Retail health clinics: The pros and cons

Retail health clinics: The pros and cons - We moms tend to worry about our children a lot, and think of ways to help them, even when they are older. Case in point: I can not wait to tell my college-age son Chris about my last useful idea because-I-Care. 

It stems from an incident last year when Chris had the flu and ended up going to the emergency room and local university clinic had a wait of two days. This year, I'm Chris arm with a backup: retail clinics.

Retail clinics are part of the great trend for health care is the most convenient. "Twenty years I had to go to an emergency room if he became ill and needed immediate attention there. 

Now we have an explosion of options, such as retail health clinics, "says Dr. Ateev Mehrotra, a researcher on the topic and associate professor of health policy at Harvard Medical School.

Clinical

Health clinics began to appear in retail 15 years. Today there are about 2,000 clinics in the United States, located mainly in pharmacies, grocery stores, settings "big box" and other large distribution chain. 

The clinics are usually open 7:00 to 7:00 p.m., seven days a week and are attended by a nurse or physician assistant. They offer all kinds of health services: everything from the treatment of minor illnesses such as colds, conjunctivitis and urinary tract infections, complete physical examinations (including laboratory work and exams), vaccines and even help you quit smoking.

Pros

Retail health clinics have many advantages. They are easy to enter, with extended and no appointment necessary hours.

Prices have been set for each service, which can be previewed on its website. For example, a tour of wellness is $ 59 at Walmart. CVS cholesterol test is $ 59 to $ 69 "We found in our clinical data that are 30% to 40% cheaper than visiting a doctor, and 80% cheaper than a visit to the OR emergency, "says Dr. Mehrotra. the clinics also have private insurance and Medicare.

But the weaker results of the price of the lower quality of care? "We found that the quality of care in retail clinics is equal or superior to the offices of some doctors, because the clinics are more likely to follow national guidelines for care," says Dr. Mehrotra.

Less

Despite all the advantages, retail health clinics may not be suitable for everyone. "Health care is different for older people. The care that you need, even for a simple problem may be more complicated.

For example, a urinary tract infection affects a very different older woman a younger woman, with wife Elderly at risk of dehydration, confusion, falls, and even sepsis, "says Dr. Mehrotra. And if you have a chronic health problem, a simple illness could indicate something big that could only be made by a doctor who sees you regularly, such as your primary care physician. 

Geriatrician Dr. Suzanne Salamon, assistant professor at Harvard Medical School, is concerned that the details of a patient visit to a retail health clinic are sent.

Although the clinics offer this service, everyone takes them on it. "The risk that scattered attention of several locations can be misleading," says Dr. Salamon. "And if people do not take their full lists of drugs at a clinic, the clinic may prescribe something that will interact with medications they are taking."

What to do

A report of the American College of Physicians recently published in the journal Annals of Internal Medicine said that retail clinics are fine for a short-term illness or a backup when you can not see your doctor. 

But they should not replace a long-term relationship with a primary care. "Going to a clinic in the minute is fine for minor problems, such as a vaccine against the flu or a sore throat, especially if you are generally healthy," says Dr. Mehrotra.

This means lower health clinic would be an excellent choice for my son Chris, or for anyone who is generally healthy and need to consult a healthcare professional immediately. However, there are still some things to keep in mind if you visit a retail clinic, even for a vaccine against the flu:

      * Bring a list of your medications with you.
      * Until your doctor your medical history and any health condition you have.
      * Ask the clinic to send details of the visit to your doctor.
      * Consider a follow-up appointment with your doctor if you have time, so that everyone is on the same page with regard to maintaining your health.

Follow these tips, and is likely to yourself, give your doctor and mother "even good ol some peace. Right, Chris?  
By: Heidi Godman

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Where it is best for the birth: the hospital or at home?

Where it is best for the birth: the hospital or at home? - In the second half of the 20th century, the birth of the hospital had become the norm in most Western countries. 

Hospital birth monitors and interventions, many of which saved the lives of mothers and babies. At the same time, births have become more and more - and some would say unnecessarily - medicalized.

Many might also argue that the pendulum has swung too far procedure. For example, from 1970 to 2010, the caesarean section rate US It doubled - but (if both are low) risk of a baby dying during delivery was unchanged, and the risk of dying mother little Rose. In an apparent effort to avoid unnecessary intervention, and find an alternative for the room environment, it is not surprising that some women have turned again to home birth.

Home birth safe?

