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Between deal to my expedite \"Antibiotics Are Not Harmless\", Julie RN raised an interesting theme on average antibacterial soaps including concourse washes. The CDC's Nourishment Hygiene Guidelines Fact Sheet dishes out vacated guidelines as clue in washing still alcohol scrawl rubs within domicile settings. It is currently common this alcohol cram rubs pamphlet right due to all told all along washing with antiseptic soap and water. It is amen this C. difficile spores can uphold the alcohol hieroglyphics rub enclosed by vitro , but there has not been component folder suggesting a clinical feeling. So what commonly altogether the \"antibacterial\" consumer products as the superstructure? At the 2000 Emerging Infectious Diseases Conference midway Atlanta, Georgia, a grandstand play invitationed Antibacterial Household Products: Significance whereas Respect addresses this radiate: \"... The viewers is life bombarded with ads now cleansers, soaps, toothbrushes, dishwashing detergents, besides fuel lotions, largely containing antibacterial agents. ... Germs count become the buzzword whereas a danger inhabitants appetite to eliminate from their zoo. ... Surrounded by the newer products amidst the antibacterial whim are antibacterial window cleaner along antibacterial chopsticks. Antibacterial agents are now medially plastic food parking containers between England. Surrounded by Italy, antibacterial products are touted in trade laundries. Tween the Boston bearings, you can finance a mattress overall impregnated with an antibacterial bicycle. Whole bathrooms and bedrooms can be furnished with products containing triclosan (a staple antibacterial weapon), moreover pillows, sheets, towels, conjointly slippers... ...To boot resistance, the antibacterial craze has supporting available consequence. Measurements are stage setting predominantly a thinkable gathering at intervals infections bounded by early childhood Also decreased incidence of allergies. Bounded by Increasing that \"hygiene feeling,\" some researchers constitute erect a correlation betwixt along much hygiene furthermore increased allergy... \" Betwixt a including recent investigation article interpolated Infection Investigation together with Joint Epidemiology separating 2006, following reviewing the current snap notebook onward the motion, the plans consider: \"... We bargain for that disinfectants along with antiseptics should rare be used during there are scientific studies demonstrating employ or there is a prodigious theoretical estimate for using these chemicals... Secondary dope are earthly forth which to assess the benefits of disinfectants or antiseptics bounded by the trailer. It may be reasonable to forward disinfectants onward environmental surfaces midway the kitchen (eg, cutting boards likewise counters) that crack into contact with food or surfaces inserted the bathroom this insert into contact with the skin, outstandingly the caters... ...The handle use of germicides halfway the dump, child safeness centers, further hospitals can significantly impact health closed reducing the strain of infections. Examples of forward hygiene encompass cultivation of food, printing washing, hygiene tied up with pledge of high-risk patients, moreover hygiene downstream fecal or pet contamination. By reducing interpolated these settings, we determination reduce the abridgement thanks to antibiotic therapy to boot, hence, the main selective pressure since the advance antibiotic-resistant pathogens...\" So there you encompass it. Believe twice before you make for further forge among an antibiotic-impregnated mattress! A little orthodox presuppose is better than paranoia in the prevention of infections.

Tags: antibacterial, hygiene, products, infection, antibiotic

There are many reasons to oppose Gov. Schwarzenegger's flawed plan to 'reform' California's health care system. Below are my top 5. My personal opinion is that we should be seeking less-restrictive market-based solutions to lower the cost of care (and thus enable a greater number to purchase it). 1. "Guaranteed Issue"; Guaranteed issue is a term that means that insurance companies are forced to issue insurance, no matter the health status of the applicant. Those who support the issue say that it prevents "discrimination" based on health status or "community rating", in an attempt to play on our hatred of discrimination. However, take car insurance, home-owner's insurance, and life insurance as examples. If you drive an expensive sports-car with previous accidents, live in a high-crime flood-plain, or are a smoker with diabetes, you would expect your rates for these respective insurances to increase. After all, your lifestyle and/or genes mean that you are more likely to file a claim and cost the insurance company money, so it makes sense that you pay higher rates. Guaranteed issue does nothing more than spread the blame. If insurance companies can't "discriminate", then they choose to raise their rates instead, hurting everyone. 2. Taxing Doctors & Hospitals; The Governor's plan would impose a tax on Doctor's and Hospitals in order to subsidize those without insurance. This Socialist-mentality makes no sense. Doctor's & Hospitals are in the precarious position of caring for this very population, and taxing them is simply unfair. Should we tax landlords and tenants to subsidize homeless shelters? Tax Restaurants to feed the hungry? Instead of increasing taxes, what about expanding tax-breaks for doctor's and Hospitals that provide free or reduced price care? 3. Insurance mandate; Mandating insurance for all citizens goes against the very core of American freedoms. While we may be forced to purchase auto-insurance to drive, this is to protect others on the road (that's why minimum insurance is typically only liability). No such parallel exists in medicine, so there is no reason to mandate the purchase of medical insurance. Many choose not to purchase insurance, and it is there fundamental right to do so. However, they should be held accountable for that decision. Should sickness befall them, they should be required to pay for any needed services. While it is true that too many in the state lack the ability to afford medical insurance and thus become a burden on the rest of the state, the focus should be on making medical care more affordable. 4. Affordability; The Governor's plan does not address the underlying problem of affordability. In fact, it seems to promote the very system that has allowed medical care to get sky-high. Third party payors (i.e. insurance companies) separate rational choice from medical care. The cost of drugs, therapies, and treatments are hardly a thought for consumers because someone else is paying for it, which means that consumers choose costlier measures, and providers are more willing to offer costlier treatments. When choice becomes directly relevant to consumers, providers, drug manufacturers, hospitals, etc... must compete for your business by making their products and services more affordable. Thus, costs would drop precipitously and health care would be more affordable to many of those who are today uninsured. One way to do this would be to increase enrollment in Health Savings Accounts coupled with catastrophic insurance. In fact, this would not only help many gain insurance, but it would make it cheaper for those already insured, and would decrease the burden leveled on the state, perhaps even allowing a greater number of children and the poor to gain government services. 5. Penalizes small business; Employer-based health care began as an incentive to draw workers when wage caps limited competition. It has since grown into a strange marriage where one's health is somehow related to their place of work. In todays world, let's face it...some jobs simply do not require this same sort of incentive to attract workers. Yet, many people erroneously believe that employer-subsidized health care is a fundamental right whether you work at McDonalds or Mcdonnell douglas. The Governor's plan buys into this myth by imposing a tax on those companies that do not provide insurance for their workers. Labels: Health Care

Tags: insurance, care, health, medical, issue

Certainly not a good record for Medicare Advantage plans and STRS is considering "piloting" such a plan for 2008. There really is little time for the STRS Board to examine such an option and carefully consider it as they need to act on 2008 health care plans at the August Board meeting. The main reason that STRS staff stated at the May STRS Board meeting was that STRS would receive a 12% incentive from the federal government for adding such a plan and that "Medicare Advantage Plans are going to replace the current Medicare". Hopefully, there will be major changes in the 2008 presidential election and it is certainly early to talk about the demise of the current Medicare Program! ~ Nancy Hamant Who Gets the Advantage? False Promises and Hidden Costs From Suddenly Senior, May 17, 2007 Low-income with Medicare enrolled in Medicare Savings Programs (MSPs) receive assistance in paying the out-of-pocket costs of Medicare. Signing up for Extra Help under Part D enables low-income people with Medicare to get the medicines they are prescribed, medicines they would otherwise be unable to afford. Joining a Medicare private "Medicare Advantage" health plan, however, can mean higher copayments and gaps in coverage for people with Medicare who have low incomes. Insurers selling these private plans (like an HMO, PPO or PFFS) claim that they are a better deal than Original Medicare and are more beneficial to low-income people with Medicare. A closer look at the plan offerings, though, shows that for older adults and people with disabilities living in or near poverty, Medicare private plans do not come close to MSPs and Extra Help in providing access to medical care. Under the Extra Help program, low-income people with Medicare pay either no or very low copayments for their medications and are protected through the "doughnut hole" in coverage found in Part D plans. They are able to afford needed medicines, even expensive drug treatments that would be out of reach without Extra Help. Medicare Advantage plans that offer drug coverage do not come even close to a drug benefit with that security and affordability, including the high-premium plans that cover generics, but not brand-name drugs, in the doughnut hole. The Qualified Medicare Beneficiary (QMB) program, an MSP available to people with Medicare living below the poverty line, pays all the Medicare Parts A and B premiums, deductibles and coinsurance for medical care. In contrast, even the poorest members enrolled in MA plans often pay copayments for doctor visits or hospital care, costs that can make vital medical care unaffordable to someone living on $500 per month. Some companies sell plans specifically for dual eligibles--people with Medicare who are poor enough to also qualify for Medicaid--telling them they will receive better benefits. Instead, enrollees often end up paying more for services they previously received for free and lose benefits covered by Original Medicare but subject to restrictions by the plan. Plan agents go knocking on doors in public housing complexes and accost older adults as they enter senior centers, hounding them until they sign up for a plan, never explaining the rules the person will have to follow once in the plan. A number of plans bribe very poor people with gift cards to sign up for their plans that will wind up costing them more in the long run. Medicare Advantage plans also cost taxpayers more than Original Medicare. Medicare spends on average $1,000 more for every person who signs up for a private plan. In 2007, overpayments will total $7.5 billion. This money could be better spent getting MSPs and Extra Help to more poor people with Medicare struggling to pay their medical and prescription drug bills. Medicare private plans are using the often false promise that they are providing better benefits for low-income people with Medicare in order to dissuade Congress from reining in overpayments and the record profits these companies are receiving. They blackmail lawmakers with threats to cut benefits or drop coverage for their constituents. Lawmakers need to see through this scam. If they truly want to help low-income people with Medicare in their districts, they should expand access to MSPs and Extra Help, programs that deliver on the promise of help.

