Understanding Healthcare Power of Attorney - Cleveland Clinic video

This is very important: Advance directives are legal documents that provide instructions about who should oversee your medical treatment and what your end-of-life wishes are, in case you are unable to speak for yourself.

Advance directives include:

- Health Care Power of Attorney
- Living Will



Everyone over the age of 18 should consider assigning Health Care Power of Attorney to someone.

Blood Management Summit and App - Transfuse 2012

Announcement: Blood Management Summit - Transfuse 2012 will be held on April 19-20, 2012 at the JW Marriott in Scottsdale, Arizona.

This conference has been developed with collaboration between Mayo Clinic and Hartford Hospital, building upon the success of three previous national conferences. "Transfuse 2012" is a unique multi-disciplinary conference focused on exploring the current state-of-the-art techniques and programs to reduce allogeneic blood utilization in hospitals. This international conference will feature national and international blood management experts from China, New Zealand and Australia along with a unique iPad app launch and one-of-a-kind hands-on animal lab.

Mayo Clinic's Mark H. Ereth, M.D. introduces the conference and the iPad app in this 3-minute video:



This conference is designed for all physicians, including surgeons and anesthesiologists, perfusionists, nurses and leaders in quality and patient safety. The conference is a CME accredited activity for physicians, nurses and perfusionists.

The Conference Website is: http://www.mayo.edu/cme/anesthesiology-2012r780

One of the course directors is Dr. Ajay Kumar, Chief of Division of Hospital Medicine at Hartford Hospital, and a good friend of mine. Another friend from the time I worked at Cleveland Clinic is also on faculty, Dr. Moises Auron.

It should be a great conference. Go check it out.

"Lifestyle 180": Cleveland Clinic 1-year program promises to reverse chronic disease through lifestyle modification

During the past 5 years, the Cleveland Clinic has moved aggressively to expand from illness management to wellness management. They even have a Wellness Institute. One example of its programs is Lifestyle 180 (R) which is "designed to reverse" the effects of chronic disease through lifestyle modification.

Here is a 5-minute video about the program from the Clinic YouTube channel:



The program focuses on nutrition, exercise, and stress management. The yearlong program is available at the Cleveland Clinic Wellness Institute campus located in Lyndhurst, Ohio.

References:

Lifestyle medicine

Interactive wellness guide by Cleveland Clinic

Lifestyle 180 (PDF)

Disclaimer: I was on faculty at Cleveland Clinic and Case Western Reserve University as Assistant Professor of Medicine until 2008.

Comments from Twitter:

Meenakshi Budhraja @gastromom: Like>>

Linda Pourmassina,MD @LindaP_MD: "the $3,000 fee for this program represents a fraction of the increasingly high co-pays for doctor visits and medications."

March Madness Vasectomies: Postop period is "a perfect situation for television", says Cleveland Clinic urologist

Vasectomy is a surgical procedure for male sterilization, and consequently, birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed. This prevents sperm from entering into the seminal stream (ejaculate). You can watch a video how the procedure is done here.



From Cleveland Clinic YouTube channel: A urologist talks about the increase in the number of vasectomies he does this time of year. "Guys get it done, then watch the NCAA Basketball tournament all weekend long." The procedure takes 5-10 minutes. Patients need to ice the area for 2-3 days.

The NCAA Men's Division I Basketball Championship is a single-elimination tournament held each spring in the United States, featuring 68 college basketball teams, to determine the national championship in the top tier of college basketball. The tournament, organized by the National Collegiate Athletic Association (NCAA), was created in 1939 by the National Association of Basketball Coaches, is held mostly in March, and it is known informally as March Madness (source: Wikipedia).



Private urology practices advertise on TV their "Vasectomy Madness" campaigns:



CNN RidicuList with Anderson Cooper: Vasectomy and free pizza (video):

Essential tremor: what are the treatment options?

Essential tremor is a common neurologic problem. It should be differentiated from secondary causes of tremor and Parkinson disease.

Impact of essential tremor

Essential tremor causes motor dysfunction (e.g. a dentist may have to quit his/her job). However, more importantly, the tremor can have a psychological impact on the patient, especially since it usually gets worse in social situations.

Diagnosis

Essential tremor is a clinical diagnosis. A thorough review of the medical history and medication exposures is a good start. Laboratory and imaging tests may be ordered to rule out a secondary cause.

Treatment

The two first-line agents in drug therapy for essential tremor are:

- nonselective beta-blocker propranolol (Inderal)
- antiepileptic primidone (Mysoline)

They can be used alone or in combination.

Severe, resistant, or atypical cases should be referred to a specialist. Botulinum toxin injection and deep brain stimulation are reserved for resistant tremor or for patients who do not tolerate drug therapy.

