#i work in pediatric health care. very often with high risk and complex patients | Explore Tumblr posts and blogs

deadmomjokes · 6 years ago

Note

woooooah wait can i ask for a little more info on the k//e//t//o thing?? is it actually that bad for you? thats the no carbs hella protein one right? i wanna learn!

Also answering the anon who asked, “….how bad actually is it to go on that particular low carb diet?”

The short answer is not likely to kill you, nor will the bad effects hit you right away, but is counterproductive if used as recommended, and could lead to heart damage and liver damage if used for too long. Also, evidence points to a moderate-carb, plant based (not necessarily vegetarian) diet as the one most likely to be associated with overall health, and long life.

The long answer is… complex. This diet is the one that, as the first anon said is “no carbs hella protein.” But the differentiating factor here as opposed to other low carb-high protein diets is that you also eat a huge amount of fats. Like, basically all your calories are coming from protein and fat, with a few “low carb vegetables” thrown in. That is where this particular diet can cause harm, as opposed to just being a silly, unsustainable idea.

It’s honestly not extremely well documented yet, and studies are still ongoing, because this particular, super-strict diet was originally developed as a way to help treatment-resistant pediatric epilepsy. Which it does very well! But the studies in efficacy there weren’t looking at long-term coronary or liver effects, because the issue in question was “will it help reduce seizures.” And for many forms of pediatric epilepsy, it does. But then adults started getting hold of it many years later and touting it as a fat burning super diet. The idea being that you give your body none of the stuff it wants to burn (carbs), and instead force it to burn fat; as a result, you often also burn your own body’s fat stores. This does, for most people, work. But the “k-e-t-o” in this diet comes from the word “k-e-t-o-s-i-s”, which proponents call the “fat burning stage” and many medical folks tend to view as mild non-diabetic ketoacidosis. You know, the bad thing diabetics can get where your body releases high levels ketones that can damage your organs.

Generally speaking, this particular diet aims for “low levels” of ketone bodies, not the high ones that can damage your liver and kidneys in ketoacidosis. But we don’t actually yet know for certain the long-term effect of low-level sustained ketone production. We have a pretty good idea, tho, with a growing body of evidence to back it up: slow liver damage. That’s why people who have liver disease are told not to do k-e-t-o.

As for heart disease, the issue comes in the fats and high quantities of sodium, red meat, and ldl cholesterol-increasing saturated and trans fats, all of which we know are dangerous. The LDL is what makes coconut oil bad for you, too. Think of LDL and HDL cholesterol this way: your arteries are a vertical pipe. LDL cholesterol, or low-density lipoprotein, is like a cotton ball. It’s light, expansive, and not very heavy. Shove a bunch of cotton balls into the top of the pipe, and they’re unlikely to fall out of the bottom. They’re too light, and they’re bunching together. Now, HDL, high-density lipoprotein, is the “good” cholesterol, and it’s like a marble or a small rock. Heavy, compact, and dense. Drop it into the top of the pipe, it’ll fall right out the bottom, bringing a lot of cotton balls with it. Saturated fats and trans fats increase your LDL, and many plant foods high in fiber increase your HDL. While too much of either is bad, high LDL is a predictor for heart disease because it clogs up your arteries. This diet is chock full of saturated and trans fats, which combined with the high levels of sodium found in many fat sources and meats, makes it very likely that long term use of the diet will cause heart disease. The first round of longitudinal studies found just that.

Note that I said “long term use.” As long as you don’t get your ketone levels too high, don’t have any preexisting complications, aren’t already have liver or heart disease, aren’t pregnant or breastfeeding, don’t have any mineral or vitamin deficiencies, are moderately active, still keep on top of your calorie count, aren’t old, and also can make it past the phase where your body literally freaks out, thinks its starving, and goes into withdrawal from the carbs it’s designed to burn, you should be good to do it for about a year. That’s the cutoff that long-term obesity studies use, because after that, it’s generally considered not the best idea. And it’s those studies that proponents love to tout as proof that it’s safe for your heart, and actually good for your heart. But the truth is, those studies are limited to clinically obese patients, they follow the diet under close doctor supervision, and only for a year at max. They stop after that. These patients are also usually transitioning to this diet from one that is TOO high in carbs and sugars, as well as processed foods. This might actually be the real reason that the diet works so well for rapid weight loss, but again, the research hasn’t got there yet. Also, most studies note that the positive effects on heart disease markers in these patients are limited in time, even before the study concluded.

The main issue is that, while it can induce rapid weight loss, cutting whole nutritional groups is not good or sustainable. Your body was built to burn carbs, that’s why you have a pancreas. Some people like to tout that the “k*to flu,” the carb withdrawal period, is proof that carbs are bad for you because you’re going through “detox.” But you can also describe dehydration as a withdrawal from water, or what happens in starvation as a “calorie withdrawal.” You can get over the withdrawal period, but eventually, you have to “relapse” to carbs because it just isn’t sustainable. To limit yourself to a truly tiny, not very nutritionally dense section of the food on earth makes it more likely that you’ll crash and burn in the diet later on. This is the problem with all restriction diets; they’re hard to follow either because your body is craving the things you cut out (and rightfully so when you can’t eat fruit!), or because it’s time, money, and labor intensive. When you inevitably come off the diet, your weight will almost certainly rebound, because your body goes “OMG we have to stock up, look what happened last time we can’t starve like that again PACK IT ON BOYS.” That’s not to say that everyone rebounds, but it’s very difficult to control. (It can be controlled, tho, don’t let me scare anyone who’s trying to transition.) But you have to come off it eventually. If you do stay on a high-fat carb free diet indefinitely, we go right back to the issue with heart disease, cholesterol levels, and potentially the long-term ketone exposure.

And then there’s a problem with nutrition. To do this diet, you basically can’t have any sugars. Including the ones in fruit. Most veggies are off-limits, too. Vegetables and fruits are extremely important in getting you your daily requirement of vitamins, minerals, nutrients, and fibers, as well as helping hydrate your body. The body craves plants. Sure, you can supplement with vitamins, but it’s really not the same; there’s something science still hasn’t quite figured out about the way your body uses food as opposed to supplements, tho it could have to do with the fact that enjoyment factors into nutrient absorption. It’s always better to get your nutrients from whole foods than a pill.

And for decades, a moderate-carb plant-based diet (not necessarily vegetarian diet, but mostly plants with meats as an afterthought) has been the number one recommended diet by everyone from the FDA to the CDC to increase life expectancy and both improve and maintain overall health.

In general, diets are a bad idea. Changing your diet, meaning your eating habits, is one thing, but going on a diet, meaning a prescribed set of dos and don’ts, is a recipe for unsustainable, yo-yo-ing changes that stress your body, lower your self efficacy, make you feel lousy, and just make your life harder in general. Get-thin-quick schemes and diets prey on our insecurities and fears, but there is no substitute for a healthful, whole, rounded diet and some moderate exercise. I say this having watched my own mother struggle with morbid obesity and try everything from weight watchers to atkins to starvation. I say this as a person who struggles constantly with their own weight, had an eating disorder in high school, and can’t seem to get down into a “normal” BMI range despite trying really, really hard. I know exactly how hard it is, and how much it looks like the Holy Grail. I was tempted for a really long time by the ultra-low-carb diets, not just this one. I did the research, talked with health science and nutrition professors at my university, talked with multiple doctors, and the conclusion I (we) came to was: it’s just not worth it.