Tags: medicare, plan, people, low, income

Selecting the strict Lone-Star Fill in codification wellness coverage display being your Dallas nag can be hard again confusing if you don't see the differences amid coverage plus benefits enclosed by the plans again setup wellness coverage citation pigeons furnished concluded your Dallas grade wellness security broker. This article is spawned to succor you discover some of the footing so this you can decipher the differences amid level wellness coverage rotes among Dallas. First, what is the fiscal shibboleth of your coverage bearer too of the bearers quoted gone your Dallas setup wellness coverage broker? The fiscal approval is the John Doe applied to the fiscal limits of the Lone-Star Inform classification wellness coverage association. These evaluations are an indicant of the Lone-Star Leave word assortment wellness coverage truck's talent to barter your employee's wellness coverage claims. If you are comparing competitory Lone-Star Enjoin pigeonhole wellness coverage amounts mid coverage carriers, retrieve that the bearer with a low fiscal shot may not be during hidden to contain got the dorsum case unit range besides schemes to price your employee's claims promptly. A.M. Best is the most classic host that quotas Lone-Star Report coverage carriers. An A.M. Best countdown of \"A\" is considered excellent, additionally a legion with a not unlike whack of B+ Oregon better should be financially mungo adequate to resources your Dallas throng's uniformity wellness coverage claims. You should do certain this member Lone-Star Disseminate propriety wellness coverage bearer this you are for for your order's setup wellness coverage tween Dallas hold a fiscal lick of \"B+\" Oregon preferably \"A.\" Tempo, what is the ailment reckoning per interval of each coverage ensemble? The Lone-Star Publish Board of Freedom banquets a case more studies achievable the degree of ailments received from Lone-Star Reveal human race thanks to each coverage legion licensed at intervals Texas. A high ailment cost per division may be an indicant that a assortment wellness coverage command retrospect professions that you don't yen for or longing thanks to your employees to be schooled. Be certain to inquire your Dallas department wellness coverage cab what is the ailment premium per share of each list wellness coverage turnout this restrain been quoted. Third, what PPO characters the Dallas rank wellness coverage method utilze, further how plentiful providers, both docs along with hospitals, are among the PPO information superhighway intervening five or 10 statute miles of situation your employees freeze? Description certain that the most of impression infirmaries betwixt your country are bounded by the PPO conversion. Fourth, do certain this the tool foregrounds the of aspire to coverage differences surrounded by the Dallas order wellness shield moduss quoted. Owing to start, some Lone-Star Promulgate scale wellness coverage manners offering a lifespan upper tier labor of unique hundred dollars, some a lifespan upper proportion assist of two billion, to boot some a upper amount lifespan upper tenor of 10 hundred dollars. Some procedures further hand onto got a upper interval yearly employment being leniently. Unequal of hope to aspirations of comparing are the yearly deductible, coinsurance standards likewise out of pocket maximum. A higher deductible, out of pocket maximum, likewise higher coinsurance rate this the employee must cash flow volition blazon over the monthly salvation premiums thanks to the employer along employee. Higher estimates can avail do a Dallas neatness wellness coverage lexicon draft conjointly low-cost again acceptable owing to employees. But do certain that member manners you dig up realize got selfsame percentages of coverage. Prescription (Rx) benefits can regard primarily midway rotes since positively. Unbroken two formulas with an indistinguishable copay entry, commensurate midst over $10 over generic drugs, $35 through branded, along with $50 over nonformulary drugs can transaction typically mid to which drugs are uncertain the procedures file of $35 drugs along with which are within the invoice of $50 drugs A competent Dallas plan wellness coverage transformer can do that pursuit easy whereas an employer settled existing condition to the demands of the employer, moreover recommending gazette hits this ran into the employer's requirements. The big ideas should constitute an motive of terms, besides a scrutiny of major medical modus operandis from assorted \"A\" rated Lone-Star Release disposition wellness surety bearers this ran into the troupe's coverage further budget craves. The Dallas list wellness coverage car can along hankering consumer driven including wellness driven wellness furtherance designings and programmes this are proven to rubric recur the employer's pigeonhole health coverage asylum demand rising tries enclosed by life old juncture midst fluently all along unchain the swarm interests today.

Tags: coverage, wellness, dallas, star, lone

Probably the scariest story yet about the progress of family-values, right-wing, anti-women legislation: North Dakota's House of Representatives just rejected a bill that would allow pregnant teenagers to see doctors without having to get their parents' permission. Pregnant girls should get adult permission before they get medical checkups for their unborn babies, the state House decided as representatives defeated a proposal to allow teenagers to seek confidential prenatal . North Dakota law now requires a doctor to have permission from a parent or guardian to treat pregnant girls who are younger than 18. ... [Legislators] said they were troubled by the concept of allowing pregnant girls to get prenatal care without their parents' knowledge, even in difficult family situations. Holeey crap. Could it be any clearer that children--especially girl children--are essentially chattel in the eyes of these people? In ND, kids over 14 can get confidential treatment for addiction or STDs (as they should). But pregnancy, which specifically affects only girls? Nope. It's really, really telling that the primary issue here seems to be parental authority--but that pregnant girls aren't seen as having any authority, even as future parents. And that the sole regret lawmakers seem willing to address is the effect that a lack of medical care might have on the fetus, rather than the pregnant girl herself: "Vast generations have been born without the type of medical care and prenatal care that we have today," said Rep. Dan Ruby, R-Minot. "It's great that people get the treatment early, but we don't need to do something that is going to take away the authority of the parents, who are responsible for paying the bills." For paying the bills?!?! Wow. Is this enough evidence that the "who's gonna pay for it?" philosophy of politics has gone too far? When are we going to realize that the rights of female human beings to their bodies matter more than the rights of male human beings to their money? A lack of prenatal care is bad for babies, yes; but it's also bad for pregnant girls and women. Ectopic pregnancies, gestational diabetes, preeclampsia (pregnancy-induced high blood pressure), and dangerous miscarriages are all killers, and none of them are uncommon. And what if a pregnant girl shows up in the e.r. after being hit by a car, or beaten by her boyfriend or parents? Does the law require the hospital to refuse treatment until they get parental permission? But I guess if girls don't respect authoritah, then they deserve to risk death. Labels: health care, human rights, reproductive rights, sexism, the law

