Conclusion Among patients with knee or hip OA using analgesics, more than half either discontinued analgesic use or shifted to lower risk analgesics following an 8-week structured exercise therapy and patient education programme (GLA:D). These data encourage randomised controlled trial evaluation of whether supervised exercise therapy, combined with patient education, can reduce analgesic use, including opioids, among patients with knee and hip OA pain.
Answers to last weeks puzzle below:
From 2019 to 2020, there was a substantial increase in the proportion of older adults who reported that their health care providers offered telehealth visits. In May 2019, 14% of older adults said that their health care providers offered telehealth visits, compared to 62% in June 2020.
Similarly, the percentage of older adults who had ever participated in a telehealth visit rose sharply from 4% in May 2019 to 30% in June 2020. Of those surveyed in 2020, 6% reported having a telehealth visit prior to March 2020, while 26% reported having a telehealth visit in the period from March to June 2020.
Over the past year, some concerns about telehealth visits decreased among adults age 50–80 whether or not they had a telehealth visit. Older adults’ concerns about privacy in telehealth visits decreased from 49% in May 2019 to 24% in June 2020, and concerns about having difficulty seeing or hearing health care providers in telehealth visits decreased from 39% in May 2019 to 25% in June 2020. Concerns about not feeling personally connected to the health care provider decreased slightly (49% to 45%).
Folic acid has a secure place in my medicine cabinet, and is there for one of the best reasons. In screening for possible causes for heart disease, my doctor ordered a HOMOCYSTEINE LEVEL. The Laboratory value came back elevated.
The treatment given was folic acid. Some background is necessary. Homocysteine is a rather toxic amino acid that can cause heart disease and neurological problems, among other things. If you do not get enough folic acid in your diet with green vegetables, legumes, nuts, eggs and the like (it is hard to be deficient with a good diet), your Homocysteine may become elevated.
You need folic acid to convert Homocysteine to the essential amino acid, Methionine. 10-15% of the population, and up to 30% of older people have elevated Homocysteine levels. Stiffness, slow gait, and heart disease can be related to these elevated levels.
Since I have a good diet, I assume that I have a weak form of an enzyme called Tetrahydrofolate Reductase, which is the rate limiting enzyme in converting Homocysteine to Methionine. A weak enzyme needs more folic acid to do its job. The MDR of Folic acid is 0.4 mg./day. I started supplementing with 1 mg. Daily, without effect on the Homocysteine level. I doubled the dose to 2 mg., and my blood level was still above the upper limits of normal, 15 micromoles/L.. I doubled it again to 4 mg., 2 mg. Twice daily.
Finally my level became normal at 10, This was a decade ago. Recently, I have been doing some research on Alzheimer’s Disease, because a Friend is losing her short term memory. I talked to a neurologist to see if a medical evaluation was mandatory, and found that he has recently BEEN GIVING FOLIC ACID supplements to his AD Patients.
Folic acid deficiency is now being suspected as being a factor in AD! This story is similar to the Vitamin D conundrum. Should I take Vitamin D or not? Am I a “believer” or not. The resolution is easy. You get a Vitamin D blood level.
The lab test will report “normal” if your level is above 20 ng,/ml. I prefer 50, which I achieve with 4000 i.u. Daily supplement. The NFL likes their players to be above 50 to be in best shape. The point is, take a measurement, and then decide.
If you chose to take a Folic acid supplement, I would suggest checking both your Folic acid blood level, and Homocysteine blood level as a reference.
Also, if you take folic (B9) supplements, you should also take extra B12, and B6, since they are involved in the same metabolic pathways. Balance is necessary in metabolism.
By providing house calls and telemedicine from physicians at a fixed monthly fee with no copays, no deductibles, and no insurance required, Heal Pass is making affordable healthcare possible for the estimated 27 million Americans who recently lost their health insurance along with their jobs because of COVID-19.
- Heal patients can register now for the new service starting at $49 per month.
- Adults can add members of their household to their Heal Pass account for an additional $10 per person each month and may register up to six people to the account.
- Patients spend an average of $800 out of pocket each year, in addition to $2,000 for an emergency room visit.
- With Heal Pass, a family of four would receive up to 36 total appointments at an average cost of less than $27.
- Individual patients can save up to $1,100 per year and the average family can save up to $2,200 per year.