For some it might be, and if used properly– with a good reason (usually obesity), for a limited time (months to at most a year), with low amounts of saturated and trans fats, under a doctor’s supervision, and with a solid plan in place for transitioning off into a healthful eating pattern that includes carbs– it could be a good tool. But as preached by fad diet sites, online “health gurus,” and public understanding, it is not safe, or a good idea. I don’t like the literature that’s starting to show that it could hurt your heart and liver. I don’t like the way most people and informational sites treat it as an indefinite lifestyle change. I don’t like the way people preach it as a cure-all. It might have its place for some people (generally those who are obese, not someone looking for a 10 or 20 lb loss), but it has too many risks for my liking, and it goes against everything I learned in my degree program about how to eat well to optimally take care of and fuel your body.

#long post #diet tw #food tw

17 notes · View notes

jazzcantalejo-blog · 6 years ago

Text

Everything You Need To Know About Dentistry

Being a dentist has its perks and hardships. Yes, studying to be any kind of a medical doctor is hard and you will definitely face some challenges, crisis, and struggles, but, it will all be worth it in the end when you become a doctor. A dentist is no stranger to that, because when you see the smiles on the faces of your patients, it’ll feel like all your weariness fades.

But first, what is dentistry? It is the treatment of diseases and other conditions that affect the teeth and gums, especially the repair and extraction of teeth and the insertion of artificial ones. A specialist or doctor that practices dentistry is called a dentist and will be given the title of DMD or Doctor of Medicine in Dentistry

Now, here are some things that you need to know about dentistry; the types of dental specialists, the importance of dentists and dentistry, the benefits of being a dentist, and of course, how and where YOU can study to become a dentist yourself!

6 TYPES OF DENTAL SPECIALISTS

Endodontist: Root canal specialist

Inside the teeth are tiny cavern-like passages called canals that contain sensitive living tissue, blood vessels, and nerves. Endodontists specialize in diagnosing and treating issues within our tooth. For example, if your tooth’s pulp becomes infected you may need a root canal.

Oral and Maxillofacial Surgeon: Oral surgery specialist

This specialist focuses on treating problems related to the hard and soft tissues of the face, mouth, and jaw. Oral and maxillofacial surgeons specialize in treatments that require complex procedures or deep levels of sedation – beyond nitrous oxide or laughing gas. Procedures performed by oral surgeons include tooth extractions, corrective jaw surgery, and cleft lip or cleft palate surgery.

Orthodontist: Alignment specialist

Orthodontics is about correcting teeth and jaws that are out of position. You may see an orthodontist if your jaw isn’t aligned properly leading to an overbite, under bite or cross bite. You may see an orthodontist if your teeth are crooked or misaligned. In these situations, an orthodontist may use braces, clear aligners, palatal expanders, or headgear as part of your treatment plan.

Pediatric Dentist: Kid dental specialist

Pediatric dentists are to a child’s oral health like pediatricians are to their overall health. They’re dentists who specialize in the oral development and care of children from infancy through their teens. Pediatric dentists help your child stay on the path to a lifelong, healthy smile. They provide routine exams and cleanings, habit counseling (stop thumb sucking), fillings for cavities, and diagnosis of oral conditions associated with other diseases like childhood diabetes.

Periodontist: Gum specialist

Periodontal dentistry focuses on the prevention, diagnosis, and treatment of diseases that affect the gums, and other structures that support the teeth. Periodontists recognize and treat the early stages of gum disease, perform minor surgery to resolve severe gum disease, and restore the appearance of your smile.

Prosthodontist: Replacement specialist

Prosthodontists focus on restoring and replacing lost or damaged teeth. Prosthodontists have a unique understanding of everything that goes into a beautiful, functional, and natural-looking smile. Prosthodontists specialize in porcelain veneers, crowns, dental implants, fixed bridges, dentures, and reconstructive dentistry.

IMPORTANCE OF DENTISTS / DENTISTRY

A Healthy Mouth Is Good For Your Body

Taking good care of your mouth, teeth and gums is a worthy goal in and of itself. Good oral and dental hygiene can help prevent bad breath, tooth decay and gum disease—and can help you keep your teeth as you get older.

A healthy mouth may help you ward off medical disorders. An unhealthy mouth, especially if you have gum disease, may increase your risk of serious health problems such as heart attack, stroke, poorly controlled diabetes and preterm labor.

Teeth that function properly allow good nutrition is critically important to health and well-being. Teeth that function properly are essential for optimal nutrition. Unhealthy teeth and gums can contribute to systemic conditions as bacteria from the mouth can more easily enter the blood stream. A smile also reveals a great deal about a person—not only one’s disposition, but how much value one places on appearance as well. It is an important ingredient for success and self-esteem. A nice smile communicates confidence, attractiveness and friendliness.

Successful dentistry should last for many years in health, provides comfort and function, improves esthetic appearance and often includes a contingency plan in the event that something goes wrong. Dentistry, like the rest of the structures in the human body, may not last a lifetime. Successful Dentistry, however, preserves the teeth for the day when the dental restorations must be remade due to changes in the oral cavity or wear of the materials.

DUTIES OF BEING A DENTIST

Dentists help their patients protect, restore and maintain their oral health. They diagnose and treat diseases, and administer care to injuries and malformations of the teeth, oral tissues and the mouth. Dentists also check a patient's head and neck areas as they relate to oral health.

Your job duties as a dentist include restoring and replacing teeth that have been damaged through disease or injury, and advising patients on proper oral health care to prevent future problems. This includes teaching your patients how to floss, brush their teeth and choose an appropriate diet. Other tasks include applying sealants to teeth, taking molds of teeth, extracting teeth, and performing cosmetic dental procedures to improve a patient's appearance.

Dentists employ a variety of procedures and equipment to prevent and treat oral health problems. You'll use advanced technologies to examine the teeth and mouth, including X-rays and computer-generated imaging. You'll fill cavities and remove tooth decay using brushes, forceps and drills.

In addition to patient care, a dentist's duties may include administrative and business-oriented tasks related to owning or running a dental practice. For instance, you might interact with suppliers and vendors. Depending on the size of the practice, you might also do bookkeeping. Management of personnel, including hiring, training and supervising hygienists, receptionists and other dental staff, may be part of the job.

BENEFITS OF BEING A DENTIST

You can specialize according to your interests

If you opt for a career in dentistry, you can pursue many avenues. For example, you might opt to focus on cosmetic procedures so that you can transform the appearance of a patient’s mouth. Alternatively, you might want to spend most of your time on oral and maxillofacial pathology, researching and managing the major diseases that affect the head, neck, face and jaw.

You will have varied experiences and meet different people

A career in dentistry will guarantee that you will never be bored. Every day, you will see a wide range of patients with unique problems and goals when it comes to their dental health. In addition, you will have a chance to meet very different people from all sorts of backgrounds during a career in dentistry, and part of your job will involve being able to relate to these people in a way that makes them feel comfortable.

You can educate the public

Dentistry is a highly-respected profession, and those who pursue a career in dentistry have a unique opportunity to influence the health of the public (spreading information and advice about maintaining good oral health). For example, in addition to educating your own patients, you may have the opportunity to visit schools and speak to children about their teeth and gums.

You will have a high degree of freedom and flexibility

By opting for a career in dentistry, you are entering a field that will allow you to have a strong influence over the balance of your work and home life. A career in dentistry means that you will have a chance to be your own boss, and you will have a wide range of job opportunities (ranging from work in private practice to a career in dentistry that revolves around research positions in hospitals).