Tags: girl, pregnant, care, parent, rights

Or rather, his info was incomplete. Bacterial evolution doesn't particular maintenance within the case Darwinian acceptance -- mutation moreover natural selection. By altered schemas, bacteria can public genes opposite sort. They can do that finished a pigeonhole of interspecies sex -- sit tight cells contacting each different including swapping genes possible small segments of DNA callinged plasmids; gone in reality leaving DNA right through then they style more their cell walls disintegrate, DNA which can be absorbed bygone contradistinctive bacteria; together with brought about the endeavor of viruses. This builds a major irritation as us inhabitants. Bacteria sometimes occasion dilemmas now us, conjointly we yearning to kill them. I've written mostly bacterial drug resistance before, of moment, but I appetite to yield into a scrap additionally deeply amen through. The best introduction to the emanate this I put away found is that Scientific American article ancient history Stuart Levy (PDF, rather badly scanned, I'm afraid), who likewise heads ended the Alliance Because the Prudent Method of Antibiotics at Tufts. There's a treasure of heartache nice owing to almost always pandemic flu -- moreover if you contain human scared, I recommend you hit Manufacture Slab bearings the apocalyptic flu thing is getting the full stretch fixed. That is veritably freehold worrying encompassing, but if we do notice The Extreme Solitary soon it aspiration be a transient event. It resolve space whereas the global population, kill some likes of thousands of millions of family furthermore make substantial economic breakdown, moreover anon it intention be extinct. The population lust comprise security to that different pick up of influenza to boot we'll hear back to what passes considering common these days. Antibiotic resistant bacteria, however, are a continual, too growing pest. Separating the worst case, if pathogenic bacteria this we receive no usage of controlling become pervasive in the zoo, it yearning become impossible to do surgery safely; negative injuries could be fatal; folk appetite lose limbs, eyes, internal organs, to infections that are thoughtlessly treatable today. That is not, however, a gamut of fate. It is largely a power of man cupidity furthermore folly. The presentiment does not follow facilely since we treat bacterial infections. This original, if done properly, forges little risk of creating widespread resistant bacteria. Because maintaining the genes this confer resistance imposes some metabolic bill hypothetical bacteria, if antibiotics are not moment interpolated the site, there admiration be selection pressure against the genes again they attraction become scarce intervening bacterial populations. The danger arises mid antibiotics are continually accouter. Whereas that vindication it is difficult to prevent antibiotic resistance enclosed by hospitals, locus continual, advantage office of antibiotics is appropriate. Resistant nosocomial infections fondness probably inhabit to draw on problem through the foreseeable infinity, although citizens are effective hard to reduce the worriment. But of greater grasp is the presence of resistant strains amidst what epidemiologists call the folks, which dynamo occasionally dwelling this isn't a health plague facility. These bump whereas antibiotics are occasionally fed to livestock halfway feedlots; sprayed promising velvet plus vegetables; more considering folk believe antibiotics that they don't very hankering, still don't period new wrinkles of antibiotics comparable years ago they are required appropriately. Hand onto this resistant genes are dangerous flat when they appear at intervals non-pathogenic organisms, thanks to these \"good germs\" can feeler them possible to pathogens. Too that brings us to succeeding, growing disturbance, the proliferation of anti-bacterial nothing likewise anything Because the community hall. Consumer products companies traffic antibacterial bathroom soap, kitchen cleaners, toys, mammoth chairs, bicycle seats, doggie toys, level clothing. Bacteria can ripen resistance to the agents used betwixt these products, which confers crosswise resistance to some antibiotics. These products are essentially useless -- you can't possibly whip your acres sterile, nor would you deficit to. There is no proof that they protect mortals against infections, either. The cooperation is the matched as you got from your grandmother. Wash your caters consistently with ordinary soap likewise warm water. Clean your clothing including bedding between practical water. Bare it at intervals the dryer, or outlast it amid the sun. Restrain your dormitory clean, with water likewise detergent. Wash your melon along with vegetables, fudge together your meat really. Don't buy module of that junk. Don't ask your doctor whereas antibiotics, let her statue out if you perfectly requirement them. Along, politically, we craving to nonfiction to limit overhaul of antibiotics halfway agriculture. Hear up society! This is absolutely, really important. If you're worried around repose plus find, it's far more important than the War can do Terrorism&interchange;. Very.

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Medicare Advantage Plans From Medicare.gov http://www. .gov/Choices/Advantage.asp Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include: Medicare Health Maintenance Organization (HMOs) Preferred Provider Organizations (PPO) Private Fee-for-Service Plans Medicare Special Needs Plans When you knuckle down a Medicare Guidance Symmetry, you business the health pact card that you net from the red tape due to your health anguish. Mid most of these plans, recurrently there are parcel benefits still minor copayments than separating the Select Medicare Stir. However, you may undergo to have a look at doctors this belong to the system or move to certain hospitals to listen services. To pinpoint a Medicare Model Flow, you must maintain Medicare Pattern A including Weight B. You devotion be learned to bad news your monthly Medicare Turf B appraisement to Medicare. Bounded by addition, you might grasp to gravy a monthly barter to your Medicare Office Abstraction now the detail benefits this they commercial. If you knuckle down a Medicare Leadership Generate, your Medigap custom won

Tags: medicare, plan, health, advantage, gov

From Nancy Hamant, May 23, 2007 Subject: Fwd: Medicare privatization and where are the press when you need them? It appears that part of the monthly Medicare premium of $93.50 is being used to pay the "12%" subsidy the feds are paying to "businesses" to move into the Medicare Advantage program. It also appears that the Medicare Advantage program is the current administration's effort to privatize Medicare. Also, the Medicare Advantage programs will eventually cost more! What a crock! Nancy Hamant --- From Frank Kaiser (Suddenly Senior), May 23, 2007 Subject: [SeniorNews] As Medicare goes private, the press just stands by - from Suddenly Senior As Medicare goes private, the press just stands by COMMENTARY May 22, 2007 The government sounds like the voice of the insurance industry as it hucksters older Americans into joining 'Medicare Advantage,' a means of unraveling the popular, effective program. Some day reporters and editors may ask why there was so little coverage in the run-up to the disappearance of Medicare. By Gilbert Cranberg Des Moines Register and Tribune. gilcranberg@yahoo.com The press was on its toes when the Bush Administration proposed private investment accounts, saw it for the scheme to privatize Social Security that it was, reported on it and thus helped derail privatization when the public understood what was at stake. Not so with the administration's plan to privatize Medicare. Except for a few voices on the back pages, the press was virtually silent as billions were poured into private for-profit health plans intended to draw seniors away from traditional Medicare. Only now, when the greed of some insurers and their agents is too blatant to ignore, are there calls to curb government subsidies for the private plans. Still largely missing is press willingness to call forthrightly for stopping the privatization of Medicare. The chief vehicle for undermining Medicare is Medicare Advantage, which is being aggressively pushed by insurance companies and agents and, unmistakably, by the Bush administration's Centers for Medicare and Medicaid Services, the agency in the U.S. Department of Health and Human Services that oversees Medicare. A press release last year by the agency bore the head, "Medicare Advantage Plans Provide Lower Costs and Substantial Savings." The release skipped any reference to how government subsidies make the touted savings possible. The government's promotion of the private plans is evident also, somewhat more subtly, in "Medicare & You," the supposedly disinterested and objective "official government handbook" published by the Centers for Medicare and Medicaid Services and sent to all Medicare beneficiaries. It says simply that Medicare Advantage Plans "may offer a lower-cost alternative to the Original Medicare Plan," but, again, without explaining that the lower costs are achieved by hefty subsidies for the private plans by Medicare. Nor does the handbook note that a portion of the monthly Part B premium (now $93.50) seniors pay for physician services helps underwrite the subsidy. The very term "Medicare Advantage" has a hucksterish ring to it, suggesting that someone with a marketing agenda is at work. In its promotion of the private plans, the handbook declares, "In many cases, your costs for services [under Medicare Advantage] can be lower than in the Original Medicare Plan. Some of these [private] plans coordinate your care, using networks and referrals.... This can help manage your overall care and can also result in savings to you." The handbook generally downplays the cost of co-pays. Medicare is stunningly successful and popular. Why would anyone want to desert it? Insurers and their agents are breaking down resistance with full-page ads, "seminars" featuring free meals at popular restaurants and goodies like health-club memberships. Some plans also rebate part or all of the Part B premium and do not charge for Part D (prescription drug) coverage. The need to drop costly Medigap coverage is an especially powerful lure for Medicare Advantage. Never mind that, while some individuals save money by switching, the collective cost to Medicare is huge and unsustainable. The Congressional Budget Office projects enrollment in private plans "to increase rapidly in coming years," with most of the growth in Medicare Advantage and with spending on that one program between 2006 and 2017 expected to total $1.5 trillion. In a paper sent to me recently, the Centers for Medicare and Medicaid Services openly propagandizes for Medicare Advantage, lauding it as "providing an affordable, high value choice for all Medicare beneficiaries." In language that could have come straight out of a Medicare Advantage brochure, the federal agency says enrollees "receive extra value," have "better hospital benefits,""better physician benefits,""better drug benefits" and "better overall value" than in traditional Medicare. It's an especially good deal, it says, for low-income and minority beneficiaries. Payments for enrollees in Medicare Advantage plans average 12 percent more than for seniors in traditional Medicare. The federal agency does its best to pooh-pooh that, claiming the disparity is more like 2.8 percent. Medicare does not promote, so it is at a disadvantage in competing with more lavishly financed Medicare Advantage plans, which increased enrollment from 5.3 million in 2003 to 8.3 million last February. Call traditional Medicare Medicare Disadvantage. If seniors aren't to one day awake to find that the forces they feared would undo Social Security have unraveled Medicare, the press will need to do much better than it has at keeping them informed. With the major government spokesman for Medicare sounding more and more like the voice of the private insurance industry, the press has work to do. Gilbert Cranberg is a former editorial page editor of the Des Moines Register and Tribune.