Uninsured individuals and their families are fearful of getting sick and accumulating high medical bills during this time of economic uncertainty.
Heal Pass is not health insurance, but it is health assurance, giving the uninsured the comfort of knowing they can get the care they need at a fixed, low fee with no surprise bills or out of pocket costs.
The new program allows up to eight house calls or telemedicine appointments per member each year in addition to an annual physical, helping with patients’ most common needs, including primary care, preventive care, non-emergency urgent care and chronic disease management.
It also includes free next day delivery of medications prescribed by a Heal doctor. Heal doctors are highly qualified and deliver house calls and care in a way that keeps patients safe from COVID-19 exposure as the country sees a pronounced second spike with 58,618 cases per day on average over the last seven days.
Telemedicine and Covid 19 are fermenting together and creating some new ideas for medical care.
Safety is a concern, and what could be better than your own home, using telemedicine, or a futuristic telemedicine booth located at convenient locations for the busy traveler?
Convenience is another attraction, with a PREPAID aliquot of healthcare; this idea was featured by Forward Health, reviewed a couple of weeks ago, which offered a package of remote monitors and 24/7 access for $149 per month.
Now, Heal pass offers 24/7 access they call “house calls” for $49. a month, with a blizzard of statistics on what you will save. We will see.
You usually get what you pay for.
The Onmed station sounds doable, and has the advantage of self-contained units that may be available to you at the right place and time. You could conceivably even wind up with a prescription as you exit the booth.
From Penn Medicine (June 24, 2020):
After surveying almost 800 gastroenterology and hepatology patients and their physicians at Penn Medicine, 67 percent of both viewed their video and telephone appointments held during the peak of the COVID-19 pandemic as positive and acceptable substitutes to in-person appointments.
From March 16 to April 10, 2020, 94 percent of gastroenterology and hepatology appointments at Penn Medicine were performed using telemedicine in order to mitigate risks of COVID-19 spread while continuing to advance care as patients self-isolated at home. A telemedicine visit meant either a video visit (similar to FaceTime or Skype) or one via phone in which clinicians largely performed routine and non-urgent care.
From Healthcare IT News (June 12, 2020):
Technology-enabled workflows now enable patients to complete most of the registration formalities prior to the visit, be it a virtual consult or a clinic visit. Registration kiosks in hospital lobbies may soon be enabled with facial recognition software to eliminate the need for touching any surface.
Routine examinations are also going virtual, with many diagnostic procedures now possible through remotely controlled devices. Caregivers are beginning to do their patient rounds through virtual visits. This trend will only grow in the coming years.
A vast and growing array of automated communication tools allows caregivers to use rule-based messaging to push everything from health coaching, post-discharge care instructions, and appointment reminders through IVR, text, SMS, and mobile alerts.
From McKinsey & Company (June 11, 2020):
For the past 10 to 15 years, virtual health has been heralded as the next disrupter in the delivery of care, but there has been minimal uptick in adoption. The COVID-19 pandemic is pushing against structural barriers that had previously slowed health system investment in integrated virtual health applications.
Health Providers, especially the systems and networks, are the key to “next Generation” health care delivery. They are the main target audience of this article. If they invest in Telehealth, and make it easy and integrated, Patients will adopt Telemedicine happily.
The article Classified the elements of the future Telehealth, citing Telemedicine As the digital equivalent of the traditional Doctor-Patient verbal Interaction. They call this “synchronized” Telehealth.
Everything else, the myriads of other activities that comprise the totality of health care, is labeled something else. The Patient is involved in some of these activities, such as being monitored by a device at home, being the recipient of her records or medications, or even interfacing with technology as in “E-triage”.
Many interactions such as Doctor-Doctor, Doctor-Pharmacist, Doctor-insurance, Rounding, To mention a few, take place away from the Patients’ sphere. The REAL change will be when these are Eventually taken over by Computers, aided by Artificial intelligence.
In the meanwhile, Providers should invest in Technology to remain competitive. Also, it goes without saying, Patients should invest in Knowledge and Technology if they are to get the most out of this new Reality.
Penn Neurology shares tips to help you complete a successful telemedicine visit. Learn what items you should have readily available for your Neurology appointment, as well as how to position your device, choose your lighting and more.