Dr. Young from Swedish Medical Center discusses some of the new treatments for essential tremor in this video:



References:

Essential tremor: Choosing the right management plan for your patient. CCJM, 2011.

Boxing and brain disease - Cleveland Clinic video

Boxing and Brain Health - a video from the Cleveland Clinic YouTube channel.

iPad app tests athletes for concussion - Cleveland Clinic video

An iPad app tests athletes for concussions (a Cleveland Clinic video). The players perform a series of balance, memory, vision, and reaction time experiments to obtain a baseline reading. If they receive a blow to the head during a game or practice, these tests can be redone to determine when it is safe for the athlete to return to action.

References:

Concussion Center - Cleveland Clinic.
Cleveland Clinic Treats Concussions With iPad App. Fox News.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.

Comments from Twitter:

@DrVes: Why are some doctors and nurses giving back their iPads? http://j.mp/Hq15aD - Easy: iPad works great for pt education, NOT for data entry. Only 10% of doctors currently use an iPad at work http://j.mp/Hq15aD - I use iPad daily to discuss these diagrams: http://j.mp/Hq1k5v

iPad is a great teaching tool @CraigCCRNCEN was able to explain to Vietnamese family AFib and clots by showing them animation from YouTube.

Brian S. McGowan PhD @BrianSMcGowan: so is the best option for docs still a touch screen laptop? teach w/ touch screen, work w/ full keyboard? #hcsm

@DrVes: iPad works well for discussing DDx, Tx options with pts. Much more portable than laptop. Full-keyboard COWs best for typing.

Jeff Bray @jeffkbray: I have been scanning all my medical reference books and store them on my iPad for quick use and no weight - great tool and mobile

The "Five Second Rule" doesn't work

In case you had any doubts, the "Five Second Rule" doesn't work, says Dr. Susan Rhem, an infectious disease specialist from the Cleveland Clinic:



A common superstition, the five-second rule states that food dropped on the ground will not be contaminated with bacteria if it is picked up within five seconds of being dropped (Wikipedia).

Comments from Twitter:

@alisha764: The "5 Second Rule" doesn't work: Food + Floor = Bacteria

Cleveland Clinic calls "Code Lavender" to improve patient satisfaction

From the WSJ:

How patients feel they were treated has always colored their opinions of a hospital. Now, those feelings are being factored into how hospitals get paid.

The Cleveland Clinic CEO, Dr. Cosgrove, says that in his own days as a top cardiac surgeon, he focused so intently on reducing complications from cardiac procedures that he gave little thought to the feelings or experiences of patients.

Times have changed dramatically since then. The Cleveland Clinic has launched a program known as HEART - for hear the concern, empathize, apologize, respond and thank—that empowers employees to handle patient concerns from the moment they arise.

It developed a Healing Services team to offer complimentary light massages, Reiki—a laying on of hands—aromatherapy, spiritual care from a clergy person or lay practitioner and other holistic services, and it will call a "Code Lavender" for patients or family members under stress who need immediate comfort.

Since 2008, the Cleveland Clinic's overall hospital ratings have increased by 89%.

"Code Lavender" has a Twitter account too (@CodeLavender), managed by the former Cleveland Clinic Chief Experience Officer who popularized the term.

From the Cleveland Clinic Twitter account: Efforts to improve patient satisfaction were featured in a NBC Nightly News story (see the video below).



References:

A Financial Incentive for Better Bedside Manner. WSJ.
Image source: Lavender Farm, Wikipedia, public domain.

Disclaimer: I was an Assistant Professor of Medicine at Cleveland Clinic from 2005 to 2008.

Comments from Twitter:

@TanyaPRpro (Tanya R. Walton): Clever and meaningful hospital care

@scottRcrawford: Brand medicine

@gruntdoc: How sad. Condolences. RT @DrVes: Cleveland Clinic calls "Code Lavender" to improve patient satisfaction goo.gl/X4Jtt

@MGastorf (Melissa Gastorf): concerns about satisfaction basis for payment- i.e. if you refuse to write narcotic and patient angry, physician payment suffers.

Pets Cause Many ER Visits For Owners Due to Accidental Falls

From Cleveland Clinic YouTube channel: Accidental falls are the leading cause of non fatal injuries in the United States according to the American Association of Neurological Surgeons, and a new study finds more than 86,000 of those falls are caused by cats and dogs.

Are you addicted to social media? Cleveland Clinic video

Adult stem cell infusion to treat MS - collaboration trial between Cleveland Clinic and Case

Cleveland Clinic, University Hospitals Seidman Cancer Center and Case Western Reserve University are collaborating on a clinical trial designed to treat the debilitating effects of multiple sclerosis by using a patient's own adult stem cells.