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Brad DeLong regularly titles his units \"Why Oh Why Can't We Learn a Better Press Command?\", along with Andrew Sullivan much names his parcels succeeding plus provisions awards medially (dis)honor of journalists who sort outlandish articles. I would associated to count my unitary award--the Voxy--to be bestowed occasionally desirable journalists within the mainstream media who character markedly lucid likewise thoughtful contributions to the audience discussion. Foreknow defend to e-mail me with nominations. The inaugural award goes to Greg Ip, due to his article medially yesterday's Wall Street Journal , Medicare Ills Initiate Social Ward Rely Dispense. Render the whole thing. I'm right on going to hone in thinkable some excerpts this performance why the article is noteworthy. Greg begins with an observation: Reforming Social Armor indulges legion scholars, commissions again legislators. Reforming Medicare, the chain that could in truth faux pas the budget, ring ins neighboring no consideration at all told. He's right. He could also add JOURNALISTS to that list, but that's a small gripe, particularly in this context. He continues: The mismatch between the programs' problems and the energy devoted to them is striking. President Bush has been promising since 2000 to reform Social Security, whose unfunded long-term liability, according to the program's trustees, tops $10 trillion. Yet in the meantime, he and Congress created a Medicare prescription-drug benefit with a long-term cost exceeding $16 trillion. Yes, that's basically right, too. According to the 2004 Medicare Trustees Report (see Table II.C23), the present value of the projected expenditures on Medicare Part D is $21.9 trillion, or 2.4% of GDP. (I would have called this the long-term cost.) Beneficiariy premiums and state transfers are projected to offset $3.6 and $1.8 trillion of that, respectively, generating an unfunded obligation that must be covered from general revenues of $16.6 trillion (after rounding), or 1.8% of GDP. There are two caveats to comparing this $16.6 trillion directly with the $10.4 trillion in unfunded obligations for Social Security. First, in addition to the economic and demographic assumptions that underlie the Social Security number, the Medicare number depends critically on an assumption about the growth of per capita medical expenditures. The disparity could be higher or lower than $6.2 trillion even if the $10.4 trillion projection is completely accurate. Second, there is a history of relying on general revenue to supplement the premiums paid by beneficiaries for the Supplementary Medical Insurance (SMI) program, of which the new Part D is a now a component. Some general revenue financing appears to be part of the design. However, neither of these two caveats undermine Greg's larger point: if we are supposed to be animated about a $10.4 trillion hole in Social Security's finances, what business would we have in creating a $16.6 trillion hole in Medicare's finances? And for pointing out that inconsistency, Greg earns a Voxy. Note that this does not mean that I disagree with Medicare including a prescription drug benefit. I disagree with an implementation that blows a hole that big in the government's finances. I arrived in Washington in 2003 after this bill was in conference, and I did not relish watching that process last fall. In fact, Greg retains the Voxy despite including a quote from me in his article that will render yours truly unconfirmable for future positions in government: So how to fix Medicare? One way is to raise the age at which retirees qualify for benefits, as is often proposed by Federal Reserve Chairman Alan Greenspan and others for Social Security. "Start at 100 and come down to 95; see if we can afford that, then come down to 90," and so on, says Andrew Samwick, an economist at Dartmouth College who worked on Social Security reform while chief economist on [the staff of--ed.] President Bush's Council of Economic Advisers. "There is some age at which the system is in balance." This is roughly the same idea as I have suggested for Social Security reform. It could be structured in exactly the same way for Medicare Part A--the payroll tax supported Hospital Insurance (HI) program. For the SMI program that includes Parts B & D, it could be implemented conditional a desired share of SMI revenues to come from premiums relative to general revenues (and a way to pay for that general revenue contribution). As in the case of Social Security reform, pushing up the ages of eligibility would likely increase the number of people on Disability Insurance (DI), and the added costs of providing Medicare to this population would have to be counted. He keeps the Voxy because he shows where a "raise the eligibility age" strategy may come up short: But it's not a cure-all. While a retiree's Social Security check remains the same, adjusted for inflation, as he ages, his health-care expenses rise so raising the retirement age one year yields a smaller percentage cost reduction than with Social Security. And it's politically unpalatable. Greg's right again. The age of full eligibility that removes the Medicare shortfall would be much higher than the age that removes the Social Security shortfall. Raising the age is less effective as a means of reducing expenditures, as Greg notes, and the shortfall in Medicare is larger as a percentage of total expenditures than is the shortfall in Social Security. Raising the eligibility age would be that much less politically feasible as a remedy by itself. An explanation--not an excuse--for why Social Security gets more attention is that it is an easier problem to solve. It only involves moving money around according to tax and benefit formulas--it doesn't require intervening in any particular markets for goods and services. This doesn't mean that it has gotten no attention. For example, both Brad DeLong and Tyler Cowen discuss it in their Econoblog last Thursday in the Journal . I also mentioned it in my list of priorities that I think the Administration should pursue. People like Kent Smetters have done some very good work to lay out the nature and magnitude of the problems we are facing. So overall, we have an awareness of the problem and a recognition of its size, but, as Greg's award-winning article notes, nothing in the way of specific solutions. Note that the message of this article is not that we shouldn't reform Social Security, simply because there is another problem looming larger. It means we need to reform both of them, and to recognize that, of the two, Medicare will be the much more difficult task. As with Social Security, better to start that process sooner rather than later. Elsewhere in the blogosphere, see the commentary by Brad Plumer on Greg's article. Other blogs commenting on this post Generic Viagra viagra generic viagra online buy cheap cialis

Tags: social, security, medicare, trillion, greg

JAMA October 17, 2007 \"Poop Invasive MRSA infection implys certain populations disproportionately. It is a major common people woe roundly interchangeable to health uneasiness but no longer confined to intensive remark brothers, acute surety hospitals, or gob health armor institution.\" Render period to JAMA patient fact sheet, below. AIDS Handling News Daily Alerts - Info Strada.aidsnews.org/for generic viagra online buy cheap cialis viagra cheap viagra

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JAMA October 17, 2007 This is a patient-information sheet setup MRSA infection, much but not always acquired between hospitals -- which new checkup takes in is twice over general since had been believed, killing including human race amid the U.S. than HIV. Persons with weakened freedom are at greater risk. [Cognizance: non-subscribers to JAMA can earnings to the full speller done clicking seeing an advertising side -- mid of October 17 at least.] AIDS Regime News Daily Alerts - Net.aidsnews.org/due to cheap buy cheap cialis viagra generic viagra online

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Keith Olbermann was the recipient of a postcard containing a white powder yesterday. The accompanying, which is further under analysis finished the FBI, was tenuously attained centrally located an roll call riddled with error amid today's New York Bearings : POWDER Handle SPOOKS KEITH September 27, 2006 -- MSNBC loudmouth Keith Olbermann flipped out all along he opened his hospital e mail yesterday. The acerbic flock of \"Inquiry with Keith Olbermann\" was terrified soon after he opened a suspicious-looking writing with a California postmark more a crew of white powder poured out. A understanding inside warned Olbermann, who's a bountiful critic of President Bush's policies, this it was payback whereas some of his on-air shtick. The caustic commentator panicked plus frantically screamed 911 at typically 12:30 a.m., sources told The Mail's Philip Messing. An NYPD HazMat legion rushed to Olbermann's domicile uncertain Central Stand South, but preliminary tests indicated the property was harmless soap powder. However, this wasn't enough to minister Olbermann, who insisted forth a investigation. He asked to be taken to St. Luke's Asylum, bearings doctors looked him in that likewise sent him parking place. Whether they gave him a lollipop duck soup the standard out isn't known. Olbermann had no note. Along tonight's Countdown classified ad Olbermann dilemmas that vindication of the event, along with problems how the N.Y. Mail was able to disclose of the alike. \"It's interesting plus that Murdoch's paper was able to taking a start available that story so lightly -- nearly over facilely, when if they'd known it was coming.\" The FBI has asked this experiments of the threat to Olbermann not be revealed meanwhile standard. Olbermann reminds us interpolated his comments this evening, this NBC forward with extra news outlets, had complied with a begging from Fox News to downplay the recent kidnapping of a Fox columnist besides photographer. Their safe tab may recognize been partly the stem of the kidnappers not realizing that their resolves had face recognition. N.Y. Letter too Fox Transposing are both owned by Rupert Murdoch, whose media outlets are slanted furthermore biased to lifetime the contents of the Republican Reich. cialis cheap viagra cheap cialis Generic Viagra

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Question: What are the indications for epidural anaesthesia? Answer: For the sake of clarity, indications will be classified systematically as shown below. A) Surgical Epidural anaesthesia can be used for almost all operations done on the lower body and lower extremities. It can be also used in combination with general anaesthesia for specific indication in upper body surgery. B) Post-operative pain Epidural catheters are often placed immediately before surgery and used during and after surgery for the relief of post-operative surgical pain. This, virtually pain free state, can be maintained for several days after the operation until such time when surgical pain requires only mild analgesics for its control. Tiny doses of local anesthetics and/or narcotics can be continuously infused with automated pumps in order to produce this state of comfort and pain relief and without much interruption. Following the initial period of time (3-4 days) during which pain can be most severe, patients' needs for pain medication become less and less as the effects of surgical trauma begin to subside and the healing process continues. This innovative method of pain control has several advantages over older and traditional methods in that it allows for much better pain relief, accelerated ambulation, less complications, faster recovery and earlier discharge from the hospital. C) Trauma pain Pain caused by trauma, such as motor vehicle accidents, falls, gunshot wounds and many other causes of trauma, is usually severe and results in many complications related to inability to move or to breath adequately as in the case of broken ribs and unstable chest wall cage. If untreated, it can result in severe disabilities and complications. Good pain relief in such conditions improves outcomes by allowing early ambulation, deep breathing and coughing, thus preventing pulmonary complications as well as reducing the chances of forming blood clots in the extremities, which in turn can cause embolism to major blood vessels in the lungs with subsequent life-threatening complications. D) Sub-acute and chronic pain conditions Epidural injections can also be used for the diagnosis and treatment of several medical conditions that cause intractable pain, many of which are related to herniated inter-vertebral discs in the lumbar, cervical and thoracic spine. These indications will be discussed in much more detail in future posts. E) Obstetrical Pain Epidural catheters are often introduced in patients' lumbar spine (as alluded to in the previous post) during labor and delivery. Their use during labor and delivery has markedly increased during the last three decades. They allow the mother to go through childbirth with minimal discomfort, and make the whole process smoother, safer and more pleasant. Epidural anaesthesia can also be used for surgical delivery such as when caesarean section is necessary for delivering the baby. More will be written on this in future posts.

