You signed up to be a doctor, not a martyr
Dear doctor,
I need you to be healthy. When I come to you for help, I need your “A” game. I need you sleep enough. Eat healthy food. Not too much. Mostly vegetables. I need you to exercise regularly and take time to take care of your own physical, emotional and spiritual needs. I need to you use the bathroom when you need to. I need you to stop and take a deep breath when you are frustrated. I need you to deal with your relationships in healthy ways. Get the help you need to be healthy. Take time for yourself. Find quiet space for creativity. Enjoy the sun on your cheeks on occasion.
I need you to laugh with yo...
Source: Kevin, M.D. - Medical Weblog - April 6, 2016 Category: Journals (General) Authors: Kathy Stepien, MD Tags: Patient Primary care Source Type: blogs
A Rose by Any Other Name...Complimentary Therapies in Palliative Care
by Susan Thrane, RN, PhDNon-western, non-medical, non-allopathic modalities have been called by many names: complementary and alternative medicine (CAM), integrative, supportive, adjuvant, placebo and hooey just to name a few. Whatever you call them (I prefer complementary or integrative), modalities such as massage, yoga, aromatherapy, guided imagery, meditation, energy therapies such as Reiki, Healing Touch, Therapeutic Touch, or creative art therapies (these include dance/movement, art, and music therapies provided by a trained therapist) do require training for the person providing th...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 5, 2016 Category: Palliative Care Tags: adolescents alternative therapy cam children complementary therapy infants integrative therapy palliative care pediatric pediatrics symptoms Source Type: blogs
MKSAP: 32-year-old woman is evaluated for anticoagulation management
A 32-year-old woman is evaluated for anticoagulation management after an uncomplicated vaginal delivery of a healthy newborn. She was diagnosed with a bilateral pulmonary embolism at 25 weeks’ gestation and was treated with therapeutic low-molecular-weight heparin (LMWH). The LMWH was discontinued at the onset of labor and was restarted 6 hours after delivery. Medical history is otherwise unremarkable, and her only medication is full-dose LMWH.
Anticoagulation for 3 months is planned. The patient wishes to breastfeed her newborn.
Which of the following is the most appropriate anticoagulation option for this patient?
...
Source: Kevin, M.D. - Medical Weblog - April 2, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Medications OB/GYN Source Type: blogs
Rooming In: The Newest Birthing Controversy
Hot on the heels of media stories about the importance of screening for post-partum depression, a debate about whether to have newborns stay in hospital rooms with their moms vs. providing nursery care for the infants is emerging. It’s an interesting topic, but binary responses to the debate do little to recognize that “one size fits all” solutions may not be sound.
The benefits of rooming in instead of providing nursery care are well known. Both research-based and anecdotal reports suggest that rooming in correlates to a lower incidence of post-partum depression in new mothers and reduced breastfeeding problems for ...
Source: Disruptive Women in Health Care - March 25, 2016 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Childbirth Patients' Rights Policy Women's Health Source Type: blogs
Health Policy Brief: Workplace And Public Accommodations For Nursing Mothers
A new policy brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) examines federal and state laws concerning workplace and public accommodations for nursing mothers in the United States. Because of breastfeeding’s proven health benefits to infants, the Affordable Care Act (ACA) contains several provisions to help increase the number of nursing mothers, with specific target goals by 2020.
The American Academy of Pediatrics supports exclusive breastfeeding for the first six months of a baby’s life; however, the Centers for Disease Control and Prevention estimated that in 2011 only 19 percent of new mot...
Source: Health Affairs Blog - March 18, 2016 Category: Health Management Authors: Lucy Larner Tags: Elsewhere@ Health Affairs Featured breastfeeding Fair Labor Standards Act Health Policy Brief Nursing Source Type: blogs
Prophylactic Mastectomies Increasing Despite No Survival Benefit
One of the more concerning trends in breast cancer treatment is the growing use of bilateral mastectomy to treat breast cancer that is present in only one breast. We call this prophylactic contralateral mastectomy – or removal of a normal breast in order to prevent future breast cancer.
A new study of almost half a million women with breast cancer reports that in 2009, 12.7% chose to treat cancer in one breast by removing both breasts, a rate almost triple that in 2002. Unfortunately, the additional surgery added no benefit, as survival rates were no better among women who had bilateral mastectomy compared to those...
Source: The Blog That Ate Manhattan - March 14, 2016 Category: Primary Care Authors: Margaret Polaneczky, MD Tags: Breast Cancer Source Type: blogs
I hated breast-feeding. How that helped my patient.
There have been many times when I have struggled to empathize with the patient. There are certain health care issues, and certain patients, that I have found consistently frustrating over the years.
I’ve written about this, and been pretty well chastised by readers. I don’t mind, because I know that 99 percent of physicians have their kryptonite issues, and just don’t talk about it. I’ll take the heat for being honest.
My kryptonite issue has been obesity. I admit, that for many a patient encounter, I’ve sat there and counseled (for the millionth time) on diet, and exercise, and priorities, an...
Source: Kevin, M.D. - Medical Weblog - March 13, 2016 Category: Journals (General) Authors: Monique Tello, MD Tags: Physician OB/GYN Source Type: blogs
Getting Beyond Baby Blues: The Importance of Screening for Postpartum Depression
In January, when attention focused on the need for postpartum depression screening because of a recommendation by the U.S. Preventive Services Task Force, an independent panel of physicians and epidemiologists that develops recommendations for clinical preventive services, I was both relieved and concerned.
