Hip and knee replacement are two of the most commonly performed operations in orthopedic surgery. UCSF orthopedic surgeon Dr. Paul Toogood takes a closer look at what Total Joint Replacement actually is, how it improves your quality of life, and what some of the considerations are when having this surgical procedure.
Monthly Archives: June 2020
HEALTH: “UNDERSTANDING ARTHRITIS” – ORTHOPAEDIC TRAUMA INSTITUTE (VIDEO)
COVID-19: “SUPERSPREADING EVENTS” – HOW THEY LEAD TO 80% OF INFECTED PEOPLE
From Scientific American (June 23, 2020):
In fact, research on actual cases, as well as models of the pandemic, indicate that between 10 and 20 percent of infected people are responsible for 80 percent of the coronavirus’s spread.
Researchers have identified several factors that make it easier for superspreading to happen. Some of them are environmental.
- Poorly ventilated indoor areas seem especially conducive to the virus’s spread – A preliminary analysis of 110 COVID-19 cases in Japan found that the odds of transmitting the pathogen in a closed environment was more than 18 times greater than in an open-air space.
- Places where large numbers of people congregate – As a group’s size increases, so does the risk of transmitting the virus to a wider cluster. A large group size also increases the chance that someone present will be infectious.
- The longer a group stays in contact, the greater the likelihood that the virus will spread among them – The benchmark used for risk assessment in her contact-tracing work is 10 minutes of contact with an infectious person, though the CDC uses 15 minutes as a guideline.
- Some activities seem to make it easier to spread respiratory gunk – Speech emits more particles than normal breathing. And emissions also increase as people speak louder. Singing emits even more particles, which may partially explain the superspreader event at the Washington State choir practice. Breathing hard during exercise might also help the spread of COVID-19.
PROVIDERS: DARTMOUTH-HITCHCOCK CENTER FOR TELEHEALTH (VIDEO TOUR)
TeleHealth Services
Our Dartmouth-Hitchcock TeleHealth Service Lines include the following:
Outpatient Virtual Visits (formerly TeleSpecialty)
Outpatient Virtual Visits connect patients and health care providers to Dartmouth-Hitchcock specialists via scheduled outpatient TeleHealth visits. Outpatient Virtual Visits increase access to specialty care services for patients located in rural or underserved areas and improves the patient experience via more convenient access to specialty care with reduced travel. D-H Outpatient Virtual Visit services currently offered including specialty clinic appointments, direct-to-patient home visits and inpatient consultations.
TeleEmergency
TeleEmergencyprovides a board-certified emergency medicine physician and an experienced emergency nurse to join the bedside team, on-demand, 24/7. Using high-quality, two-way audio-video communication, the TeleEmergency team assists by whatever means requested, including nursing documentation, direct patient care, consultation, a second set of eyes, assistance with transfer coordination, acceptance, and/or transport.
TeleICN
TeleICN allows D-H Neonatologists to join your bedside team to serve the needs of you and your patients for a wide variety of diagnoses. Some babies require a higher level of care as they adjust to life outside of the mother’s body. The 24/7 support of ICN services helps keep patients and families closer to home by supporting clinical decision making and providing expert evaluations and recommendations. If a transfer is necessary, our specialized ICN team will assist in transporting that patient.
TeleICU
TeleICU provides experienced intensive care physicians and critical care nurses to augment, not replace, the bedside team. In addition, the service provides behind-the-scenes, high-level monitoring and sophisticated analytical algorithms to identifying concerning trends prior to patient deterioration. Not only does this result in decreased mortality and length of stay; it also allows more patients to get their ICU care close to home.
TeleNeurology
TeleNeurologyprovides board-certified neurologists on-demand 24/7 for Emergency Department and inpatient consultations. This includes not only stroke (including evaluation and recommendations, and assistance with tPA administration), but also assistance with other adult neurologic emergencies. This allows a lower cost coverage option for hospitals with limited or no neurologist access, improved tPA administration rates and decreased transfers.
TelePharmacy
TelePharmacyconnects hospitals to a team of dedicated pharmacists who can provide medication order review and processing as well as clinical consultation, allowing hospitals to optimize their internal staffing while remaining compliant with order review regulations. D-H TelePharmacy improves medication efficacy, patient safety and staff satisfaction while also supporting the integration of pharmacy delivery within hospital systems and/or regions, including protocols and order sets.
TelePsychiatry
TelePsychiatryenables prompt assessment and management of patients in the Emergency Department or inpatient setting for locations that do not have around-the-clock psychiatric coverage. Board-certified psychiatrists provide 24/7, on-demand assessments including expedited admit vs. discharge decisions, early management recommendations, and assistance with medication management, while improving the ultimate patient trajectory.
TeleUrgent Care
TeleUrgent Care provides back-up, support and consultation to Urgent Care providers by emergency medicine physicians via high-definition, two-way audio-video conferencing. TeleUrgent Care physician input can include general recommendations, real-time patient assessments, second opinions, advice regarding the need and timing of additional emergent or urgent evaluations, review of radiographic images, and assistance with volume surges.
INFOGRAPHIC: PHYSICIANS OFFICES (%) THAT USE TELEMEDICINE (JUNE 2020)
PATIENT EDUCATION: THE “2020 WEEKLY CROSSWORD PUZZLE CHALLENGE”
DR. C’S PODCAST: WEEKLY MEDICAL NEWS (JUNE 20)
DR. C REVIEWS MAJOR MEDICAL NEWS FOR THE WEEK ENDING JUNE 20, 2020.