Mesenchymal stem cells, or MSCs, are found in the bone marrow. More than 150 clinical trials are currently testing MSCs' ability to encourage tissue repair as a way to treat a variety of conditions such as osteoarthritis, diabetes, emphysema and stroke.

In this trial, a patient's MSCs are harvested at Case's University Hospital, cultivated in a special laboratory and then injected intravenously back into the patient at the Cleveland Clinic.

See the two videos below that describe the project - the first is from the Cleveland Clinic and shows one of the patients, the second is from Case and focuses on the researchers:





References:

Clinical trials using adult stem cells to treat MS. Cleveland Plain Dealer.
Anti-CD20 monoclonal antibody ocrelizumab helps patients with relapsing-remitting multiple sclerosis (MS) (Lancet, 2011).

Related:

The Singing Doctor

From Cleveland Clinic YouTube chanel: Who knew doctors can sign? Hear the ENT doctor Paul Bryson sing the National Anthem sing at an Indians Game (Cleveland baseball team).

Comments from Twitter:

@scanman Wow!! Great voice!!

@DrSnit this was a lovely singing voice.

@faisal_q Working talent @ClevelandClinic

@gastromom Ruled out GERD ;)

Positive thinking: 1-minute video advice from a Cleveland Clinic psychologist

Positive thinking. Stop thinking bad thoughts. Scott Bea, Clinical Psychologist, offers a simple solution to negative thoughts. He discusses how mindfulness encourages positive thoughts. Uploaded by ClevelandClinic on Apr 4, 2011.

Sports Health With Cleveland Clinic (video)

There are a lot more sports health-related video from Cleveland Clinic on YouTube. I find many of these useful but they often don't get the numbers of views they deserve, for example the video embedded above was watched only 20 times as of 03/23/2011 (it was posted on 01/10/2011).

Collecting family history predicts cancer risk better than 23andMe genetic testing

Collecting family history predicts cancer risk better than 23andMe genetic testing, according to a recent study from the Cleveland Clinic:

As you're sharing fond family memories, don't forget to bring up family health history -- it's the best gift you can give. Dr. Charis Eng comments on a study she led looking at the important role of family history in predicting future disease risk.

Whole genome sequencing fails to predict risk of most common diseases, according to BMJ.

Related reading

Beware the fortune tellers peddling genetic tests - BMJ http://goo.gl/F0DQt

Family History and Personal Genetic Risk Assessments: A Perspective on the Cleveland Clinic Study. 23andMe.com.

FDA panel: genetic testing should not be available directly to consumers without what amounts to a "prescription". WebMD, 2011.
Genetic testing is available for approximately 2000 clinical conditions - Preparing for Precision Medicine - NEJM, 2012.
How to talk to patients about genetic testing  http://goo.gl/kkW4m

Comments from Twitter

@23andMe: See our perspective of Cleveland Clinic study - http://bit.ly/c373aj - bottom line is 2 aren't the same, so can't compare h2h. Also, we agree that family history is a very important piece, and believe it complements detailed genetic info.

New U.S. Diet Guidelines: No more than 1.5 gm of sodium/day, get off your "SoFAS" - Solid Fats and Added Sugars

This is a summary of the Cleveland Clinic commentary on the new U.S. Diet Guidelines via their Twitter account, provided by the dietitian Kristin Kirkpatrick:

Decrease in salt consumption

The main recommendation is a decrease in salt consumption. New recommendation is below 1,500 mg/day for at-risk populations. At-risk populations include African-Americans, people with high blood pressure or kidney disease, and people over 51. Americans not at risk can consumer up to 2,300 mg of salt per day (for now, until the next update of the guidelines - commentary of the blog author). Kristin Kirkpatrick: I think the 1,500 mg/day recommendation should apply to the entire population for many reasons. There is strong scientific evidence that limiting salt can help prevent heart attacks and stroke. The problem with the current recommendations is that nearly everyone will enter the at-risk population at some point in their lives. In order to decrease your risk for a number of chronic diseases, it is advisable to consume as little salt as possible.

How to cut salt?

77% of sodium consumption in the US is obtained through processed foods.

Limit any food that can sit on your shelf for two years and still taste great when prepared. Try to only consume foods that will eventually rot if not eaten in 10 days or so.

Learn how to cook! Take a cooking class or experiment at home. Use spices, herbs for flavor instead of salt.

Investigate your eating-out choices beforehand. A typical restaurant meal averages 3,500 mg/salt.

Don't purchase canned soup - make your own! Most canned soup is very high in sodium.

Sea salt has more minerals and is less processed, but it contains the same level of sodium (or more) as iodized salt.

Get off your "SoFAS" - decrease Solid Fats and Added Sugars

Another recommendation is to replace solid fats with fats that are liquid at room temperature.