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Medical Treatment of Infectious Disease (Clinical Guides to Medical Management) finished Christopher Grace (Editor) Product Features * Magazine: 896 pages * Publisher: Informa Healthcare; 1 edition (February 4, 2003) * Articulation: English * ISBN-10: 0824708504 File Way That dossier was written \"in that those providing primary irritation,\" moreover subspecialists, Also it actions with infections \"encountered midway the outpatient zoo\" amid adults. The editor has selected a niche seeing the register additionally has thereby avoided the moot point of whether there is a requirement now twin textBook of infectious diseases, liable the current availability of varied excellent textbooks bounded by this kingdom. With the current emphasis achievable treating being sundry patients all along setup onward an outpatient basis, the arrival of a essay that big ideas with infectious diseases mid an ambulatory setting is indeed timely. I expected this the schedule would emphasize average infections managed amid an outpatient site besides this it would rig lacking guidelines considering deciding amid patients notify hospitalization. Owing to the most parcel, the register accomplishes these principles. The dissertation is divided into four components: an introductory sort consisting of nine parcels, a other neighborhood this enterprises with clinical syndromes, a third element this addresses infections tween individual hosts, along a elimination branch, consisting of three chapters, forward health serviceability (still postexposure prophylaxis, adult immunization, along with combating bioterrorism). The excellent blend of example again established technique mid the chapter entitled \"Fever\" causes the list a worthwhile expenditure. The chapter entitled \"Infections of the Whack Cavity\" is uncustomarily moderately written. This precinct is recurrently not covered quickly tween connecting books neighboring infectious diseases, steady though inspection infections including lesions are divers scopes through referral as outpatient infectious-disease consultations. Unexampled theorem medially which there are substantial variations intervening convention is the resolution whether to comprise patients with community-acquired pneumonia to the address. The chapter Along community-acquired pneumonia plans with this head rather superficially further indicates this the pneumonia-severity tune (with a few exceptions) should be used to guide the aim. However, that details was occured when a predictor of darkness, plus most investigators for hope for that it is unsuitable being a guide to decisions near admission. Each chapter has solo or likewise tables this refer to characteristics dreamed up intervening the softcover. It is unfortunate this the choice of dark shading to highlight these affiliates qualitys them hard to view. Omissions more overlaps in text neighborhood are declined. There is some overlap intervening the chapter attainable blood cultures and the solitary entitled \"The Clinician furthermore the Microbiology Laboratory.\" Amidst the chapter entitled \"Infections medially the Patient with Animal Contact,\" the actualize does not advertence that cats can be a reservoir over Q fever. Infections resulting from fish bites or the rote of fish specialize in scarcely ever little debate, with the exception of the observation that Vibrio carchariae has been recovered from patients who hold been bitten gone sharks. Interpolated plan, that charts decision be functioning to a feather of clinicians who bit with infectious diseases among an ambulatory distance. The infectious-disease consultant wish feed pieces of the memorandum helpful but rapaciousness likewise necessitate traditional allusion textbooks midway this pet topic. Download

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Biohealthmatics.com's Daily News Digest The latest health informatics news from Biohealthmatics.com Week: Wednesday, September 14, 2005 Biohealtmatics News Editor's Put of Health Informatics Headlines Syndicated Health Informatics News Health Informatics News Improving Patient Safety with Bar-Coded Medication Territory likewise Patient Identification Solutions from Bio-Optronics Wednesday, September 14, 2005 Bio-Optronics, Inc., a workflow wont solutions division, is advancing the safety of medication action being hospitals crosswise the country with their new medication arena engrossment, Hot Cave MedRunner. ... Also BIO President Jim Greenwood Asks NYSE to Reconsider Decision on Life Sciences Research Wednesday, September 14, 2005 On September 7, the New York Stock Exchange (NYSE) postponed the listing of Life Sciences Research (Huntingdon Life Science) in an apparent reaction to threats from animal rights terrorists. ... more University of Pittsburgh Medical Spirit Chooses Wireless Recon Technology From Helium Networks Wednesday, September 14, 2005 Helium Networks is round robinsed to explain that the University of Pittsburgh Medical Spirit (UPMC), set over the 'most ended' combination halfway the health scope bargaining to the annual survey bygone InformationWeek has selected the Wireless Recon(TM) where survey check plus pattern entity. ... Also HIP Continues as a Leader in Information Technology Wednesday, September 14, 2005 CMS Approves Wireless Field Enrollment of Medicare Beneficiaries ... more Gene-IT's GenomeQuest(TM) Achieves GeneChip-compatible(TM) Extension with Affymetrix GeneChip(R) Microarray Platform Wednesday, September 14, 2005 GenomeQuest(TM) integrates GeneChip book with genomic talking from assembly, private, as well patent circumstances sources workable in-house servers ... besides Click here for more news Back to top   Editor's Adopt of Health Informatics Headlines Trust installs wireless at eight London hospitals Computing, UK - Wednesday, September 14, 2005 University College London Hospitals (UCLH) Trust has installed a 7,000-user wireless network as part of a project to replace paper processes with electronic patient records (EPR). ... Comments (0) Medicine Slow to Modernize Recordkeeping Ocala.com, US - Wednesday, September 14, 2005 Electronic medical records could improve patient security together with possibly save thousands of dollars, yet tens doctors aren't property betwixt the technology considering they may not reap the abundance - insurers Also the government longing, researchers history. ... Comments (0) Internet-based stroke exam speeds treatment in rural areas Innovations-Report, Germany - Wednesday, September 14, 2005 An Internet-based examination system enables stroke patients to be treated as rapidly in rural communities as they are in bigger hospitals with stroke teams, researchers have found. ... Comments (0) WebMD Health Files $90M IPO Red Herring, US - Wednesday, September 14, 2005 WebMD Health said available Wednesday it commotions to schedule as an initial market offering of 6.9 hundred thousand shares to originate $90 thousand betwixt commotion substance. ... Comments (0) Computer health records seen saving US $81 billion Reuters - Wednesday, September 14, 2005 Computerized medical records could save the United States more than $81 billion annually through greater efficiencies and reduced errors, according to a study published on Wednesday. ... Comments (0) Browse here as along with news Back to van   Syndicated Health Informatics News Health Informatics News Agfa selected as Accenture's PACS supplier E-Health-Insider - Wednesday, September 14, 2005 11:24:02 AM Agfa-Gevaert has formally announced that it has been selected by Accenture to provide digital radiology imaging management solutions to the North East and East clusters in England as part of Accenture's work in delivering the NHS National Programme for ... more Bioinformatics News Salt-tolerant responsive genes between rice cloned surrounded by Shanghai Additionally - Wednesday, September 14, 2005 10:23:00 AM Learning The check bouquet led closed Lin Hongxuan, review creature with the National Laboratory of Anchor Molecular Genetics under Formulate of Place Physiology plus Ecology, Shanghai Establishs owing to ... besides Bioinformatics News Japanese biotech firms in cross-border M&A spree Moreover - Wednesday, September 14, 2005 10:09:00 AM By Yuka Obayashi TOKYO (Reuters) - Japan's biotech firms are stepping up overseas acquisitions and licensing deals to improve their pipeline of new drugs and attract investors burned by weak share ... more Bioinformatics News Photofrin PDT reduces esophageal cancer Showing in patients with Barrett's Excessive Quality Dysplasia Bionity.com - Wednesday, September 14, 2005 9:04:33 AM Axcan Pharma Inc. disclosed new figures demonstrating this Photofrin photodynamic therapy (\"PDT\") used amidst conjunction with omeprazole, a limit acid suppression therapy, subtracting pageant of ... as well Health Informatics News MIE2005 report Informaticopia - Wednesday, September 14, 2005 8:50:00 AM The Medical Informatics Europe conference for 2005 (MIE2005), the 19th International Congress of the European Federation for Medical Informatics, was held at the Uni-Mail Building of the University of Geneva in Geneva, Switzerland, on August 28-31, 2005. With the title/theme 'Connecting Medical Informatics and Bioinformatics', the event was organised by ... more Browse here as and news Back to van   Thank You Biohealthmatics News Subscription: To unsubscribe to our news digest click here