HOW TO BE A DENTIST AND WHERE TO STUDY IN THE PHILIPPINES

To become a dentist here in the Philippines you’ll need to study Dentistry and pass the board exam. Some universities offer a 6-year dentistry course, while some don’t. If you opt to take a pre-med before taking up dentistry proper, it will take longer, which will take up to 8 years.

But, here is a list of top schools and universities in the Philippines offering dentistry courses.

1. University of the East

2. Centro Escolar University

3. University of the Philippines

4. University of the Visayas

5. Our Lady of Fatima University

6. Emilio Aguinaldo College

7. Cebu Doctors' University

8. University of Baguio

9. National University (Philippines)

10. Adventist University of the Philippines

And that concludes my blog about everything you need to know about dentistry. I hope you learned a lot!

References:

https://www.deltadentalwa.com/blog/entry/2018/03/6-types-dental-specialists

https://www.edwardfeinbergdmd.com/adult-dentistry/importance-of-dentistry/

https://www.123dentist.com/four-major-benefits-choosing-career-dentistry/

https://www.thetoptens.com/best-dentistry-school-philippines/

https://learn.org/articles/What_Are_the_Duties_of_a_Dentist.html

1 note · View note

vijaysharmagastrologistlive-blog · 6 years ago

Text

BENEFITS OF HOME HEALTHCARE SOLUTIONS PROVIDED THROUGH KARMAONCALL HEALTHCARE PLATFORM karmaoncall offers FREE CLOUD space to save all important documents related to family health and job.

Parents and adult children may live thousands of miles away from one another, separated by different cities, states, or even countries. Often, the demands and pressure of providing care can result in caregiver burnout—a state of physical, emotional, and mental exhaustion. It occurs when family caregivers do not get the help they need and are trying to do more than they are able to.

KARMAONCALL HEALTHCARE PLATFORM CAN SOLVE SOME PROBLEMS OF Home health care

For many families, home health care is a beneficial choice—karmaoncall healthcare platform provides a safe and affordable solution that supports the family, while allowing your loved ones to stay in the comfort of their own homes and communities.

If you are caring for a loved one, here are ten ways karmaoncall healthcare platform home health care can support you:

Home health care professionals can be there when you aren’t able to be. If you are caregiving from a distance, karmaoncall healthcare platform home health care can give you peace of mind. Trained and qualified professionals can assess safety risks and make simple corrections in the home through karmaoncall healthcare platform

—from placing a rug on a slippery floor, to recommendations for ambulatory assistance.

Home care supports activities of daily living (ADLs). karmaoncall healthcare platform In-home services allow adults to receive day-to-day help with the personal care they need, preserving their dignity and maintaining a good quality of life. karma Assistance with activities of daily living can include bathing, grooming, and medication reminders.

Access to skilled nursing care at home. Skilled medical care can be delivered at home by thoroughly supervised nurses, certified, licensed and knowledgeable about high-technology medical equipment booked through karmaoncall healthcare platform . karma on call healthcare platform home health care can ensure that your loved one’s complex medical needs are met.

Home health care professionals provide caring companionship. Research shows that aging adults stay healthier with social interaction. karmaoncall Home health aides can become trusted friends for walks, reading, cards, games, movies, meals, and other social activities. karma on call accompaniment on errands such as grocery shopping, medical appointments, and other activities are also added benefits.

karmaoncall healthcare platform Home care helps with light household chores. When aging adults struggle the daily demands of housework, such as laundry, vacuuming, dishes, and simple chores home care helps to consistently maintain a safe and healthy living environment.

karmaoncall Home health care clients have comparable or better health outcomes. Research has shown that clinical results are comparable or better with fewer complications when home care is provided to individuals with chronic conditions such as pneumonia, diabetes, or COPD.

karmaoncall ensures One-on-one focus and support. Home health care services are truly unique, providing meaningful, one-on-one personal and skilled care that builds strong bonds between professionals and their clients. According to the Cleveland Clinical Journal a person who is seen by a clinician in the comfort of home more readily trusts that the health care team places their needs first.

karmaoncall healthcare platform Support with diet and nutrition.

Are your loved ones getting the nutrition they need to stay healthy? Adults age 65 and older, people with chronic conditions, and those recently discharged from a hospital or nursing facility are likely to be nutritionally at-risk. Aging, bed rest, illness, and injury can all contribute to the loss of lean body mass. karmaoncall healthcare platform home care may include nutritional counselling and home-cooked meals to protect your loved ones against malnutrition.

karma on call Medication management. If your loved one is on multiple prescriptions it can be confusing to manage. karmaoncall healthcare platform home health care professionals can ensure the right medications are being taken at the right times to control health conditions and prevent harmful drug interactions.

karma on call Home health care professionals provide caring companionship. Research shows that aging adults stay healthier with social interaction. karma on call aka karmaoncall home health aides can become trusted friends for walks, reading, cards, games, movies, meals, and other social activities. Accompaniment on errands such as grocery shopping, medical appointments, and other activities are also added benefits.

karma Home care helps with light household chores. When aging adults struggle the daily demands of housework, such as laundry, vacuuming, dishes, and simple chores karma on call home care helps to consistently maintain a safe and healthy living environment.

karmaoncall Home health care clients have comparable or better health outcomes. Research has shown that clinical results are comparable or better with fewer complications when karmaoncall AKA karma on call home care is provided to individuals with chronic conditions such as pneumonia, diabetes, or COPD.

karmaoncall ensures One-on-one focus and support. Home health care services are truly unique, providing meaningful, one-on-one personal and skilled care that builds strong bonds between professionals and their clients. According to the Cleveland Clinical Journal a person who is seen by a karmaoncall clinician in the comfort of home more readily trusts that the health care team places their needs first.

karmaoncall AKA karma on call is an affordable alternative to facility or hospital care. For many families, home health care can be just the support they need to help manage caregiving responsibilities, while avoiding caregiver burnout. Could you or someone you love benefit from karmaoncall home health care service

other benefits of karmaoncall healthcare platform

1. karmaoncall is for the benefit of people, benefit of society. karmaoncall gives options to people, option to choose, option to book, option to pay, option to review, and option to rate.

2. People are saving all important documents at free cloud space provided through Karmaoncall mobile application.

3. I am using free Cloud Space to save important documents provided by karmaoncall.

4. Doctors and public are keeping their medical record Safe at karmaoncall healthcare platform, 5. neighbours and caretakers book medicine home delivery, book ambulance with GPS navigation facility of karma on call ,

5. Now we can book nuclear medicine imaging, book laser and skin procedures cosmetic procedures by top expert in city through karma on call AKA karmaoncall .

6. All neighbourhoods are booking Medicine, Endoscopy, CT, MRI, USG, Lab test, Eye, Dental, ENT Procedure at best laboratory and hospital in jaipur by karmaoncall healthcare platform,

7. people like to book Doctor visit , book Nurse visit, book personal trainer visit, book physiotherapist home visit in Jaipur through karmaoncall healthcare platform,

8. my friends have booked Urology procedures, book Cardiac test and book Endoscopy best centre in Jaipur City with karmaoncall mobile app. it was seamless, neat, fast, efficient.