We do not have better data to answer this question. The ideal way to respond would be a randomized controlled trial. But the random part (the place of delivery would essentially be decided by the draw) would be unacceptable to most women.

So instead, women and their doctors have had to rely on after analyzing the reality of large sets of administrative data (such as information recorded on birth certificates). 

There are some problems with this type of analysis.

There may be differences between women who give birth at home and those who delivered at the hospital are not counted in the time to draw conclusions. For example, a woman may choose to give birth at home because she does not have access to care, and can therefore be more likely to suffer complications. 

On the other hand, maybe the women who choose home birth focuses on a lifestyle designed to prevent problems and health interventions in general (healthy diet, not smoking, etc.). 

So when evaluating the results of the home birth, it is possible that the results are due to factors on the woman herself both as a place where you have your baby. 

One of the things that make mockery of these hard data is that until recently, there was no way to distinguish between planned home births and planned home deliveries. planned home births may include factors that make home birth are riskier than it may actually be (eg, birth due to unexpected emergencies or in women who have not had access to regular prenatal care ). 

On the other hand, counting the deliveries from the house, but can not be completed as "hospital births" could hide the risk of delivery at home complicated.Women and those who care about their health and have been an urgent need for better data and analysis.

A single set of data gives an idea

A recent article in the New England Journal of Medicine describes a study in which the Oregon researchers have managed to overcome some of these data problems. Oregon birth certificate register if an expected mother to give birth at home or in hospital.

The researchers also had access to information about the health of the mother (such as diabetes or high blood pressure), which puts them at higher risk for problems during labor and delivery. For the study, the researchers excluded planned home births and that included what appeared to be healthy singleton deliveries (no twins or more). 

In its analysis, the risk of dying of a baby was small in any context, but the group is providing 1.8 per 1,000 for planned hospital births compared to 3.9 per 1000 births for unplanned outside the hospital.

Provided outside the hospital at birth was also associated with lower Apgar scores and a greater likelihood that the baby has a crisis or need a respirator, and a mother who had need a blood transfusion. 

However, planning for home delivery has also been associated with lower rates of admission need a baby to an intensive care unit and a lower rate of obstetric interventions, including the use of drugs or other ways to start (induce) or strengthen (increase) labor or vaginal forceps or vacuum delivery, cesarean delivery, and severe lacerations of the vagina.

What this means for women and their doctors? 

These results are consistent with other studies of sense to me, since many obstetricians. Sometimes an emergency occurs and you have the tools, medicines and facilities to respond quickly can make a difference. But have all these things on how the hand can also be used in cases where doing nothing would have been just as well. 

It is important to recognize that although the risk of problems for the babies was "superior" in the home birth group are not "high" in both groups. The difference was considered in absolute terms of the order of 0.5 to 2 infant deaths per 1,000 births. 

This risk is similar to other options supported in obstetric care, as a trial of labor after a cesarean past. The group home birth had lower rates of caesarean section and other complications that can affect the health of the mother. 

The risks to be considered for each option are very different, but this data can help women make decisions based on what they value most.

 

Finally, about 15% of women planning home birth requires a transfer to the hospital. Note that currently, there are no national standards of the United States to integrate home birth in a continuum of care.  

There are no agreed criteria to help identify good candidates for home birth, and there are rules to ensure adequate training for assisted home births. We need these systems and criteria to the US You should consider matching the recent call in Britain to encourage and support home birth. 

By: Jeffrey Ecker, MD.

 

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Guns and health

Guns and health - People choose to possess weapons for several reasons: hunting, shooting, picking ... The number one reason is for protection now. 

As physicians, we also care about your protection. Our mission is to treat the disease, promote quality of life and prevent injury and death. Health and safety issues are discussed confidentially, without prejudice. We asked to depression, domestic violence, and drugs.

We make recommendations on the practice of safe sex and the use of seat belts. But some believe that doctors should not talk about guns. In fact, Florida has passed legislation restricting such discussion. But weapons will affect health and safety.

In the US, the number of deaths by firearms continues to increase (currently at about 33,000 per year, far more than any other developed country per capita) and is expected to exceed the death of motor vehicles in 2015. It is the second cause of death among children.

Death by association 

Weapons have been successfully used in self-defense. But the reality is that owning a gun is associated with an increased risk of injury or death family. Manslaughter and suicide attempts or completed are far superior to the use of firearms in self-defense. 

In fact, more households have guns in a particular state, most firearm deaths there - even after adjusting for crime, unemployment, urbanization, alcohol and poverty. 