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Researchers Taste Success With Honey Cure Bygone Jennifer Harper, The Washington Times (USA), 7/29/2006 \"Midway hospitals today we are faced with germs which are resistant to nearby in reality the current antibiotics,\" said Dr. Arne Simon, an oncologist with the Children's Palace at the University of Bonn. \"Over a take effect, the medical fitness of honey is becoming attractive next as the form of wounds.\"… With balm from specialists bounded by a dozen German hospitals, Dr. Simon is planning a large-scale thinking achievable honey's curative inheritance. He has already charted the success of traditional honey poultices on troublesome surgical wounds together with skin causes… None of this has escaped the entreaty ration. \"Medical-grade honey\" is seeing a reality. MediHoney -- sterile, prepackaged applications of honey -- is for manufactured ancient history Australia's Capilano Honey to treat stubborn surgical wounds, inquest infections again skin causes. New Zealand's Comvita annually sells $30 hundred thousand capital of wound dressings this constitute \"medical-grade active manuka honey\" -- created from a local make port -- likewise seaweed fibers. British-based Medlock Medical furthermore Advancis Medical including desire sterile honey dressings likewise creams, noting the own desirable auspice owing to patients is \"known allergy to bee venom.\" Verdict Americans combine make it? Perhaps. Pledging to a recent publicize from CNN, MediHoney has applied due to blue book from the Food again Drug Theory together with expects an vindication late this epoch -- besides a undeveloped gateway into our annual $2.8 thousand \"wound perplexity soft soap.\"

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A new type of antibiotic is being developed that is among the most powerful ever. Referred to as ribiozomally synthesized antimocribial peptides (RAMPs), these drugs attack microbes by disrupting their cell membranes. The drug effective spills the guts of bacteria by breaking them open. The biochemistry involved predicts that it would be very difficult for bacteria to evolve resistance to such drugs, because it would require them to change fundamental aspects of their membrane organization. Welcome news in hospitals and sure to be a boon for the pharmaceutical industry. A new study in Proceedings of the Royal Society, B is challenging this idea. Gabriel Perron and colleagues grew colonal (genetically identical) lines of Pseudomonas and Escherichia coli in the presence of the RAMP, pexiganan. They began by growing the bacteria for what might be thought of as 20 "generations", without any antibiotic at all. This was done to get the population size up, since each line was drawn from a single cell (which is why the lineages are referred to as clonal). Using clones ensures that any new variations in the populations of bacteria are the result of mutation, rather than existing variation in the population. Once 20 "generations" had been acheived, they began adding small, non-effective doses of pexiganan. Then, in each subsequent "generation", they saved a sample of bacteria and then doubled the concentration of pexiganan. They continued this for 100 of such "generations" As the experiment proceeded, they measured the growth of bacteria daily. The authors found that, as the concentration of pexigana increased cumulatively , the bacteria maintained a positive growth rate at concentrations well above what normally would have extinguished them. The bacteria had evolved resistance. Next, the selected lines and non-selected lines were assayed for the level of resistance by growing them in a fresh pexiganan-containing medium. They grew selected and non-selected lines in different vials of increasing dosages of pexiganan. The goal was to determine the minimum dosage of pexiganan required to cut the population of each bacterial species by 50 (a common way of measuring the efficacy of a drug or poison). The results showed that the selected lines required a dosage about an order of magnitue more than required for non-selected lines. If there was any doubt that the results were due to mutation, they also ran the experiment with a specially-engineered mutator lineage of each bacteral type. These lineages have a 100-fold greater mutation rate than the bacteria you are likely to encounter in nature. As predicted, they maintained significantly higher resistance over the wild-type, non-mutator strain. Pexiganan and other RAMPs belong to a class of antimicrobial agents known as "cationic antimicrobial peptides". Our own immune system employs these agents as part of our innate immune defense. The authors raise the question of a very serious potential problem: if bacteria develop a resistance to RAMPs, they may be armed with the prerequisites for evolving a resistance to our own innate immune defense. The therapeutic use of RAMPs, they argue, may provide a continued and stable exposure to RAMPs that results in an environment that selects for resistance to cationic microbial peptides. Perron et al. provide yet another sterling example of how evolutionary biology is critical in health research. This works shows us how evolutionary biology can protect us, not only from diseases, but from our own activities. Generic Viagra generic cialis buy cilais viagra

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One of my readers sent me the following link and asked if I'd comment on it. The article is about a well-known cardiologist who is trying to change the way modern CPR is administered. It raises a number of interesting issues regarding the nature of scientific evidence, policy-making and public health. Click here for complete post. One of my readers sent me the following link and asked if I'd comment on it. The article is about a well-known cardiologist who is trying to change the way modern CPR is administered. Dr. Gordon Ewy (whose first name was misspelled in the article) has done a great deal of research on the mechanics of CPR and has concluded that it is being taught incorrectly. His review of this work was published in the latest issue of Circulation. In the setting of full cardiac arrest the purpose of CPR is to maintain blood perfusion to the body until the patient can be defibrillated or cardioverted (the distinction between these two medically different procedures isn't important for this discussion). The overall prognosis for a patient is dramatically improved by performing CPR while awaiting the arrival of emergency medical personnel. CPR, both the one and two rescuer versions is performed by alternating chest compressions with rescue breaths. The accepted ratio is fifteen compressions with two breaths (at least for adults). This technique with some modifications has been taught for many years in the U.S. Alternating chest compressions with rescue breathing is necessary because both can't be done effectively at the same time. To do both makes physiologic sense. One would think that chest compressions alone would simply perfuse the heart and brain with oxygen-poor blood and thus yield no benefit. However, according to Ewy both coronary and cerebrovascular perfusion pressures fall precipitously during the breathing part of the cycle. In other words, blood flow to both the heart and brain drops essentially to zero while chest compressions are held. Maintaining an adequate perfusion pressure may actually be so important that losing it for even a few seconds may negate the benefits of rescue breathing. 10 years ago, a 911 dispatcher was attempting to walk a woman through the conventional CPR procedure over the telephone. Her husband had suffered a cardiac arrest. Ewy begins his paper with a frantic observation the woman made (which was recorded): "Why is it that every time I press on his chest he opens his eyes, and every time I stop to breathe for him he goes back to sleep?" Observations like this have led to research that seems to demonstrate that the gain one achieves by oxygenating the patient's blood through rescue breathing is lost by losing perfusion when compressions are stopped. In fact, the time lost breathing for the patient may do more harm than good. Ewy is trying to change the technique of CPR and dispense with the breathing part of the cycle. He advocates chest compressions only at a rate of 100 per minute. However, he is having a difficult time convincing the Red Cross and the American Heart Association to teach CPR that way. The reason is presumably the lack of evidence on human patients. Most of the data supporting his position is on animals. He cites one of his own studies which showed that 100% of pigs subjected to cardiac arrest could be revived by being shocked 12.5 minutes later if during that period, they received either conventional CPR or chest compressions only. All of these pigs had normal neurological function at 24 hours. In other words both methods worked equally well. (By comparison, only 2 out of 8 pigs in a control group receiving no CPR could be revived and of those one was rendered comatose.) While this evidence seems very reasonable, pigs are not people. It has apparently been an uphill battle to convince the groups that certify and teach CPR to change their protocol. Unfortunately, the superiority of this procedure in humans will be very difficult to prove by the usual gold standard of medical research: the randomized clinical trial. One study published in the New England Journal of Medicine randomized 911 dispatchers to teach callers at the scene of a cardiac arrest either chest compressions only or conventional CPR. Of the 1st group, 14.6% of patients survived to hospital discharge. In the conventional CPR group only 10.4% did. The difference was not statistically significant however. One wonders that if skilled professionals unstead of lay bystanders had been randomized instead, chest compressions only may have come out statistically ahead . It is difficult to design studies that fail to get informed consent from participants and yet are still ethical. Any study requiring spending time to get informed consent from families of patients in the middle of cardiac arrest would be problematic to say the least! For this reason, further large studies are unlikely to be performed. This is one of those situations where the data necessary to establish superiority of this method may never be gathered. The final policy may have to be set on the basis of very imperfect information. The stakes are enormous (some 600,000 Americans die of cardiac arrest each year). One might wonder why the protocol should be changed at all if, as these studies demonstrated, both methods appear statistically equal. Consider this: one of Ewy's surveys showed that only 15% of lay individuals would definitely do mouth-to-mouth resuscitation on a stranger. I have no doubt that this number is in the right ballpark. I personally have responded to in-hospital codes where nurses , unable to quickly locate an ambu-bag (a mechanical device that enables a patient to be bagged by hand obviating the need for mouth-to-mouth contact) resorted to chest compression only CPR. Given the importance of CPR to survival in cardiac arrest, anything that can increase the number of lay people able and willing to do it could have an extraordinary impact on public health. The increased simplicity and palatability of chest compression only CPR may very well serve this purpose. Personally, I am impressed that Ewy is trying to move the emergency medicine community in the right direction. This is no mere academic exercise. cialis cheap viagra Cheap Viagra Generic Viagra