By KARMAONCALL App.

http://bit.ly/2SFLwoo

https://apple.co/2Szra0Q

https://www.karmaoncall.com

recent survey by karmaocncall.com suggested that dr vijay sharma is the BEST gastroenterologist, gastrologist .stomach doctor , liver spleen expert, he the best liver specialist, endoscopist, physicain. according to recent survey by karmaoncall. many people confirmed that dr vijay sharma is the best physician, best doctor, best GIT expert, best hepatologist, best biliopancreatic expert, top in gut care, running best gastrocare centre, doctor vijay sharma has the best team ofnurses, doctors, technicians, staff, management, supporting staff, best stomach doctor. doctor vijay sharma is running Best gastro liver centre, best endoscopy centre, best diagnostic laboratory in jaipur rajasthan india, dr vijay sharma is the owner of best gastroenterology gastrology stomach liver clinic in jaipur rajasthan India. he has the best Gastrosurgeon abdominal surgeon, liver surgeon, biliopancreatic surgeon, cancer surgeon, general surgeon, intestinal surgeon, palliative surgeon, cardiac surgeon in jaipur rajasthan with him, team has best gisurgeon, gut surgeon, proctologist, proctosurgeon, pediatric surgeon in jaipur rajasthan. dr vijay sharma is renowned as best pancreas expert in jaipur rajasthan. we have best general doctor, physican, general practitioner, diabetologist, endocrinologist, pulmonologist in jaipur rajasthan. doctor vijay sharma is working at the best hospital, best clinic, best laboratory, best nursing home in jaipur rajasthan, doctor vijay sharma manages the best stomach gastrology Liver clinic in jaipur rajasthan India. dr vijay sharma is the best doctor in Rajasthan according to recent survey by RIHMR, they have team of best general practitioner jaipur rajasthan, there are top cancer expert, best urine problem expert, top urology care, best urology treatment, high quality oral ulcer care, high end allergy expert, best in class allergy treatment, high level allergy clinic, laboratory has all the facilities like x ray, ultrasound, CT scan, MRI, endoscopy, blood test, NABH best hospital in jaipur, best clinic refer patients, to doctor vijay , top nursing home have connection to Dr vijay sharma gastro and liver clinic, doctor vijay sharma gastro and liver clinic does provide general care, best geriatric medicine care , manage dysphagia , provide best swallowing problem treatment, manage chronic diarrhoea very well , top jaundice treatment, team has jaundice doctor, standard anaemia care, classical pain abdomen management, regular skin problem care , high end dermatology care, team has dermatology expert, hospital has top skin expert. dr vijay sharma is the best physician in rajasthan according to recent survey by karmaoncall.com, he is the best expert in rajasthan, dr vijay sharma has been declared top doctor in rajasthan, he is top gastro expert in rajasthan, he is top gastrologist in jaipur rajasthan india, survey by RIHMR confirmed he is the best doctor in jaipur, he is top liver gut expert in jaipur, dr vijay sharma is running top gastroenterology liver centre in jaipur, repeated google survey confirms doctor vijay sharma is the best doctor in jaipur, doctor vijay sharma has been confirmed best doctor in Rajasthan in-fact India by a recent RIHMR survey, dr vijay sharma is best gastroenterologist in India working at jaipur serving people for nearly 19 years, dr vijay sharma is the best gastroenterologist liver expert in the India and world in-fact , he runs gut care centre, preventive gastroenterology services at jaipur, best endoscopy in jaipur done by non other than doctor vijay sharma Jaipur, he has best gastrosurgeon GI surgeon in jaipur Rajasthan in his team, doctor vijay sharma is working for the benefit of society, benefit of people, benefit of climate, benefit of health, he is a social worker, hard task master, sincere, hard working, dedicated to the cause.

#healthcare platform #healthcare service platform #healthcare application #clinic #hospital #laboratory #nursing home #diagnostic centre #healthcare marketplace

1 note · View note

juniperpublisherscasestudies · 4 years ago

Text

Juniper Publishers- Open Access Journal of Case Studies

Accident, or Homicide? Sub-Register of Infant Death Cases, Undetected Neglect and Abuse

Authored by María Teresa Sotelo

Abstract

The average rate of infanthomicides (recognized) In underdeveloped countries is of 6.6%. In developed countries 2.3% per 100,000 inhabitants. Although this rate comes from a worthy statistic sources, is farther from reality, due that Innumerable murders of children, not properly identified, vanished into anonymity. The American Academy of Pediatrics adverted that in 63% of the cases, declared as Sudden Infant Death Syndrome, in reality were accidents, in most cases, intentional suffocation homicides, perpetrated by parents or by caregivers. Lamentably, it is a common practice in health institutions, not to scrutinize the death by infectious diseases in children from 0 to 9 years old, with post mortem analysis. It is a prevailing custom on neglect mothers to feed the baby with unwashed milk bottles, infected with larvae. Very so often, clinical reports of severe malnutrition, frequently correlates children deprived of nourishment, as a cruel practice of their parents. Deaths clinically reported as infectious, many hides intentional poisonings.

Keywords: Child abuse; Infections; Detection; Subregister post mortem

Introduction

There is a subtle difference, but of deadly consequences, not adequately feeding a child for economic reasons, from not feeding him/her because of inflicting punishment. It is uneven not obtaining potable water to wash a baby bottle, from not to wash it out, because of indolence. There is a big difference not protect the child from the cold, due to lack of money, that stripping him/her the clothes, to rejoice with the suffering of the child.

In this divergence of concepts, errors lie in the medical diagnosis regarding diseases and deaths caused by child abuse. Countless deaths classified as pneumonia, anemia and intestinal infections were induced by maltreatment, negligence and of The Syndrome of Munchausen. The 10% of the population attends at a pediatric hospital, corresponds to abuse and neglect cases Loredo A [1].

This asseveration may surprise some, due that cases of child abuse most of the times, are linked just to scandalous physical trauma, burns, or injuries. Nevertheless, child abuse occurs silently in cases of parental negligence, and the Syndrome of Munchausen. The Mexican Ministry of Health, Carried out a survey in 2008, to determine the rank of deaths preventable diseases in children. The 11% corresponded to children less than one year, 38.1% in ages between the year and four years, and 32.8% for children between 5 and 14 years.

Despite the lack of information to which I alluded, and the consistent sub classification of deaths, due to parental negligence in childhood, the statistics offers a guidelines emblance of the problem. The International Organization, Save of Children, states in its publication "Los Peligros para la Niñéz in Mexico that 12.4% of children from 0 to 59 months of the country, suffer from malnutrition. The mortality rate of children under 5 years old (deaths per thousand live births) is 13.2%. The document indicates that the homicide rate for girls and boys is 5.5% per 100 000 inhabitants, whose ages range from 19 to 19 years in the year 2015.

In underdeveloped countries with enormous economic limitations, to support substantial budgets to health institutions are denied, restricting the hospital’s guidelines to select the endemic issue relevant to deal with. Generally the child abuse and neglect, is not considered among the public health issues, even when this is considered by the WHO, as a global public health scourge, furthermore, is the first child’s morbidity in underdeveloped countries, being Afganistán the country with the highest infant mortality rate in the world, more than 120 out of every 1,000 births die. México and Haiti is to occupies the first place in parental homicides. Source: OECD (Figure 1 & 2).

Presentation of the Case

Typification of infant death underlying child abuse

A 5-year-old girl, victim of physical abuse and neglect. The mother was the suspected aggressor. The mother reported that the 5 year old girl, while playing, the television that rested on the furniture, had fallen on her daughter's head; likewise there had been a short circuit which had caused her hand to get burned.

She arrived at the hospital in serious conditions, with cranioencephalic fracture, her hand totally burned. It had to be amputated. The narrative of the mother, from beginning to end, was plagued with contradictions. The severity of the injuries with the sequential argument did not match. The degree of the malnutrition, indicates that she was a victim of multiple abuse. According to the nurse's account, the mother during hospital visiting, was cold and displeased with her daughter, there was no physical contact or any sign of affection.