And which is intended to be protected can be a threat. In an unauthorized entrance examination in homes, 1.5% of reported cases with a gun to defend himself, but twice that of the loss of his gun the intruder.

Moreover, most homicides (54%) are committed by someone known to the victim and another 25% were for the family, especially with firearms. When you have access to firearms in the house, the risk of dying from domestic violence of women quintupled.

Suicides 

As the possession of weapons has increased, so has the number of suicides. Two-thirds of gun deaths are suicides. However, firearms owners have more mental health problems, depression or suicidal thoughts than those without weapons. The problem is more easily accessible. Nobody thinks it could happen to them or their families, but many suicide attempts are unexpected and done on impulse.

Damage to children

Children also use weapons to commit suicide; 82% of suicides involving firearms in the house, most of the time stored unlocked. When suicide attempt, 90% of children do when firearms are used, compared to 5% by other means. It is difficult to prevent because young people often act impulsively and may have signs such as suicidal thoughts. 

Children often accidentally thrown by a friend or a brother. We think we know our children - but do not underestimate the secrets they keep. One study found that parents often mistakenly believe that their children had never handled their weapons. One third of children said otherwise.

Choose wisely

Weapons are your good choice. But know that even weapons can protect, chances are higher that they will hurt those who intend to keep. Education and commitment can help us work toward acceptable means to stem the rising tide of deaths related to firearms. That's why I'm going to talk to my patients the security of firearms.

What can you do?

       * If you plan to bring a weapon, consider the real risks for you and your family. If there is a history of domestic violence, or if someone in your family suffers from depression, consider removing any weapon.

       * If you choose to have a gun, keep it locked. Although this will not eliminate all risks, arms locked away will probably be less prone to theft and curious children. The Bureau of Justice estimated that firearms were stolen 1.4 million between 2005 and 2010, mainly domestic burglaries. 

       * If you decide to have a gun, store it with the button and ammunition separately. Explore the latest features and new technologies unlocked scanning and storage of fingerprints gun safety locks.

       * Before your child goes to a playdate, consider asking parents if they have a weapon, and if they are stored safely. This may be difficult at first. One day it might come as easy as asking about food allergies and safety seats for carpooling.

       * Talk to your children about what to do if they find a gun, or if your friend wants to show a weapon. Advise them, "Do not touch the gun, immediately leave the area and tell an adult."

       * Research on Firearms Support injuries so we can better understand the problem and find solutions. Research on the prevention of firearm injuries CDC stopped after funding was excluded for nothing interpreted as promoting stricter laws on weapons.
By: Wynne Armand,MD

 

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Why your baby may need wheezing TLC, not drugs

Why your baby may need wheezing TLC, not drugs - When a baby is sick with fever, coughing and wheezing, it is natural to think that they need is a drug - as an antibiotic, or one of the drugs used to treat wheezing in children with asthma (like albuterol). It is only if a condition called bronchiolitis is the culprit, the best treatment is no treatment. 

Bronchiolitis is a bad cold (caused by several viruses) that is installed in the lungs. When he does, leading to fever, heavy congestion, coughing and wheezing or noisy breathing. It is incredibly common.

In fact, five babies under 12 months ending in the doctor's office for bronchiolitis - and 2% to 3% until the end of hospitalization. It can be very serious, especially when it is caused by a particular virus called respiratory syncytial virus (RSV).

So here in the US It is rarely fatal, in other countries with less medical resources, thousands of babies die each year of bronchiolitis.

If it can be so serious, why the latest guidelines say doctors should not use antibiotics, albuterol, or other treatments? Because it does not help - and can have side effects that are not good for babies. 

Not that we can do nothing to help children with bronchiolitis. We just have to help in different ways.Some babies have a higher risk of getting really sick with bronchiolitis. Including premature babies, babies with lung disease or heart disease, and those who have problems with their immune systems are included.

For babies, it is recommended that they receive a monthly injection, called Synagis during the winter (around September-March) to help prevent RSV. If your baby falls into one of these categories and is under a year, you should definitely talk to your doctor about this treatment. 

For other babies, what we recommend is that families and caregivers use non-medical ways to help them feel more comfortable and breathe better. They understand:

       * plenty of fluids - dehydration can make things worse congestion
       * a humidifier to loosen congestion
       * a pear to clear the baby's nose (nasal saline drops, available in all pharmacies, can help you get the most out of the nose)
 
       * acetaminophen or ibuprofen for fever.

