICU. Patients who are underweight may be malnourished and have vitamin deficiencies that impact immune function and wound healing, placing them at higher risk for skin breakdown. An international pressure ulcer prevalence survey and a study by Hyun et al. found that underweight and extremely obese patients were at higher risk for pressure ulcers [27]. Several studies have shown that the risk of infection, such as pneumonia, follows a U-shaped curve, suggesting that both underweight and obese patients are at higher risk [28,29]. While we saw a higher risk of pneumonia in the underweight cohort, it is possible that in our study, by not further splitting super-obese patients from obese patients, we did not see a higher risk of pneumonia in the higher BMI group. Additionally, while our study found that patients who are below a healthy body weight also had a higher risk of inpatient mortality, our regression showed that the higher a patients BMI, the higher the risk of inpatient mortality, similar to that found in the literature [8]. Obesity is associated with several comorbidities such as diabetes, heart disease, and increased risk for stroke, all health issues that have higher rates of mortality [27,30]. Patients who are underweight or obese can be identified as higher risk on arrival, allowing for timely intervention and appropriate medical management. Prior to discharge, counseling can be provided on effective nutrition plans and active lifestyle adjustments to help patients attain healthy body weight.

The inclusion of these modifiable risk factors in the STTGMA tool allowed for effective triage of high-risk patients into appropriate risk quartiles. Stratification using STTGMA_MODIFIABLE identified patients who experienced not only higher rates of inpatient mortality, 30-day mortality, and the need for the ICU but also higher rates of serious inpatient complications such as sepsis, DVT/PE, MI, and AKI. Providers may use these added clinical variables to better identify patients who may require more intensive medical management and timely intervention. This may have implications to improve outcomes and reduce hospital costs by proactively managing patients to help lower complication and mortality rates while shortening hospital admissions.

This study has several limitations. First, as a retrospective study, it is subject to the common biases associated with this study format. Second, our analysis relied upon database entries for a patients smoking status. Therefore, we were unable to assess a patients smoking status if it was not recorded in the electronic medical record (EMR). However, as only 30 patients did not have a smoking status EMR entry, the impact of this limitation may be minimal. Third, our study did not include the number of cigarettes, packs, and pack-years for each patient. As the adverse effects of tobacco smoking may have a dose-dependent relationship, our analysis could not account for this component of a patients smoking status. Further analysis may be done to include a weighting factor that considers smoking amount. Fourth, our study did not distinguish super-obese patients from obese patients. There may be an additional risk or protective factors associated with super-obese patients. Additional studies may also be conducted to include a cost analysis to assess the impact of different BMIs and smoking status on hospital costs. Lastly, future studies may focus on a prospective analysis comparing mortality risks overtime in a cohort that modifies its risk (i.e., by losing weight or stopping smoking) versus a cohort that does not.

Smoking, obesity, and being below a healthy body weight increase the risk of perioperative complications and poor outcomes. Including smoking and BMI improves the STTGMAHIP_FX_SCOREtool to predict mortality and risk stratify patient outcomes. Because smoking, obesity, and being below a healthy body weight are modifiable patient factors, providers can counsel patients and implement lifestyle changes to potentially decrease their risk of longer-term poor outcomes, especially in the setting of another fracture. For patients who are former smokers, providers can use this information to encourage continued restraint and healthy choices.

View original post here:
The Role of Smoking and Body Mass Index in Mortality Risk Assessment for Geriatric Hip Fracture Patients - Cureus

Preventative medicine in Rochester Hills MI

Phone & Video Consultations Available - 248-289-6643

Rochester:248-289-6643

Bingham Farms:248-548-3060

Improve the Quality of Life for All

We are on the threshold of a new paradigm; for the first time in history we can apply advanced technologies for early detection, prevention and even reversal of disease

This is evidence-based medicine!It is no myth! -Dr. Lewerenz

Patient Case Assessment & Evaluation Using Functional Medicine

Hormone Replacement Therapy and Functional Medicine Philosophy

2 yearsago

Rest assured! At Longevity Health Institute we are taking every precaution possible regarding the Coronavirus. Our highest priority is the safety and health of you, your family, our staff, and our doctors.Our office has been practicing the highest level of cleanliness, sanitation, and sterilization since...