According to the contention of the medical staff, the complaint of child abuse had been submitted in time to the public prosecutor's office, who rejected the clinical diagnosis of presumptive child abuse, instructing the hospital to give the patient back to the mother, once she were in healthy conditions.

Fifteen days after, the girl was released from hospital confinement in good conditions, was again admitted through hospital emergencies under severe conditions of malnutrition. Finally the victim died, without having done justice to child, leaving the mother without any legal imputation for the crime. This case leaves many questions unanswered. Did the hospital proceed to the legal complaint timely? Faced with such an obvious situation of physical abuse, will the public prosecutor have determined to risk the girl? Returning her the mother? Unfortunately the death occurred, and it is not feasible to know the truth behind (Figure 3).

Discussion

The referred case report says the dimension of covert mistreatment in medical institutions, whether by medical neglect, lack of knowledge of regulating institutional procedures, or default training about Kempe Syndrome.

While it is difficult for the pediatrician, to determine the underlying causes of the illness, it is recommendable at the slightest doubt of abuse or neglect, to order laboratory and cabinet studies, incorporating a checkup methodical standards of size, weight, vaccines, dental condition, as well general cleanliness. It is advisable to consider the parents behavior during child hospitalization, assessing sequential part of events. Is the child regularly visited during hospital staying? Or, there is a recurrent abandonment. Visual and corporal contact family- child, describe the emotions of both, particularly when it comes to a victim-victimizer relationship. There are five elements in variably present in abusive families; the narrative incident falsehood, manipulation of the facts, complicity, cruelty, and the silent witness.

It is advisable to gather information on the clinical history, the answers could yield valuable details regarding the child's clinical ambulatory background. Has the child been hospitalized frequently? Why? It is recommendable to inquire, which hospitals, and who attended the boy/ girl. When obtaining these clue data, the chronological information background should be cross; Hospital movements, dates and causes. Victimizing parents, invariably change the health service, with a medical institution ambulatory story behind, so as not to arouse suspicion among health personnel. Deceased children, as well as frequent abortions, is a remarkable characteristic of abusing parents, this antecedent is a valuable red focus, to take into account as a predictability of Munchausen, in killer mothers. Though, before issuing a diagnosis of child abuse, all clinical, social and psychological antecedents, must be gathered, thereafter all the pieces are accommodated, and the dark elements begin to narrate a possible outcome. A thorough analysis must be done, to avoid falsehood of legal complaint of abuse, when it was not.

In my professional experience, the pediatric hospitals, that integrates a interdisciplinary team for the detection and comprehensive care of child abuse, with trained personnel: Pediatrician, social worker, paido psychiatrist, and the lawyer (to assume legal issues) the result is surprisingly efficient to detect cases, due that the medical and paramedical staff, feel released from direct responsibility of presenting the legal procedures, and to get involved in the tricky lies of violent families.

Considering the complexity ofthe Syndrome of Kempe, having a team of specialists; medical and paramedical staff, are not distressed in inquiries, of legal issues, whereas, these are carried out by the lawyer of the interdisciplinary child abuse specialized team. It usually works as follows: When a pediatrician during a routine consultation, suspects of a possible case of child violence, he refers the case to the assigned team of experts, who through an exhaustive clinical, social and circumstantial evaluating facts, they altogether arrives with an accurate diagnosis, that confirms or discards the pediatrician suspicion.

Conclusion

Even though the undeniable advances in the field of medicine, the protection of children from abuse, continues to be weak in stagnant terrain in many countries. After many years, dealing with medical practitioners and principals, the experience has shown me, that when a pediatrician with not high standards of ethics, is faced with a child abuse potential case, which procedures involves innumerable procedures, other assumption of taking risky legal steps to confront the abuser, many fix on, to cover up an abuse, even when the legal complaint is mandatory.

Nevertheless a hospital designed lawyer working with an interdisciplinary team of experts, is by far, the most effective institutional scheme, to prevent and detect child abuse. It is imminent to adequate clinical protocols that include scrutiny in diagnosis laceration of internal organs, respiratory and intestinal infections, or recurrent diseases in the kid to inquire potential Syndrome of Munchausen or neglect.

It is not a matter of disregard the lack of protocols and medical mistakes, in the diagnosis of child abuse, the outcome has invariably been of fatal consequences for the little victim. No matter the weight of the law was evaded, to be the indirect responsible, or, co-responsible of the infant death, it will always be a crime, which in one way or another culpable must assume.

For more articles in Open Access Journal of Case Studies please click on: https://juniperpublishers.com/jojcs/index.php

#Juniper Publishers Indexing List #Juniper Publishers Journals #Epidemiology #Medical Genetics #Otolaryngology #Trauma Surgery

0 notes

snmaposts · 7 years ago

Link

Medical student keeps up academics and diversity work in spite of his own cancer diagnosis

Published Wednesday, Mar. 7, 2018, 1:21 pm Third-year student Omar Salman outside of the Virginia Tech Carilion School of Medicine

As a medical student at the Virginia Tech Carilion School of Medicine, Omar Salman had learned a lot about cancer: from what goes wrong at the cellular level to cause it as well as patient risk factors and treatment options.

Through the school’s patient-centered curriculum, Salman had explored real patients’ cancer experiences through clinical, scientific, and emotional lenses.

But cancer became something new when Salman got his own diagnosis of bone marrow cancer near the end of his second year of study. “I didn’t know what to do next. The school administration is great, but what am I supposed to tell them? I might be dying? It was weird,” Salman said. “You are torn between feeling like you are asking for special treatment but then you realize, I have cancer. Why am I so worried about school?”

Despite the diagnosis, Salman completed his second year of study, even passing the first phase of his national board exams, while undergoing treatment. This year, Salman’s third year of study, the school administration worked with him to rearrange his clerkship rotations in various medical specialties to help with his recovery.

The treatments have been successful and Salman is cancer-free. But the experience has given the future physician a window into the complex realities of recovery for patients.

“The only way I can think of the experience is that it was very humbling,” Salman said. “You realize there is so much outside of ‘You’re better now.’ Because what is ‘better?’ I think we in medicine often define ‘better’ as you no longer have cancer or high blood pressure because you took a pill or did chemo or radiation. Shouldn’t we also consider better to mean that our patients are coping well emotionally with what happened to them? That was, in the long run, the harder piece for me.”

Salman has relied on his classmates to help with both his physical and emotional recovery. “A lot of my classmates really stepped up. They would help me figure out how to work my oxygen tank and other medications or equipment. A big part of it for me is continuing to check in with people and being able to tell them when I’m not okay and recognizing that it is fine to have some good days and some bad days.”

Despite the whirlwind year, Salman received two big honors for his efforts in medical school, both in and out of the classroom.

In June, Salman was selected as a Point Foundation Scholar, recognizing his work to support the LGBTQ community. “For me, being part of an organization that is made up of LGBTQ people for LGBTQ people is particularly special,” Salman said. “I have a community of people who are similar to me with similar aspirations and who provide a network of support.”

When Salman came out as gay while an undergraduate student at Vanderbilt University, he faced some challenges, including his family cutting off ties with him. Since then, he has advocated for the community, particularly in regards to health disparities.

While at the Virginia Tech Carilion School of Medicine, Salman became chair of LGBTQ+ Issues for the American Medical Association and founded the VTCSOM Student National Medical Association, which focuses on diversity issues in medicine.

