All posts by doctorswithoutwaitingrooms

EMPOWERING PATIENTS THROUGH EDUCATION AND TELEMEDICINE

TOP MEDICAL PODCASTS: ‘DIVERTICULAR DISEASE’ (BMJ)

Colonic diverticulosis refers to herniation of the mucosa and submucosa through the muscular layer of the colonic wall and may be the result of colonic smooth muscle over-activity. Diverticular disease may be defined as any clinical state caused by symptoms pertaining to colonic diverticula and includes a wide-ranging spectrum from asymptomatic to severe and complicated disease. 

Mohamed Thaha, Senior Lecturer & Lead Consultant in Colorectal Surgery, National Bowel Research Centre, Barts and The London School of Medicine and Dentistry, tells us more. 

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Podcast: ‘Health Policy After The 2020 Election’

Dr. Sherry Glied is dean of the New York University Wagner Graduate School of Public Service. Dr. Mark Pauly is a professor of health care management at the Wharton School of the University of Pennsylvania. 

Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. S. Glied. Health Policy in a Biden Administration. N Engl J Med 2020;383:1501-1503. M.V. Pauly. Health Policy after a Trump Election Victory. N Engl J Med 2020;383:1503-1505.

TELEHEALTH: ‘ADVANTAGES & DISADVANTAGES’ (HARVARD)

Telehealth is defined as the delivery of health care services at a distance through the use of technology. It can include everything from conducting medical visits over the computer, to monitoring patients’ vital signs remotely. Its definition is broader than that of telemedicine, which only includes the remote delivery of health care.

Telehealth can be delivered in one of three ways:

  • Synchronous—when the doctor communicates with the patient in real time via computer or telephone
  • Asynchronous—when data, images, or messages are recorded to share with the doctor later
  • Remote patient monitoring—when measurements such as weight or blood pressure are sent to the health care provider

What you can do with telehealth

All of the following activities and services are possible with the help of telehealth:

  • Recording measurements like your weight, food intake, blood pressure, heart rate, and blood sugar levels either manually, or through a wearable device, and sending them to your doctor.
  • Having a virtual visit with your doctor or a nurse over your computer or smartphone.
  • Using an online portal to check your test results, request prescription refills, send your doctor a message, or schedule an appointment.
  • Sharing information such as your test results, diagnoses, medications, and drug allergies with all of the providers you see.
  • Coordinating care between your primary care provider and any specialists you visit—including the sharing of exam notes and test results between medical offices in different locations.
  • Getting email or text reminders when you’re due for mammograms, colonoscopies, and other screenings, or routine vaccinations.
  • Monitoring older adults at home to make sure they are eating, sleeping, and taking their medications on schedule.

Downsides to telehealth

Telehealth offers a convenient and cost-effective way to see your doctor without having to leave your home, but it does have a few downsides.

  • It isn’t possible to do every type of visit remotely. You still have to go into the office for things like imaging tests and blood work, as well as for diagnoses that require a more hands-on approach.
  • The security of personal health data transmitted electronically is a concern.
  • While insurance companies are increasingly covering the cost of telehealth visits during the COVID-19 pandemic, some services may not be fully covered, leading to out-of-pocket costs.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #18: SKIN INFECTIONS

The skin is the protective barrier between the inside of our bodies and the outside world of microorganisms, parasites and toxins. It is often the site of inflammation and infections.

In past times, before the advent of cleanliness and antibiotics, mankind was plagued by erysipelas, boils, carbuncles, and other severe infections of the skin, which are rarely seen now. The beta hemolytic streptococcus and Staphylococcus aureus were ubiquitous in the past, and mostly are contained today.

Severe Infections presently require some skin abnormality, immune deficiency, neglect, animal bite or other breach of skin integrity to be a problem. Antibiotic resistance, however, is allowing some organisms like MERSA to make a comeback.

ECZEMA. or Atopic Dermatitis, was common in my medical practice. This condition weakens the skin barrier, allowing Staphylococcal infection to gain a foothold. In my day, If there were a flare of eczema severity, antibiotics would often help. Leg edema and swelling. such as from heart failure, especially coupled with diabetes and blood vessel disease is also an invitation to infection, such as cellulitis.

Redness, swelling, warmth and pain- the classic rubor, tumor, calor and dolor- as well as swollen local lymph nodes and fever often betray infection of the skin. Please see the recently posted infographic on celulitis.

IMMUNE DEFICIENCY raises the likelihood and risk of severe skin infections. Infection from “flesh-eating bacteria”, often beta hemolytic streptococci in deep tissue planes , is a medical emergency. Immediate surgery is often needed.

Disproportionate PAIN after injury or surgery is often a clue. Certain age groups have characteristic skin infections, such as the scalded skin syndrome of infants, and the acne of adolescents. Viruses, molds, and arthropods can also infect the skin.

Viruses, such as herpes in particular can simulate bacterial infection. Ringworm from fungi is easy to distinguish, but arthropod bites, and especially bee sting can look very much like bacterial infection. Scabies and mite infestation are so itchy as to be distinct.

Topical antibiotics applied on skin breaks like cuts or breaks are useful in preventing infection. These ointments and creams are like “artificial skin”. Once again, prevention is key.

–Dr. C.

CDC INFOGRAPHICS: ‘HEAT STROKE & HEAT EXHAUSTION’

COMMENTARY:

THERMOREGULATION, preservation of the normal body temperature, is well developed in humans, and monitoring the body temperature has been useful since the development of thermometers.

Indirect measurement by Infrared detectors is being widely used today to detect FEVER as a sign of Covid in gatherings such as schools. Reactive increase of body temperature in a cool environment is a body defense mechanism that I have discussed earlier. Contrary to general practice, Fever, in my opinion, should be left untreated unless excessive, such as above 103 degrees F., or even 104 degrees.

Excessive environmental temperature, such as in a closed car, Jacuzzi, or heat wave can defeat the body’s ability to defend the normal temperature. Children, with their high body surface to mass ratio, are particularly at risk, as periodic newspaper articles testify. HEAT STROKE is the most serious of heat-related illnesses, leading to high and increasing body temperature, mental symptoms, even convulsions, and is a MEDICAL EMERGENCY.

The treatment is to call 911, and to lower the body temperature by removing insulating clothing, and immersing in cold water. There are a variety of other conditions based on excessive exertion, water or salt loss.

These include HEAT EXHAUSTION. Older Workers are particularly susceptible, and medical clinic attention may be needed for fluid and electrolyte replacement. MUSCLE CRAMPS and even damage( Rhabdomyolysis), FAINTING (this has been discussed before) and Heat Rash can result from too hot an environment. Furry Animals Pant instinctively to get their highly vascular Tongue to “air condition” their bodies. Humans should dress and exercise appropriately when the environment requires it.

–Dr. C.