3 yearsago

Founder of the Longevity Health Institute and Lewerenz Medical Center, Dr. James Lewerenz has been named one of Detroits Top Docs of 2019 by Hour Detroit Media, publisher of Hour Detroit magazine. This honor is exclusive to the area, and top docs are nominated by...

3 yearsago

The male hormone, Testosterone (considering only men) typically lowers with aging. Typical declines are about 1-3 percent a year starting at age 35 to 40. Sometimes even greater. It is not uncommon for me to see a man age 45 with a Testosterone level of...

- Mary C

- Michael L

- Regina G

- Susan F

- Jennifer R

- Vincent S

- James C

- Jason H

- Anon

- Terry T

- Anon

- Lawrence C

- David F

- Heather S

- Rhonda P

- Lisa S

- Luana C

- Anon

- Allison R

- Kathleen W

- Lawrence C

- Mary R

- Margaret F

- Gregory J

- Christine F

- Anon

Dr. Lewerenz named Top Doc by Hour Detroit Magazine

3 yearsago

A study from a European Journal of Clinical Nutrition in 2017 showed that Vitamin C supplementation can improve glycemic (sugar) and insulin regulation. This was a high-quality randomized control trial of the effects of Vitamin C on Glucose, HGBA1C and Insulin.Not only did Vitamin C...

3 yearsago

Consider this: The average American eats 295mg of Cholesterol and 3-4 eggs per week.A new Observational study in JAMA by Dr. Zhongs from the American Medical Association, examined Cholesterol consumed and eggs consumed, both respectively for 17.5 years from a group of 29,615 adults for...

3 yearsago

Who wouldnt want improved sleep, reduced stress, less pain and cramps, improved mood, improved heart, bone and muscle health?Well, that can be achieved by obtaining optimal levels of Magnesium in your body. Magnesium is a critical mineral that the body uses in more than 300...

3 yearsago

CBD or therapeutic hemp oil (cannabidiol) is experiencing a huge growth in the medical world.There is medicinal value and massive public demand in the wellness, holistic and alternative therapy world. There are vast medicinal benefits but what is hype, what is harm and what has...

Site contents 2022 Longevity Health Institute

See the article here:
Preventative medicine in Rochester Hills MI

Family Practice Center, PC, is a comprehensive medical practice where we provide healthcare the way you hoped it could be. Our attentive, patient-focused approach to medicine is the main reason we have become one of the highest-rated primary care practices in the Georgia. We pride ourselves on providing a wide variety of healthcare needs for our patients including top-level care and in-house-diagnostic testing. Led by practice Founder and CEO Dr. James Wheeler, along with a team of doctors. These physicians, as well as a full team of physician assistants, nurse practitioners, medical assistants, and other healthcare professionals, pride themselves on providing the best possible experience for each and every patient we see.

We strive to offer a wide variety of medical treatments and services, including staying up-to-date with the latest health news and trends, in order to best serve our patients and their loved ones. In addition to general family medicine, our physicians specialize in providing dermatological care, sports medicine, womens health service, and preventative medicine (including immunizations). Our selection of in-house diagnostic testing includes x-rays, bloodwork, ultrasounds, echocardiograms, and more. We are able to perform minor surgical procedures in our office at the convenience of our patients.

Our healthcare providers consider it an honor to take care of our patients and their families. Contact Family Practice Center today for more information or to schedule an appointment. Ask us about Medicare eligibility. And keep an eye out for news about our new locations in the metro Atlanta area.

Excerpt from:
Family Health Care Atlanta | Primary & Preventative Medicine

We all know that heart-sinking feeling when our dog gets ill or injured or has a sudden emergency. But lets step backward in time before that illness or accident, and take a look at ways it might have been prevented.