“Studies show there are better patient outcomes when patients feel like a provider is someone who understands them culturally or ethnically or religiously. We all can benefit from being in a more understanding and accepting society. We can be part of that as future physicians.”

Salman also volunteers for the Roanoke Diversity Center and is associate director for the Medical Society of Virginia Foundation (MSV), a philanthropic organization dedicated to improving patient access.

In October, the MSV Foundation awarded Salman a 2017 Salute to Service Award for Service by a Medical Student or Resident, recognizing him for his community involvement and work to advocate for health care equality. (See video about Salman and the award.)

Beyond his experience as a gay man, Salman saw health disparities firsthand growing up. He immigrated to the United States, the son of two Palestinian refugees living in Kuwait and then Jordan, when he was 8 years old. “I’m interested in the intersection of culture and medicine,” Salman said. “Where can we find the connection to create good health, not just the absence of illness, but the active prevention of illness.”

When Salman graduates in May of 2019, he plans to pursue a career in pediatric hematology and oncology to treat patients with diagnoses like his own and to help their families cope with their treatment, all while continuing his work to help underserved populations.

Salman also spends a great deal of time completing an in-depth research project in pediatric neurology. He is working with Stephanie DeLuca, research assistant professor at the Virginia Tech Carilion Research Institute and assistant professor of pediatrics for VTCSOM, on medical device research for children with cerebral palsy, in collaboration with Alan Asbeck, assistant professor of mechanical engineering.

“It is interesting when the body is fine but the brain is what is making the problems happen. For me, unraveling that mystery is really exciting and interesting. Especially with child neurology, you get a lot of diversity of conditions that show improvement with a mix of medicine and lifestyle modifications.”

Salman is one of two students this year to receive the VTC School of Medicine Charter Class Scholarship, a fund started by the school’s first class that graduated in 2014. These are the first scholarships to be awarded from the fund.

“As a member of the charter class and VTC alumnus, it is so great to see that our scholarship fund is starting to provide some support for current students,” said Matthew Joy, plastic and reconstructive surgery resident for Carilion Clinic-Virginia Tech Carilion School of Medicine. “The entire charter class benefited from scholarship support during the formative years of the medical school, so I know we all appreciate how much it means to medical students who can potentially be facing a mountain of educational debt as a result of their desire to pursue a career in medicine. Since we were so fortunate to have that support from the institution, I think it’s fitting that our class has its own scholarship to give some back.”

For Salman, scholarships give him an opportunity to reflect on his journey. “Sharing stories is really powerful. It keeps us human and accountable to our patients and to each other and to ourselves as future doctors,” Salman said. “For me, even applying to a scholarship is me writing out my story and reminding myself of what I want to do. Maybe someone will read your story and they can relate and see themselves pursuing something similar.”

#cancer #snmaproud #snma

1 note · View note

dentalinfotoday · 4 years ago

Link

What are dental sealants?

Dental sealants are thin, plastic coatings that seal over the narrow grooves found on the chewing surfaces of back teeth (molars and premolars).

When placed perfectly on these deep pits, sealants can prevent a significant amount of tooth decay (cavities) by protecting sensitive tooth surfaces from acid that causes cavities.

Sealants are not generally placed on baby teeth but on the tooth enamel of permanent teeth (“adult” teeth).

Source: CDC

Dental sealants function much like sealing cracks in a driveway or on the sidewalk. The grooves in the chewing surfaces of back teeth are sealed so that food particles and bacteria will not settle within the fissures, causing cavities.

Application of sealants may be appropriate for some pediatric dental patients to prevent tooth decay in kids. However, they are not a substitute for brushing, flossing, and a healthy diet.

Dental sealants can be placed by your dentist, dental hygienist, or other dental professional. Some states dental boards have laws governing by whom, how, and in what circumstances dental sealants can be placed.

While I will recommend sealants at my office, I do so with very strict criteria, application techniques, and only the cleanest materials. So, are dental sealants worth it for your children’s dental health?

How are sealants applied to teeth?

Sealant placement is a relatively easy process.

First, the teeth are cleaned of plaque or food particles and then thoroughly examined for tooth decay.

Each tooth is dried and surrounded by absorbent material so it remains dry throughout the procedure.

The tooth is cleaned with a mild etchant (acid etch solution) to roughen the tooth surface and encourage bonding of the sealant material.

The etchant is rinsed and the teeth are dried again.

Depending on your material of choice, a thin layer of bonding agent may be used prior to the placement of the very viscous sealant material.

The sealant is painted directly onto the chewing surface of each tooth.

Finally, a curing light may be used to harden the dental sealant.

The teeth must be nicely isolated so no contaminants, such as saliva, affect the bond. Ozone gas can be applied to ensure bacteria on or around the tooth is reduced or eliminated prior to sealing.

If a small cavity is detected, air abrasion or a dental laser or drill can be used to clean out the infection prior to any material placement.

Can a sealant be placed over existing tooth decay?

Technically, clear sealants can be used over small cavities to prevent major spread of the decay.

However, it’s best to treat any existing decay (or take steps to reverse it, depending on the extent of the decay) before placing a dental sealant.

How long do dental sealants last?

Depending on the techniques used, sealants can last from 3-10 years or more.

Sealants may not last as long for patients who:

Clench/grind their teeth

Have acid reflux

Eat a highly acidic diet

How do I care for my sealants?

Dental sealants are easy to care for and can be brushed and flossed as normal. Use a toothbrush with soft bristles and a toothpaste using a remineralizing agent like hydroxyapatite.

They may stain with diets high in berries, coffee, teas, and red wine. Sealants may “pop” off if you are eating sticky, gummy, chewy foods.

Do dental sealants work?

Do dental sealants prevent cavities? Yes, sealants do work to prevent cavities (tooth decay) if placed perfectly and at the right time.

Most research shows that sealants do reduce cavities, but more long term follow-ups are needed.

In a 2017 Cochrane review, researchers stated that “resin‐based sealants applied to occlusal surfaces of permanent molars reduced caries when compared to no sealant.” However, “trials with long follow‐up times are needed to research the effectiveness of sealing procedures related to different caries prevalence levels.”

The CDC (Centers for Disease Control and Prevention) found in a 2016 study that “Children without sealants had almost three times more cavities in permanent first molars compared with children with sealants.”

The same study stated that dental sealants can prevent 80% of cavities in permanent molars (where 9/10 cavities develop).

This study did not control for dietary patterns, dental hygiene habits, or level of dental care during the same period of time. It only controlled for sex, race/ethnicity, family income, and highest level of education by the head of the household.

Why does this matter? It’s possible that confounding variables — such as diet, dental visits, or dental hygiene habits — may have artificially inflated these numbers.

For example, children who received dental sealants may also have visited the dentist, brushed, and flossed more often. They may be the same children who do not eat sugary or highly acidic foods, which will impact cavity formation.

These statistics should be examined with a hefty grain of salt.

Risks of Dental Sealants

Dental sealants are painless and scientific research has not revealed any adverse effects likely to happen when dental sealants are placed.

However, there are risks if the teeth are not thoroughly examined for dental caries (tooth decay) prior to placement.

Very frequently, I will go to remove or replace a sealant only to find hidden decay underneath. If left undetected, otherwise healthy teeth need extensive fillings and sometimes even nerve therapy or extractions after being covered by a sealant.

A PLoS One study found that even “after adjustment by non-conditional logistic regression for sociodemographic variables, oral health behaviors (toothbrushing, daily use of dental floss and dental appointments) and experience of dental pain, the findings of the present study demonstrate that dental caries is associated with fissure sealant application.”