MEN’S HEALTH: YOUR “FIRST PROSTATE CHECKUP” (UCLA)
Dr. Jesse Mills, Director of The Men’s Clinic at UCLA talks about what to expect during a first prostate checkup.
COMMENTARY
Prostate checking, especially by PSA, has been controversial in recent years.
The naysayers have cited statistics that show too many unnecessary operations on slow-growing, non-life threatening cancers lowering quality-of-life.
My old urologist was following a prostate nodule with yearly checks with PSA tests. He retired, and the enlightened, younger urologist, who replaced him, thought PSA superfluous.
A friend, also a Doctor, was similarly advised, dropped the PSA screening, developed high grade prostatic Cancer, and died of it.
I continued checking my PSA every 6 months, risking a positive test, leading to biopsy, leading to unnecessary treatment.
The UCLA prostate checkup video touts Prostate MRI as an intermediate step, and, in my mind validates my choice of continuing PSA screening.
—Dr. C
CORONAVIRUS: RESPIRATORY-DROPLET CONTACT IS MAJOR WAY COVID-19 SPREADS
From the Wall Street Journal (June 16, 2020):
Health agencies have so far identified respiratory-droplet contact as the major mode of Covid-19 transmission. These large fluid droplets can transfer virus from one person to another if they land on the eyes, nose or mouth. But they tend to fall to the ground or on other surfaces pretty quickly.
Some researchers say the new coronavirus can also be transmitted through aerosols, or minuscule droplets that float in the air longer than large droplets. These aerosols can be directly inhaled.
Sufficient ventilation in the places people visit and work is very important, said Yuguo Li, one of the authors and an engineering professor at the University of Hong Kong. Proper ventilation—such as forcing air toward the ceiling and pumping it outside, or bringing fresh air into a room—dilutes the amount of virus in a space, lowering the risk of infection.
Another factor is prolonged exposure. That’s generally defined as 15 minutes or more of unprotected contact with someone less than 6 feet away, said John Brooks, the Centers for Disease Control and Prevention’s chief medical officer for the Covid-19 response. But that is only a rule of thumb, he cautioned. It could take much less time with a sneeze in the face or other intimate contact where a lot of respiratory droplets are emitted, he said.
PREVENTION: “FORWARD CLINICS” ARE ALL-INCLUSIVE, FLAT-FEE PRIMARY CARE
Forward care is evidence-based, focused on prevention and improvement. Set goals and collaborate for better health.
- Connect Your Biometrics Sensors
- Receive your Sensor Kit
- Record measurements in the app
- Review insights together with your doctor
- Complete Your Labs at Home
- Schedule your at-home blood draw with a lab specialist
- Receive comprehensive results
- Create a Personalized Plan During Your Baseline Visit
- Discuss your health goals and concerns
- Review your biometrics and lab results
- Develop a personalized, preventive plan
- Answer Questions In-App for Insights on Your Mental Health
- Answer a short series of questions in-app
- Receive a measure for anxiety and depression
- Partner with your doctor on your results
- Customize Your Plan Based on Your Genetics
- Receive your Genetics Kit
- Review the results with your doctor
- Update your plan to address your risks
- See Your Doctor In Person for a Custom Follow Up Visit
- Request an in-person visit in the app
- Review your progress with your doctor
- Complete a physical exam and diagnostics
- Assess Your Skin Cancer Risk
- Complete a physical exam of your skin
- Capture high-definition images of any moles or blemishes
- Discuss your skin health and cancer risks with your doctor
- Receive a Message From Your Doctor to Update Your Plan
- Your doctor will check-in regularly
- Update your doctor on progress and goals
- Ask questions, anytime from anywhere
- Develop Nutrition Goals Based on Recurring Labs
- Review your latest labs with your doctor
- Develop a nutrition plan for targeted results
- Measure progress with future labs
COMMENTARY
Forward Healthcare differs from a conventional primary care clinic in several, generally good ways.
Most importantly, they stress PREVENTATIVE care. Blood tests that monitor diabetes, metabolic syndrome, and anemia are done regularly, since they have a laboratory on premises. They have their own EMR (electronic medical record) platform, and their own telemedicine platform, which are downloaded on the initial visit.
They give out a “sensor kit” consisting of temperature monitor, Pulse-oximetry, and a BP monitor, which wirelessly sends information to medical records.
Telemedicine is available through their own Downloaded platform. Although I get the impression that Telehealth isn’t as central as I would have expected in a technology oriented operation, it is increasingly important.
The monthly membership fee of $149 pays for the above and unlimited Doctor Availability 24/7 without copay.
Concierge Medicine has the monthly/yearly fee and unlimited access, but has a copay. Both will utilize your insurance, and neither treats patients in the hospital or provides referral care.
Government Health care is coming, and with it longer waiting times, shorter Doctor interaction times, and probably less time for Preventative Health Care.
Systems like Forward Health and Concierge Medicine will be the upper tier of a 2-tier system.
Proactive attention to Health in my opinion is essential in the future if we are to have a healthy nation, and not “bankrupt the system”. Telehealth is growing in importance, and offers help in making medical expertise more convenient, widely available and for less cost.
I am happy to see progressive Systems like Forward Health offer a preventative option to the present, broken, reverse-incentivized, fee-for-service System.
Doctors Without Waiting Rooms 