Too many of us dont think a lot about preventive care; instead, we only take action when our dog is clearly sick, badly injured, or due for a vaccination. But thats backward-looking care, when we should be looking forward.

One of the most important preventative steps is to take your dog for annual veterinary checkups. (If your pup is a senior, you should be looking at vet visits twice a year, since older dogs are more likely to suffer from life-threatening health issues like cancer, heart problems, or kidney disease. Theyll also help you catch age-related problems such as hearing or vision loss, cognitive issues, arthritis, and obesity before they become acute.)

Comprehensive veterinary exams can also give you an opportunity to have a frank discussion with your vet about your dogs lifestyle, activity level, mental health, life stage, and behavioral questions. Talk too about what vaccinations and preventative medications are essential for our specific area, and which ones you can skip. For instance, because Lyme disease is endemic in Nevada County, many vets recommend annual Lyme boosters. Another example is heartworm: because this disease can be fatal, its crucial that your dog begins and stays on heartworm preventative for her entire life. Your vet can also help you decide when to spay and neuter your dog, and can do routine procedures like checking to make sure his microchip is scanning properly. (Your dog IS microchipped, isnt he?)

Another prevention suggestion that you may not have thought about is keeping your dogs toenails trimmed. A too-long toenail can easily get snagged, resulting in a painful, torn nail.

Remember that many potential problems can be alleviated if your dog understands basic commands like sit, come, stay, and leave it. These commands arent just a matter of good manners: they can literally save your dogs life if he gets away from you and starts to dart into the road, or puts something dangerous in his mouth.

In the car, always secure your dog with a harness and dog seatbelt, or in a crate or carrier thats strongly fastened in the car. Never let your dog be untethered or uncrated in the open bed of a pickup truck. (In fact, its illegal in California to have an untethered dog in the back of a pickup.) And speaking of cars, remember to NEVER leave your dog alone in a parked car during warm weather unless youve taken strong precautions to keep him cool. Ill talk about some of these ideas in a future column.

Make sure your yard is secure: check your fencing regularly for things like holes, downed sections, and areas where your dog could scoot underneath and get out. Make sure any gates cant be opened by a curious or rowdy dog. Reliable fencing also prevents other animals from getting in and initiating a fight, or in the case of wild animals, badly injuring your dog. And dont rely on so-called invisible or electronic fencing: while it may keep your dog contained (or it may not: many a dog has broken through the electronic barrier and either disappeared or been hit by a car), it wont keep other dogs or animals from coming into your yard and potentially attacking your dog.

Keep all medications out of reach of your dog. Particularly deadly are meds like beta blockers, ACE inhibitors, and ADD/ADHD medications. Even common over-the-counter meds like ibuprofen, acetaminophen, and naproxen can cause serious and even fatal effects if your pup ingests them. And something you think of as harmless like a multivitamin or nasal decongestant can also cause serious health problems for your dog.

The same is true for dog treats, or any type of food your dog might find tasty. Dont assume that your dog probably cant reach a counter or table, or get into a bag of chocolate chips. Most of the time, gorging on a half-full bag of dog cookies will only result in a bout of vomiting or diarrhea, but theres a chance it could trigger a potentially deadly condition like pancreatitis or bloat.

Try to brush your dogs teeth. Dogs can suffer from dental problems just as humans can, and the problems it can cause arent restricted to only their teeth: the bacteria created by periodontal disease can enter the bloodstream and travel to areas like the heart, the liver, and the kidneys. If your dog absolutely refuses to let you get anywhere near him with a toothbrush, try a dog chew specifically made to address plaque and tartar buildup. There are several on the market, but some are more effective than others, so talk with your veterinarian about what she recommends.

So remember: prevention really IS the best medicine!