In plain terms: If sealants are not properly placed, they can actually cause cavities by either creating ledges to catch plaque and food on or by sealing in bacteria and undetected decay to fester and grow underneath the material.

Many parents are concerned about the adverse reactions/effects of dental sealant material.

Most dental sealants contain BPA (bisphenol A) and/or bis-GMA. These are both known endocrine disruptors and should generally be avoided in growing and developing children.

From a 2012 publication: “Researchers found an estrogenic effect with BPA, Bis-DMA, and Bis-GMA because BPA lacks structural specificity as a natural ligand to the estrogen receptor. It generated considerable concern regarding the safety of dental resin materials.”

According to the American Dental Association (ADA), there is “not enough [BPA] to cause you or a loved one any harm” in dental sealants.

The amount of BPA exposure is at its highest during the application and is believed to “level out” within the 24 hours after the procedure. Thus far, there is no known harm of immediate toxicity after placement of sealant material.

However, this has never been tested using blood (serum) BPA or bis-GMA levels, which may present a concern.

To avoid toxic sealant materials (even in very small amounts), ask your dentist what materials they are using for their sealants. Ceramic-based materials, rather than those with BPA, Bis-DMA, or bis-GMA materials, are associated with the smallest level of risk to overall health.

Who should get dental sealants?

Children who benefit most from dental sealants include those:

With very deep grooves in their molars

At a high risk for cavities

Who eat a diet high in processed foods, refined flours and sugars, and sugary drinks

With special needs that make dental hygiene and/or a healthy diet more challenging

Ideally, sealants should be placed immediately after eruption of the first molars (around ages 6 and 12). Sooner is better to ensure the grooves have not been affected with bacteria or early cavities.

Sealants in Adults

In general, dental sealants are not used on adults, though some sources like the CDC and ADA claim they can help prevent decay. (This has not been tested in clinical trials.)

Dental sealants for adults may not be a good idea because the tooth has been exposed to the oral microbiome for a much longer time. Complex systems of bacteria are more likely to be trapped under the sealant in a deep groove.

To place a dental sealant in an adult tooth, it is important that the grooves be drilled out, treated with ozone, and immediately sealed. This best reduces the risk of growing decay under the sealant material.

Can dental sealants be removed?

Dental sealants can usually be removed in a quick and easy procedure involving either a laser or a dental drill to carefully remove the material used.

This leaves the healthy tooth structure intact, after which it can be resealed if desired.

Removing dental sealants is done to:

Reseal the tooth with a ceramic sealant (which is considered “cleaner” than traditional sealant)

Correct chips or cracks in existing dental sealants

Eliminate poorly placed sealants

Expose buried decay that can then be restored

Once a sealant is placed, it’s generally not removed unless a dentist spots a problem or the patient (or parent) requests it for other reasons, such as to change the materials being used.

How much do dental sealants cost?

Dental sealants cost $30-60 per tooth before insurance or discount plans.

Sealants placed on adult teeth may be billed as a one surface, posterior resin. This may cost $200-300 before insurance.

Are sealants covered by dental insurance?

Yes, dental insurance almost always covers dental sealants for people under 18.

Some insurance companies will only cover sealants on specific teeth or after a dental exam.

Many states have school-based sealant programs to provide dental sealants for children unlikely to have regular dental visits. These programs are usually provided to kids from low-income families and are funded by the CDC in 20 states and 1 territory.

Are sealants right for my family?

You and your dentist can use the information here to make an informed decision — there is no “right” answer that applies to every person for dental sealants.

Simply put, you know your child.

If they snack and graze, eat a lot of sticky, processed foods (think crackers, granola bars, pretzels, chips, fruit snacks, etc.), have deep, groovy anatomy on their teeth, or have a history of cavities, then they should probably get sealants.

If your dental hygiene routine is average at best, they should probably get sealants.

If you really trust your dentist and their materials and their techniques, you should consider getting dental sealants.

I generally advise them in higher risk patients, including children with special needs or sensory disorders, simply because homecare and hygiene can be such a challenge.

If you find a dentist who uses diagnostic tools to ensure you are not sealing in decay, uses an antibacterial like ozone to disinfect the surface, and utilizes more non-toxic ceramic materials, sealants can be a wonderful decision for your child.

Recently, I did elect to put sealants on my six-year old daughter’s teeth just as soon as they had erupted enough for me to have proper access to the chewing surfaces. I used all the protocols I mentioned above and feel really good about it.

My reasoning? I cannot and will not always be in control of her hygiene and diet and I want to set her up for success. I hope that I have taught her about proper oral care and dietary choices, but frankly, I want her to avoid experiencing the most common chronic disease in the world…cavities!

Ultimately, of course, it is a parental decision and your advocacy for your child is unparalleled.

Ask questions about the procedure and materials used to your provider and if you do not like the answer, simply decline! Focus instead on cleaning up the diet, improving the hygiene routine, and keeping your oral microbiome in balance and you will thrive.

Not only will your smiles be happier, but your whole-body health will shine!

How to Prevent Cavities without Dental Sealants

Humans survived, thrived, and evolved for millions of years without dental sealants. However, I do feel they can be beneficial if our diets are not ideal or the anatomy of your tooth is exceptionally “groovy.”

If you trust the process your dentist uses, they can be an effective way to prevent decay even with a clean diet.

To prevent cavities:

Eat real, nutrient-dense, whole foods.

Practice good oral hygiene, including flossing, tongue scraping, brushing teeth, and oil pulling.

Try oil pulling, which can also help to dislodge sneaky bacteria in nooks and crevasses.

Use hydroxyapatite toothpaste to benefit the remineralization and strengthening of our teeth.

Avoid “grazing” eating patterns and eat at specific times during the day.

Note and address any mouth breathing, which can cause dry mouth and disrupt the oral microbiome.

Don’t skip dental check-ups where your dentist can closely monitor any new signs of tooth decay.

Foods that support healthy teeth include those high in:

Protein

Healthy fats

Fiber

Antioxidants

Vitamins

Minerals like phosphorus, magnesium, and calcium

For more on how to prevent and reverse cavities during childhood (from prenatal development through high school), check out Dr. B’s Guide.

6 References

Ahovuo‐Saloranta, A., Forss, H., Walsh, T., Nordblad, A., Mäkelä, M., & Worthington, H. V. (2017). Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database of Systematic Reviews, (7). Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483295/

Griffin, S. O., Wei, L., Gooch, B. F., Weno, K., & Espinoza, L. (2016). Vital signs: dental sealant use and untreated tooth decay among US school-aged children. Morbidity and Mortality Weekly Report, 65(41), 1141-1145. Full text: https://www.cdc.gov/mmwr/volumes/65/wr/mm6541e1.htm?s_cid=mm6541e1_w

Veiga, N. J., Pereira, C. M., Ferreira, P. C., & Correia, I. J. (2015). Prevalence of dental caries and fissure sealants in a Portuguese sample of adolescents. PloS one, 10(3). Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372347/

Pulgar, R., Olea-Serrano, M. F., Novillo-Fertrell, A., Rivas, A., Pazos, P., Pedraza, V., … & Olea, N. (2000). Determination of bisphenol A and related aromatic compounds released from bis-GMA-based composites and sealants by high performance liquid chromatography. Environmental health perspectives, 108(1), 21-27. Abstract: https://ehp.niehs.nih.gov/doi/abs/10.1289/ehp.0010821

Rathee, M., Malik, P., & Singh, J. (2012). Bisphenol A in dental sealants and its estrogen like effect. Indian journal of endocrinology and metabolism, 16(3), 339. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354837/

Azarpazhooh, A., & Main, P. A. (2008). Is there a risk of harm or toxicity in the placement of pit and fissure sealant materials? A systematic review. Journal of the Canadian Dental Association, 74(2). Abstract: https://pubmed.ncbi.nlm.nih.gov/18353205/

The post Dental Sealants: What are they, are they safe, and do they work? appeared first on Ask the Dentist.

from Ask the Dentist https://askthedentist.com/dental-sealants/

#Dentistry #Blog

0 notes

kristinsimmons · 4 years ago

Text

Dental Sealants: What are they, are they safe, and do they work?