You should always consult your doctor if you think your baby has bronchiolitis and your doctor may want to see the baby to ensure that nothing is done that needs treatment. You should also call your doctor if, after being diagnosed with bronchiolitis, your baby grows

       * high fever (over 102 degrees F), or a new bout of fever after being sick for a few days
       * shortness of breath that is not relieved humidifier or bulb syringe (signs include shortness of breath or rapid breathing, sucking around the coast)

       * a pale or blue skin
       * sleepiness and irritability which is much worse than normal
       * refusal to take fluids, or not wetting diapers every 6 hours.

It is more likely that they are not going to happen, and that your baby is well. As with medicine and parenthood that most babies with bronchiolitis need a lot of TLC - and a little patience.
By: Claire McCharthy, MD. 

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What happens when you faint?

What happens when you faint? - You were watching the news on CNN recently, when the anchor Poppy Harlow collapsed during a live? She spoke in a graphic on the screen at the time, over a period of 10 seconds or more, his speech was halting and paste - and then there was silence.

With the schema in the approval rate of President Obama is on the screen, the issue moved to a commercial.

After a brief stuffed CNN colleague, Ms. Harlow, who is pregnant, has reappeared and assured his audience that was fine.

She explained that she was a little hot, fainted briefly, and now it felt good. She closed the show and quickly informed his doctor. Soon after, she tweeted that she and her baby were fine. The video series was widely distributed. It is not every day that you can see (or hear) someone low on live television. But have you ever wondered exactly what is fainting?

Fainting is not just one thing

As the term is commonly used, fainting is a sudden and temporary loss of consciousness. The medical term is "syncope" which comes from "syncope" Greek meaning "contraction" or "cut". 

It is an appropriate term because syncope occurs due to a sudden reduction of blood flow to the brain. Syncope is common: nearly a third of people report having at least one episode of loss of consciousness during his lifetime. 

But while "fading" is commonly used to describe people in good health low may be due to a number of conditions, ranging from harmless to life threatening.

Some of the most common causes of fainting include:

    * Vasovagal syncope. The name of the report refers to increased activity of the vagus nerve which signals the heart to slow down and blood vessels ("vasopressin") to open. This combination of effects results in a drop in blood pressure and too little blood flow to the brain.

The sight of blood or emotional or physical stress are common triggers of this condition. Straining during defecation or even strong cough can also cause vasovagal syncope. And therefore can a hot or a sense of panic or claustrophobia.

   * Abnormal heart rhythm. If the heart rate is significantly slower or faster, blood pressure and fainting can fall may follow. Among the many triggers an abnormal heart rhythm are heart disease itself, certain medications, or an overactive thyroid gland.

    * Orthostatic hypotension. This term means a drop in blood pressure that develops during the movement of the supine to standing or sitting. Dehydration, medication or drugs (including alcohol) and blood loss are common culprits underlying. The condition also becomes more common with age.

There are many other causes of fainting, such as blood sugar or seizures. But in many cases you can not find the cause. 

Although nearly 75% of people who do not have anything serious vanish as the cause, it is important to have controls to ensure that you are in that 75%. And even when he did not find anything serious, many people get injured if they fall when they lose consciousness.

People who lost consciousness and occupations involving passengers or heavy machinery operation may be recommended to restrict activities that could themselves or others at risk if they are still missing. 

Pregnancy is another condition that can make it more likely fainting. Blood vessels tend to dilate during pregnancy and blood pressure is usually on the low side. Not much to drop enough to cause fainting blood pressure.

When fainting is fashionable 

In some circumstances, fainting in a specific signal - "fade" or "fail" - has become a cultural expectation. For example, it was common for aristocratic women of Victorian England for a low particularly dramatic moment.

Examples abound of "hysterical fainting" where a lot of people close to each other begins to fail due to a common illness or exposure to a toxin or even a curse. And then there is the game we played in the gentle district intentionally: we breathe deeply and rapidly for some time and then hold our breath and push. It has never worked for me - which is fortunate, because it can be dangerous.

The bottom line 

The circumstances of the disappearance of Poppy Harlow - a warm atmosphere under the studio lights, pregnancy and stressful job - seem more than enough to trigger an episode of fainting. But it was the right thing to be checked by your doctor. In fact, perhaps the only surprise of fainting - including recent event Poppy Harlow in the air - is that this does not happen more often. 
By: Robert Shmerling, M.D.  

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