Joan Merriam lives in Nevada County with her Golden Retriever Joey, her Maine Coon cat Indy, and the abiding spirit of her beloved Golden Retriever Casey in whose memory this column is named. You can reach Joan at joan@joanmerriam.com. And if youre looking for a Golden, be sure to check out Homeward Bound Golden Retriever Rescue

Originally posted here:
Joan Merriam: Prevention is the best medicine - The Union

We all know that heart-sinking feeling when our dog gets ill or has a sudden emergency. But lets step backward in time before that illness or accident, and take a look at ways it might have been prevented.

Too many of us dont think a lot about preventive care; instead, we only take action when our dog is clearly sick, badly injured or due for a vaccination. Thats backward-looking care, when we should be looking forward.

One of the most important preventative steps is to take your dog for annual or semi-annual, if your pup is a senior veterinary checkups. These comprehensive exams can catch little problems before they become big ones. They also give you an opportunity to have a frank discussion with your vet about your dogs lifestyle, activity level, mental health, life stage and behavioral issues. Talk too about what vaccinations and preventative medications are essential for your specific area, and which ones you can skip. Your vet can also help you decide when to spay and neuter your dog and can do routine procedures like checking to make sure his microchip is scanning properly. (Your dog is microchipped, isnt he?)

Another prevention suggestion that you may not have thought about is keeping your dogs toenails trimmed. A too-long toenail can easily get snagged, resulting in a painful, torn nail.

In the car, always secure your dog with a harness and dog seatbelt, or in a crate or carrier thats strongly fastened in the car. Never let your dog be untethered or uncrated in the open bed of a pickup (In fact, its illegal in California to have an untethered dog in the back of a pickup).

Make sure your yard is secure: check your fencing regularly for things like holes, downed sections and areas where your dog could scoot underneath and get out. Make sure any gates cant be opened by a curious or rowdy dog. Reliable fencing also prevents other animals from getting in and initiating a fight, or in the case of wild animals, badly injuring your dog. And dont rely on so-called invisible or electronic fencing: While it may keep your dog contained (or it may not: many a dog has broken through the electronic barrier and either disappeared or been hit by a car), it wont keep other dogs or animals from coming into your yard and potentially attacking your dog.

Keep all medications out of reach of your dog. Even common over-the-counter meds like ibuprofen and naproxen can cause serious and even fatal effects if your pup ingests them. The same is true for dog treats, or any type of food that your dog might find tasty. Dont assume that your dog probably cant reach a counter or table or cant get into a bag of chocolate chips. Most of the time, gorging on a half-full bag of dog cookies will only result in a bout of vomiting or diarrhea, but theres a chance it could trigger a potentially deadly condition like pancreatitis or bloat.

Try to brush your dogs teeth. Dogs can suffer from dental problems just as humans can, and the problems it can cause arent restricted to only their teeth: the bacteria created by periodontal disease can enter the bloodstream and travel to areas like the heart, the liver and the kidneys. If your dog absolutely refuses to let you get anywhere near him with a toothbrush, try a dog chew specifically made to address plaque and tartar buildup. There are several on the market, but some are more effective than others, so talk with your veterinarian.

So remember: prevention really IS the best medicine!

Joan Merriam lives in Nevada County with her golden retriever Joey, her Maine coon cat Indy and the abiding spirit of her beloved golden retriever Casey in whose memory this column is named. You can reach Joan at joan@joanmerriam.com. And if youre looking for a golden, be sure to check out Homeward Bound Golden Retriever Rescue.

See the rest here:
Prevention is the best medicine | Caseys Corner - Oroville Mercury-Register

If you do not already have a primary care provider, summer is a great time to establish a relationship with a professional to guide you on your health care journey.

RiverView Health has various primary care providers specializing in Family Medicine and Internal Medicine. A primary care provider (PCP) should be the first person in the healthcare system that you contact when you are sick or have a question about your health. They can provide care and answers to your questions or recommend a specialist to meet your needs.