Read your labels and keep any foods with partially hydrogenated oils out of your shopping cart. Partially hydrogenated oils are linked to increased "bad" LDL cholesterol and decreased good "HDL" cholesterol

Focus more on consuming plant-based foods than animal-based foods to decrease saturated fat intake.

Don't forget that any kind of fat - good or bad - has, on average, 100 calories per teaspoon.

Good fats include avocado, seeds and nuts, olive and canola oil. Keep good fats to 20-25% of total caloric intake per day.

Vary protein sources in the diet - add seafood

Another recommendation is to vary protein sources in the diet.

It is recommended people consume 8-12 oz. of seafood per week. That's about 2 servings. Aim for seafood choices that provide omega-3 fatty acids like wild salmon, sardines, halibut, and trout. Pregnant women want to avoid higher mercury fishes like shark, swordfish, and king mackerel.

Eat a variety of fruits and vegetables

Another recommendation is to eat a variety of fruits and vegetables. Make sure to include dark green, red and orange vegetables in your diet. Kale, peppers and beets are good examples.

Food fact: The darker the color of the vegetable, the higher the antioxidant content.

Aim to consume five handfuls of fruit per day. When possible, keep the skins on for extra fiber.

Consume half of grains as whole grains

Another recommendation encourages Americans to consume half of their grains as whole grains. It is better to consume all of your grains as whole grains, however. Consume breads that contain 100% whole grain or whole wheat. Read the labels! Switch white rice to brown rice.

Check your pasta! The only ingredient should be 100% whole wheat. If "whole" or 100% isn't in front of "wheat", put it back. Pasta doesn't need to be wheat-based. You could also consume brown rice pasta. Brown rice pasta is gluten-free.

Practice healthy eating EVERY day

Most importantly, practice healthy eating patterns every day.

Eat together as a family, and turn off the TV and smartphone during meals. Distracted eating causes you to eat 40% more. Stay within your individual caloric needs. With all these recommendations, portion control is still key.

References:

Dietary Guidelines for Americans. USDA.

New U.S. Diet Guidelines tell you what NOT to eat - Get off your "SoFAS" - Avoid Solid Fats and Added Sugars. WebMD.
Primary takeaway from the new U.S. diet guidelines: Enjoy your food, but eat less. NYTimes.
How We Eat: Analyzing Half a Million Meals - 5 INFOGRAPHICS

Image source: Cleveland Clinic logo.

Heart numbers to know - by Cleveland Clinic

Cleveland Clinic has been ranked the number one hospital in the U.S. for heart disease and heart surgery for the last 19 years. They must know what they are talking about when selecting the "heart numbers to know". This is the list by the cardiologist Dr. Richard Krasuski and the Clinic Twitter account.

Knowing your risk for heart disease depends on knowing and understanding some important numbers:

- Blood pressure should be less than 120/80 mm Hg

- Fasting blood sugar should be less than 100 mg/dL

- Total cholesterol less than 200 mg/dL

- LDL (bad cholesterol) less than 100 mg/dL, HDL (good) greater than 40 mg/dL

- Waist circumference should be less than 40 inches for men and less then 35 inches for women

- Body Mass Index (BMI) should be between 18.5 and 25. Calculate your BMI here: http://bit.ly/glMJE5

I worked at the Cleveland Clinic until 2008 and at that time the imposing building of the Heart & Vascular Institute was just getting completed:

Cleveland Clinic Heart & Vascular Institute

Image source: Cleveland Clinic logo.

Atrial fibrillation - Cleveland Clinic video

Atrial Fibrillation - Cleveland Clinic video with information for patients. Dr. Walid Saliba, Cleveland Clinic staff cardiologist, discusses atrial fibrillation, the most common irregular heart rhythm that starts in the atria.

After a lung transplant, an aria: a story of survival from end-stage pulmonary hypertension

TED talks: "You'll never sing again, said her doctor. But in a story from the very edge of medical possibility, operatic soprano Charity Tillemann-Dick tells a double story of survival -- of her body, from a double lung transplant -- and of her spirit, fueled by an unwavering will to sing. A powerful story from TEDMED 2011."

Tillemann-Dick was diagnosed in 2004 – at the age of 20 – with Idiopathic Pulmonary Hypertension, a disease that causes high blood pressure in the pulmonary artery, which connects the heart to the lungs. People with the disease typically have a two-to-five-year mortality rate after diagnosis.

Her physicians at Johns Hopkins put her on the lung transplant list at Cleveland Clinic. In September 2009, organs became available, and she had a double lung transplant. After a 13-hour surgery and 2 cardiac arrests in the OR, her recovery was extremely complicated but she is happy to be able to sing again.

If you have a minute, don't forget to check the comments on YouTube and the TED Talks site.

References:

Faith, Hope... and Charity. Cleveland Clinic.