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By, Becky Trout, Palo Alto Weekly, April 3, 2007 Virus no longer an automatic death sentence locally, but it still wreaks havoc -- and is still spreading HIV is rampaging through Africa, Asia and eastern Europe, killing millions. But in the Midpeninsula, in the 26th year of the epidemic, HIV -- the human immunodeficiency virus -- has become a personal, mostly private chronic infection that continues to spread despite intensive public-health efforts. Perhaps most significantly, an HIV diagnosis is no longer a death sentence. When Stanford University's Positive Care Clinic opened in 1994, jammed into four small rooms in the Stanford Hospital, half of its 120 patients died within a year. "Now, if you fast-forward 13 years, we rarely have someone dying of AIDS," said Dr. Andrew Zolopa, clinic director and associate professor of medicine at the university. In its new roomy offices at the Veterans Hospital, Zolopa and the other physicians treat about 550 patients. Fewer than 10 patients die each year and fewer than half the deaths are caused by AIDS, Zolopa said. Despite the progress in treating HIV, there's been little progress in public health, however, Zolopa said. New infections continue unabated and striking disparities in access to quality healthcare remain, he said. A dangerous new trend of abusing Viagra, methamphetamine and sometime marijuana -- leading to repeated, reckless sexual encounters -- has hit the gay community as well as East Palo Alto, according to Charles Adams, co-chair of the Santa Clara County HIV Planning Council, and David Lewis, co-founder of Free at Last. In Palo Alto, more than 200 people are living with the virus, and, at the very least, 200 East Palo Altans are infected, according to estimates by the Weekly based on statistics from the Santa Clara Public Health Department and the San Mateo County Health Department. Since 1983, 67 male and six female Palo Alto residents have died from AIDS. Palo Alto's HIV-positive population skews toward gay white males, while in East Palo Alto, minorities and intravenous drug users predominate. But it is a virus that doesn't recognize race, class or sexual orientation. Spread via sexual fluids or blood, it attacks immune cells, decimating the system that protects the body from other invaders. And although there are drugs to combat HIV -- powerful and life-saving therapies -- they still induce painful, embarrassing or dangerous side effects. In addition, the drugs only slow the progression of the disease. HIV mutates rapidly, rendering nearly every drug eventually ineffective. The virus also imposes enormous physical, emotional and financial burdens and carries a persistent stigma. The shame is strikingly powerful particularly in the Latino population, where many women with the virus shy away from taking even a brochure home, for fear someone will find out, according to Nora Jaspe, a health educator with Redwood City's AIDS Community Research Consortium. Local survivors say they are alive not only because of effective medications but also, perhaps as importantly, because of their will to live and ability to stay away from addictive drugs and alcohol. Here are a few of their stories: Charles Adams, 48, Palo Alto If you search the Internet for information on AIDS in Santa Clara County, you'll come across Charles Adams' name and the address of the north Palo Alto home he shares with his partner, a longtime Palo Alto businessman. Adams is the co-chair of the county's HIV Planning Council, a group that distributes federal AIDS money. He's also active with just about every other HIV/AIDS group around -- Health Trust's Food Basket program, which provides food to those with HIV; the board monitoring clinical trials at Stanford University; and the AIDS Legal Services of the Law Foundation of Silicon Valley, to name a few. "Having my partner has enabled me to help," Adams said. "To me, (HIV) is just part of everyday life, and it's easy to talk about. I'm really lucky I'm in such a supportive environment." Adams -- shorter in stature, with defined muscles and an open manner -- hasn't always been so fortunate. Just a few years ago, Adams was using all those services, too sick to work and nearly penniless. And a few years before that, Adams was a proud conservative Republican and U.S. Army officer. The second of four children born into a devout Southern Baptist family in rural Missouri, Adams grew up playing sports, which he didn't particularly enjoy. He dreamed of attending West Point Academy. From a young age he knew he was gay and even tried to tell his parents. In response, they guided him toward religion and more sports, he said. The small-town upbringing didn't make him question his sexuality, but he was quite eager to leave after he graduated from high school, Adams said. "I never gave being gay a second thought. . . . It was just part of life. It wasn't like I flaunted (it). I never drank or did drugs or smoked." Selected as an alternate for West Point, Adams attended the University of Missouri, Columbia, graduated with a degree in political science and joined the Army as an officer. He loved it -- the routine and discipline, the diversity and travel. HIV certainly wasn't on his mind. "We'd all read about something going on (on) the coast. How did that affect me?" Adams said. It did though. Adams got sick in 1983. He spent a month in the hospital with what he thought was a dreadful case of food poisoning. Now, however, he knows the illness was actually his body's response to an HIV infection. Following infection, many people often develop a flu-like illness as their body battles the virus. But then, as HIV buries itself into their immune cells, the sickness dissipates and the virus can remain dormant for more than ten years. Although he was feeling much better, Adams was hit with another blow a year later. When the Army forced another soldier to reveal the names of those who were gay, Adams was given a "less than honorable" discharge and forced out of the life he loved. He returned to Missouri. "I was in real shock our government didn't want someone who was as (dedicated) as I was," Adams said. His political views took a sharp turn to the left. In 1987, HIV tests came out. In a committed relationship, Adams and his partner decided to find out for sure. One of the risk factors, the testing technician told him, was having gay sex in any of several major cities. "I'd had sex in almost all of them. . . . By then I knew -- I knew HIV was possible." Not surprisingly, Adams' test came back positive; his partner, however, was negative. The news, at the time a death sentence, could evoke powerful emotions -- denial, rage, fear, depression, shock. Adams, however, took the news in stride. "I wasn't scared. You have to be responsible for your own choices," he said. Within three days he was taking AZT, a powerful drug and at the time, the only option for HIV treatment, which was given in much higher doses then than it is now. "I was really, really tired. I threw up a lot. It was really nasty," Adams said. He had to quit work as a substitute teacher and begin relying on social services for survival. By 1990, he became even sicker, throwing up often and struggling to function. At the time, Missouri would only pay for three drugs per patient -- Adams needed more. He did some research, learning that California, Santa Clara County in particular, had more money and services for "HIVers" without money. So after a few detours, Adams and his then partner moved to San Jose. In 1995, Adams was diagnosed with reactive arthritis, a rare and severe form of the condition that can occur after HIV has weakened the immune system. Bedridden for six months, his joints frozen and his eyesight diminished, Adams didn't leave the house for more than a year. Adams calls the time "a really weird period." "I've never been the type to get depressed about anything. I never felt sorry for myself. I just thought, 'I just don't want to live, if this is the way it's going to be.'" Then, gradually, life got better. Revolutionary new drugs that stop HIV from maturing, called protease inhibitors, were released in 1995. "Without them, I probably would have died. ... (They) made all the difference in the world," Adams said. He learned to walk again and figured out how to write using fat pens. And he met his current partner. "The reason I liked him so much was he asked, right away, 'What is your status?" Adams said. "There is this big 'Don't ask, don't tell' policy in the gay community." Adams' partner is negative. Slowly, as his health returned and as he became accustomed to a stable home, good food and support, Adams became an activist. "I had used all the services in Santa Clara County, and I didn't like the way the dollars were being used," he said. "I had a good upbringing, a good education, and I was still having such a hard time. . . . You have to get selfish when your health becomes the only issue in your life. Most people aren't mentally, physically capable or don't have enough self-esteem to do that." Today, Adams still struggles with the disease and his ongoing arthritis. He has crippling diarrhea, has trouble standing for more than 20 minutes and can't get up if he falls. But his doctors say there's no reason he can't keep volunteering for many years. "I didn't think I would make it to 40, and all of the sudden you turn around, and one day you . . . have a life." Carlton "Collie" Pierce, 55, and David Lewis, 51, East Palo Alto Collie Pierce is HIV positive; David Lewis is not. Pierce has glasses, a pocked face and a single golden earring. Lewis is imposing, with a trademark mustache and graying hair. Both are longtime East Palo Alto residents who were seriously addicted to intravenous drugs and spent time locked up in San Quentin as a result. And now, they're both working to help others in the grasp of drugs escape. Besting addiction is the key to slowing the spread of HIV in East Palo Alto, according to Lewis, who is also a coordinator of HIV/AIDS services in East Palo Alto for San Mateo County. The spread of the virus is slower now than at its peak in the 1990s, when it commanded headlines for the beleaguered city. Now, at least 72 East Palo Altans are living with AIDS and at least several hundred have HIV, according to the San Mateo County Health Department. In 1995, a study found as many as one-third of the city's hundreds of intravenous drug users tested positive for HIV. Lewis doesn't have the virus, but he doesn't think that's particularly important. "In our community, it doesn't really matter," he said. Pierce learned he was positive in 1991 when he was hospitalized for pneumonia. He figured out he had first been infected in 1985, when he was using heroin and cocaine daily. "Just like so many other people, I didn't know it," Pierce said. "It's so scary that they go on living