If a specialist is needed, your PCP will work to coordinate information between all of your healthcare providers. That provider will also ensure there is no duplication of care and testing and that nothing is left out. Your provider can also help you find other resources, such as support groups and classes.

Preventative Care

One of the primary responsibilities of a PCP is to provide preventative care. A PCP can help you catch problems before they arise. Your provider will get to know you, your history, and your family history. They will ensure you get necessary screenings and identify and treat any minor problems before they become major ones.

It is important that you build an honest relationship with your PCP. While it can be intimidating and embarrassing to openly discuss your health concerns, discussing even the most personal health problems is important. Remember that your provider will not be embarrassed, shocked, or offended by even your most embarrassing symptoms.

Play an active role in your health. Make sure you speak up with any questions or concerns about your health, regardless of how minor they may seem. Take your providers warnings seriously, and do not hesitate to ask for more informational resources.

The easiest way to prolong life and keep healthcare costs affordable for everyone is to take measures to prevent illness whenever possible. Annual exams and a healthy lifestyle are two great preventative measures you can control. At the same time, a competent PCP offers the continuity of care that health maintenance over a lifetime requires.

RiverView Health has primary care providers in Crookston, Fertile, and Red Lake Falls. Choose the provider who best suits your needs and knows that you are not alone in your lifetime journey of good health for you and your family.

Family Medicine

RiverView Clinics offer a wide variety of Family Medicine providers including medical doctors (MD), a Doctor of Osteopathic Medicine (DO), certified nurse practitioners (CNP), family nurse practitioners certified (FNP-C), and physician assistant (PA). Family Medicine providers care for people of all ages from infants through end-of-life. These providers often care for the same patients throughout their lives, and in many cases, they care for multiple generations of family members simultaneously.

Family Medicine providers at RiverView Health and their practice locations include:

Internal Medicine

Internal Medicine providers, also called internists, care primarily for adults. Internal medicine doctors specialize in diagnosing, treating, and preventing disease in their adult patients. They offer care for a wide variety of health conditions and counsel their patients on prevention and overall wellness.

The following Internal Medicine doctors offer primary care at RiverView:

If seeing a PCP during regular office hours does not fit into your schedule, RiverViews certified nurse practitioners and family nurse practitioners offer early and late appointments at Crookstons extended hours clinic, which is open Monday through Friday, 7:00 a.m. to 7:00 p.m., and weekends from 9:00 a.m. to 1:00 p.m.

All RiverView Health providers are taking new patients. To schedule an appointment with any of the providers listed above, call 281-9595 and ask for an appointment to establish care with the provider of your choice or ask the patient access representative for options.

Originally posted here:
RIVERVIEW PRIMARY CARE PROVIDERS AVAILABLE TO OVERSEE YOUR HEALTH NEEDS - kroxam.com

(WQOW) - With Father's Day in mind, Mayo Clinic wants men to be mindful of their health.

Men are sometimes uncomfortable seeing a doctor for their medical issues, but health officials with Mayo say that some of the best medicine is preventative medicine.

Dr. Tobias Kohler said that sometimes problems with erections are early indicators of other cardiovascular issues, and could predate a heart attack or stroke.

"It's one of the many examples of how some problems can tell us more information than just that individual structure. That's why it's so important to go in and be checked as we age," he said.

Health officials also talked about the importance of prostate cancer screenings. Dr. Jeff Karnes said early detection can potentially save men from severe symptoms, and ultimately increase their chances of survival. Prostate cancer is the second leading cancer cause of death in men in the U.S.

Karnes said while some men don't have symptoms with prostate cancer, there are symptoms to look out for.

"Some things that I think men should seek immediate attention for is a sudden change in urination, and symptoms that could be attributed to an urinary tract infection," he said.

Both doctors say that even though some men are uncomfortable going to the doctor unless absolutely necessary, getting screened for these illnesses can save a life.

Have a story idea? Let us know here

Link:
With Father's Day in mind, Mayo Clinic doctors remind men to be mindful of their health - WQOW TV News 18