As a women’s health advocate and educator I worried that screening could contribute to further pathologizing women’s experiences, especially when they are connected to their reproductive lives. I also feared that Big Pharma wanted to cash in, and that fetal effects from antidepressant medication might be unduly mini...
Source: Disruptive Women in Health Care - March 2, 2016 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Childbirth Women's Health Postpartum depression United States Preventive Services Task Force Source Type: blogs
Maternity matters: what does a great service look like?
Healthwatch Cumbria -Healthwatch Cumbria has worked in partnership to find out the views of women and their significant others regarding their maternity services. The survey took place in Cumbria and North Lancashire during November 2015. There were 1234 respondents. The survey found there were generally high levels of satisfaction with the care received at all steps of pregnancy and after the birth of the baby. However there were comments about how services could be improved.The themes of most significance were; the importance of continuity of care, consistency of information, postnatal support for breastfeeding, support ...
Source: Health Management Specialist Library - February 25, 2016 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Patient involvement, experience and feedback Quality of care and clinical outcomes Source Type: blogs
Hidden voices of maternity: parents with learning disabilities speak out
Picker Institute Europe - This research aims to capture the experience of a seldom-heard group and it offers recommendations for service improvements to support care to become more person- and family-centred. It found that support group and buddy schemes, community midwifery services and advocacy services were identified as positive aspects of service provision. However, the respondents identified staff attitudes, conflicting information and lack of support for breast feeding and when babies are taken away were the key negative experiences for parents with learning disabilities.
Report
Press release (Source: Health ...
Source: Health Management Specialist Library - January 15, 2016 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Patient involvement, experience and feedback Source Type: blogs
The View disses breastfeeding. Here’s why they should stop.
Yet again, the topic of breastfeeding has been discussed in the mainstream media and — not surprisingly — was depicted in a less-than-factual way. It seems every few weeks these stories surface, and usually it’s a mom who’s been shamed for nursing in public. It happens so often I have almost stopped paying attention because they are so equally infuriating and repetitive.
This time, however, it was the hosts of The View who had their say about nursing. This isn’t the first time these ladies have discussed breastfeeding with a negative spin. They do it so frequently it almost makes you wonder if they realiz...
Source: Kevin, M.D. - Medical Weblog - December 20, 2015 Category: Journals (General) Authors: Jennifer Lincoln, MD Tags: Conditions OB/GYN Pediatrics Source Type: blogs
Influenza virus in breast milk
During breastfeeding, mothers provide the infant with nutrients, beneficial bacteria, and immune protection. Fluids from the infant may also enter the mammary gland through retrograde flux of the nipple. Studies in a ferret model reveal that influenza virus replicates in the mammary gland, is shed in breast milk and transmitted to the infant. Virus may also travel in the opposite direction, from infant to mother.
The role of the mammary gland in influenza virus transmission was studied using a ferret model comprising lactating mothers and nursing infants. Intranasal inoculation of nursing mother ferrets with the 2009 H1N1 ...
Source: virology blog - November 12, 2015 Category: Virology Authors: Vincent Racaniello Tags: Basic virology Information aerosol breast breastfeeding H1N1 infant influenza influenza virus mammary gland milk mother pandemic transmission viral Source Type: blogs
Working Toward Happier Birthdays: An Effort In California To Lower C-Section Rates
Birth is universal, and because of this fact, it is also a big health care issue. Childbirth is the number-one reason for hospitalization in the United States. The stakes are high, both healthwise and costwise. It is the only instance that begins with one patient and ends with at least two. And at about $15,000-$20,000 per birth, it is an expensive proposition. Additionally and importantly, birth is a compelling Medicaid issue, because nationwide, Medicaid pays for half of births.
Within the topic of maternity care, cesarean section (“C-section”) figures prominently, especially in the United States, where the rate is o...
Source: Health Affairs Blog - November 3, 2015 Category: Health Management Authors: Stephanie Teleki Tags: Costs and Spending GrantWatch Hospitals Medicaid and CHIP Payment Policy Quality California California HealthCare Foundation Health Care Costs Health Care Delivery Health Philanthropy Maternal Health Patient Safety pregnancy St Source Type: blogs
Healthcare.gov Improvements And New Investigative Reports (Updated)
This report is beyond the scope of this blog. (Source: Health Affairs Blog)
Source: Health Affairs Blog - October 23, 2015 Category: Health Management Authors: Timothy Jost Tags: Costs and Spending Following the ACA Medicaid and CHIP ACA Marketplace budget reconciliation insurance fraud open enrollment Prevention Preventive Services Mandate social security Source Type: blogs
Nice job, mama! How a physician makes breastfeeding work.
At a family outing to the zoo a few weeks ago I sat on a bench to nurse my 6-month-old son while my husband took our older son on the carousel. I felt a tap on my shoulder. “Nice job, Mama!” I looked up and saw a woman smiling ear to ear as she was dragged by her own child towards the carousel. I got a little misty. Even as a neonatal intensive care doctor who is well-versed in the numerous, well-documented benefits of breastfeeding, acts of solidarity from total strangers sometimes do more to strengthen my resolve to keep doing this … this, not the nursing, a truly gratifying experience for which I am deeply gratefu...
Source: Kevin, M.D. - Medical Weblog - October 21, 2015 Category: Journals (General) Authors: Naomi Laventhal, MD Tags: Physician Pediatrics Source Type: blogs