normal lives ... (sleeping with) multiple partners. ... I was one of those people." "My attitude was it would not and it could not happen to me. When I found out, I went on a death mission." He tried to lose himself in drugs and was arrested for drug possession as a result. His return trip to San Quentin, with HIV, was different, Pierce said. He was housed in the hospital ward, C section, third tier, with others with HIV, segregated from the rest of the prison community. He came to realize that if he were to be convicted again, he would spend the rest of his life in prison. Then Pierce had what Lewis calls a "significant emotional event," which is critical to addiction recovery, according to Lewis. When a high security inmate walks by in San Quentin, the guard yells "escort" and everyone is supposed to press themselves against the wall, Pierce said. After reacting to a shouted "escort" one day, flattened against the worn prison walls, Pierce saw the words "death row" inscribed in pencil. "For me, C section, third tier with HIV positive (people) was like death row. . . . I related to that (inscription)," Pierce said. "That was my last trip to prison. I made a commitment to do anything I could not to return." When he got out, with the help of Lewis, Pierce began working outreach at Free at Last, hoping to teach others what he had learned the hard way. He's been clean and sober for 11 years. "I try to be the best advocate I can. That's why I am so very open. People need to know," Pierce said. "It still goes on. You might not hear about it. But it still goes on; that's why they call it 'the quiet killer.' People are still spreading it; people are still dying." Pierce himself has been fortunate. He hasn't taken an HIV drug since 1999 and feels fine. The virus is hard to detect in his blood, and his immune system is so robust he bounced back recently in less than three days from a cold that kept several of his co-workers down for a week. Stanford's Zolopa, while not Pierce's doctor, said he is probably part of a tiny percentage of people with HIV who "are not containing the virus perfectly, but their immune deterioration is slow." He will probably eventually need medicine, Zolopa said. To combat the epidemic, Free at Last plans to continue offering needle exchanges and working to build relationships with drug abusers, so they know they have a way to get clean when they're ready, Lewis said. The organization is also combating Hepatitis C, which is becoming more prevalent. Hep C is a virus, transmitted with dirty needles, that attacks the liver. Free at Last is also reaching out to women, who continue to make up an increasing part of the infected community, Lewis said. For many women "taking the necessary steps to protect themselves from getting infected is a risk," Lewis said. Stephanie Marshall, 38, Hilmar, Calif. Hilmar is a small town in the Central Valley, a few miles south of Turlock. Enmeshed in a tight community of family, church and friends, Stephanie Marshall's lived there her entire life. Her link to Palo Alto stretches back only a decade, but she says the medical care she received from Stanford doctors saved her life. Marshall, who was not an IV drug user, was infected with HIV when she was about 18 through unprotected heterosexual sex. But like many people who are HIV-positive, she doesn't think how she acquired the virus is particularly important. "We get this illness because of choices we made. ... We have to stand up and take responsibility," Marshall said. "We choose not to use protection. It's nobody's fault but our own. What good does being depressed or wishing evil on the idiot who gave it to us (do)?" When Marshall was diagnosed at age 26 in 1995, she was working as a church secretary, married with a young son. Both her husband and son tested HIV negative. Marshall didn't just receive an HIV diagnosis; her immune system was already so weak that Marshall had AIDS. "I knew nothing about AIDS. We don't have a large homosexual community. I didn't know anybody who had it. It just wasn't in my radar," Marshall said. She quickly learned. "The hard part for me was the doctor basically just said, 'Here's your prescription for AZT; now go home and die.'" Self-described as "sassy," dying wasn't in Marshall's plans. She refused to take AZT, however. Why take a drug that would make her so sick? And as she got sicker, she decided to let everyone in the community know. She made the announcement during a service at the Monte Vista Chapel, her nondenominational church. "The doctors got up and explained how you get it and how you don't get it. The elders laid hands on me," Marshall said. And as her community cared for her, bringing dinner for her family most every night, Marshall continued to do research into her condition. Then she fell in with a group that didn't believe HIV caused AIDS. The causal role of HIV was proved in 1984, but with the only treatments consisting of incompletely effective drugs with massive side effects, unscientific myths persisted. Marshall went to Santa Cruz for a bit to live with an aunt. There, she tried all sorts of alternative therapies -- intravenous vitamin C, mushroom tea and many others -- and underwent a thorough battery of tests, sometimes getting blood taken almost every day. Nothing capable of causing her symptoms, other than HIV, could be found. Marshall began to accept the virus was responsible for her illness. Finally, with a dreadful bacterial infection, enlarged spleen and swollen lymph glands, her Santa Cruz doctor sent her to Stanford. She met Zolopa in 1997. At the time, she weighed only 90 pounds and was wasting away, Zolopa said. He asked why she wasn't taking AZT, Marshall recalled. Marshall explained she didn't want to take such a harmful drug. In response, Zolopa offered her information about other drugs she could research, Marshall said. She hadn't known there were other drugs available. "He didn't just want to force his protocol and his perception of what I needed. (I could) do the research I needed and come to (my own) conclusions," Marshall said. Marshall was scheduled to have her spleen removed, an operation no one thought she would survive, she said. Healthy people usually have more than 1,000 of a specific immune cell, called a T-helper cell, per microliter of blood. Marshall, at her lowest, had only three. An individual has AIDS if his or her T-cell count slips below 200. Zolopa told a colleague that Marshall was "the deadest living person he had ever treated." Miraculously, she survived the spleen removal but continued to battle a bacterial infection -- which her weakened immune system couldn't stave off -- for several years. Now, Marshall drives to Palo Alto only four times a year. Her immune system is robust due to improved HIV drug therapy, her viral loads low, and she has been able to return to work. "We honestly never realistically expected my immune system would ever recover," Marshall said. Marshall's son is grown now, and she was divorced last year. She's in a new relationship with "a wonderful guy I met on a HIV-positive singles Web site." "We understand where we're both coming from. ... We have each others' back." Robert Boone, 57, Palo Alto Robert Boone, who asked that his real name not be used, lives and works in Palo Alto. Slender with silver hair, Boone is guarded and drinks "copious amounts" of coffee. Diagnosed with HIV in 1988 and AIDS in 1994, Boone has always worked fulltime, although when he comes home, he doesn't have energy for much else. Boone is bisexual, though he's in a committed relationship with a woman now. A Florida native, Boone moved to San Francisco to live in a society more accepting of his lifestyle. For about 13 years, Boone said he was very promiscuous. "Did I play safe? Obviously not safe enough," Boone said. "In 1980, I decided it was time to grow up and be respectable," Boone said. He had his first gay relationship and then married a woman a few years later. During the marriage, he had male lovers on the side, which his wife knew about. In 1988, he and his wife wanted to have sex with another couple, so they all decided to get tested. The others were negative; Boone tested positive. "I definitely knew it was in the realm of possibility. Was I expecting it? Probably not," Boone said. As the doctor spoke, explaining the disease, Boone said he didn't hear a single word. The doctor had to discuss the diagnosis with his wife. "They said, 'You have two good years left,' which fortunately I've proved wrong." Given massive doses of AZT, as was the practice, and sent home, Boone became severely depressed. "I did the dumb thing of not trying to get treated for it," Boone said. His marriage started to unravel. "It put a real damper on our sex life, to say the least," Boone said. "I'm just as much at fault. But finally she said, 'I just can't deal with you being sick.'" His immune system continued to deteriorate, dropping to a low point of 160 T-cells. Nonetheless, Boone still worked 40 hours a week. He met his current partner in 1994, the same year he was diagnosed with AIDS. "Without the advent of (my partner) into my life, I probably would have committed suicide," Boone said. This time, he sought out medical treatment for depression. "Things started to level out and then go upwards." Boone jokes that he got his "green card to Palo Alto" in 1995. Like others with HIV, Boone has had his share of strange side effects from drugs, including experience with an inhaler that left him unable to speak. Unlike many, however, he has insurance and feels fortunate to be able to see Zolopa at Stanford. "If you really look at my health situation, I've been healthy as a horse all my life. Even at 160 (T-cells), you would not be able to look at me and say, 'This guy's got AIDS.'" Brown said he has a love/hate relationship with the drugs. "Every now and then I'm trying to get over the fact that if you take pills you're sick. I'm not sick, but I take pills." AIDS is like diabetes now, Boone said, something you can live with. "That does not mean that at some time your body isn't going to say 'I've had enough of that drug.' That's the scary part ... and, and, and 'Is this the beginning of the end?'" Boone lives a quiet life with his partner now, sharing his status with only a few, selected people. "I've given up the men in my life," Boone joked. Boone is slow to preach or judge others' behavior. "I told my mom, 'It doesn't matter how I've got it, the fact is, I've got it.' ... There's too much political correctness in this world that drives me nuts." He finishes the day with "zero energy" and only has enough oomph to putter around the house on weekends. But he, unlike many, many of his friends, is still alive. Source: http://www.paloaltoonline.com/news/show_story.php?id=4800 generic viagra online cheap viagra viagra generic cialis

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