What are dental sealants?

Dental sealants are thin, plastic coatings that seal over the narrow grooves found on the chewing surfaces of back teeth (molars and premolars).

When placed perfectly on these deep pits, sealants can prevent a significant amount of tooth decay (cavities) by protecting sensitive tooth surfaces from acid that causes cavities.

Sealants are not generally placed on baby teeth but on the tooth enamel of permanent teeth (“adult” teeth).

Source: CDC

Application of sealants may be appropriate for some pediatric dental patients to prevent tooth decay in kids. However, they are not a substitute for brushing, flossing, and a healthy diet.

How are sealants applied to teeth?

Sealant placement is a relatively easy process.

First, the teeth are cleaned of plaque or food particles and then thoroughly examined for tooth decay.

Each tooth is dried and surrounded by absorbent material so it remains dry throughout the procedure.

The tooth is cleaned with a mild etchant (acid etch solution) to roughen the tooth surface and encourage bonding of the sealant material.

The etchant is rinsed and the teeth are dried again.

Depending on your material of choice, a thin layer of bonding agent may be used prior to the placement of the very viscous sealant material.

The sealant is painted directly onto the chewing surface of each tooth.

Finally, a curing light may be used to harden the dental sealant.

The teeth must be nicely isolated so no contaminants, such as saliva, affect the bond. Ozone gas can be applied to ensure bacteria on or around the tooth is reduced or eliminated prior to sealing.

If a small cavity is detected, air abrasion or a dental laser or drill can be used to clean out the infection prior to any material placement.

Can a sealant be placed over existing tooth decay?

Technically, clear sealants can be used over small cavities to prevent major spread of the decay.

However, it’s best to treat any existing decay (or take steps to reverse it, depending on the extent of the decay) before placing a dental sealant.

How long do dental sealants last?

Depending on the techniques used, sealants can last from 3-10 years or more.

Sealants may not last as long for patients who:

Clench/grind their teeth

Have acid reflux

Eat a highly acidic diet

How do I care for my sealants?

Dental sealants are easy to care for and can be brushed and flossed as normal. Use a toothbrush with soft bristles and a toothpaste using a remineralizing agent like hydroxyapatite.

They may stain with diets high in berries, coffee, teas, and red wine. Sealants may “pop” off if you are eating sticky, gummy, chewy foods.

Do dental sealants work?

Do dental sealants prevent cavities? Yes, sealants do work to prevent cavities (tooth decay) if placed perfectly and at the right time.

Most research shows that sealants do reduce cavities, but more long term follow-ups are needed.

The same study stated that dental sealants can prevent 80% of cavities in permanent molars (where 9/10 cavities develop).

Why does this matter? It’s possible that confounding variables — such as diet, dental visits, or dental hygiene habits — may have artificially inflated these numbers.

These statistics should be examined with a hefty grain of salt.

Risks of Dental Sealants

Dental sealants are painless and scientific research has not revealed any adverse effects likely to happen when dental sealants are placed.

However, there are risks if the teeth are not thoroughly examined for dental caries (tooth decay) prior to placement.

Many parents are concerned about the adverse reactions/effects of dental sealant material.

Most dental sealants contain BPA (bisphenol A) and/or bis-GMA. These are both known endocrine disruptors and should generally be avoided in growing and developing children.

According to the American Dental Association (ADA), there is “not enough [BPA] to cause you or a loved one any harm” in dental sealants.

However, this has never been tested using blood (serum) BPA or bis-GMA levels, which may present a concern.

Who should get dental sealants?

Children who benefit most from dental sealants include those:

With very deep grooves in their molars

At a high risk for cavities

Who eat a diet high in processed foods, refined flours and sugars, and sugary drinks

With special needs that make dental hygiene and/or a healthy diet more challenging

Ideally, sealants should be placed immediately after the eruption of the first molars (around age 6) and second molars (around age 12). Sooner is better to ensure the grooves have not been affected with bacteria or early cavities.

Sealants in Adults

In general, dental sealants are not used on adults, though some sources like the CDC and ADA claim they can help prevent decay. (This has not been tested in clinical trials.)

Can dental sealants be removed?

Dental sealants can usually be removed in a quick and easy procedure involving either a laser or a dental drill to carefully remove the material used.

This leaves the healthy tooth structure intact, after which it can be resealed if desired.

Removing dental sealants is done to:

Reseal the tooth with a ceramic sealant (which is considered “cleaner” than traditional sealant)

Correct chips or cracks in existing dental sealants

Eliminate poorly placed sealants

Expose buried decay that can then be restored

Once a sealant is placed, it’s generally not removed unless a dentist spots a problem or the patient (or parent) requests it for other reasons, such as to change the materials being used.

How much do dental sealants cost?

Dental sealants cost $30-60 per tooth before insurance or discount plans.

Sealants placed on adult teeth may be billed as a one surface, posterior resin. This may cost $200-300 before insurance.

Are sealants covered by dental insurance?

Yes, dental insurance almost always covers dental sealants for people under 18.

Some insurance companies will only cover sealants on specific teeth or after a dental exam.

Are sealants right for my family?

You and your dentist can use the information here to make an informed decision — there is no “right” answer that applies to every person for dental sealants.

Simply put, you know your child.

If your dental hygiene routine is average at best, they should probably get sealants.

If you really trust your dentist and their materials and their techniques, you should consider getting dental sealants.

I generally advise them in higher risk patients, including children with special needs or sensory disorders, simply because homecare and hygiene can be such a challenge.

Ultimately, of course, it is a parental decision and your advocacy for your child is unparalleled.

Not only will your smiles be happier, but your whole-body health will shine!

How to Prevent Cavities without Dental Sealants

If you trust the process your dentist uses, they can be an effective way to prevent decay even with a clean diet.

To prevent cavities:

Eat real, nutrient-dense, whole foods.

Practice good oral hygiene, including flossing, tongue scraping, brushing teeth, and oil pulling.

Try oil pulling, which can also help to dislodge sneaky bacteria in nooks and crevasses.

Use hydroxyapatite toothpaste to benefit the remineralization and strengthening of our teeth.

Avoid “grazing” eating patterns and eat at specific times during the day.

Note and address any mouth breathing, which can cause dry mouth and disrupt the oral microbiome.

Don’t skip dental check-ups where your dentist can closely monitor any new signs of tooth decay.

Foods that support healthy teeth include those high in:

Protein

Healthy fats

Fiber

Antioxidants

Vitamins

Minerals like phosphorus, magnesium, and calcium

For more on how to prevent and reverse cavities during childhood (from prenatal development through high school), check out Dr. B’s Guide.

6 References

The post Dental Sealants: What are they, are they safe, and do they work? appeared first on Ask the Dentist.

Dental Sealants: What are they, are they safe, and do they work? published first on https://wittooth.tumblr.com/

0 notes

mrlongkgraves · 6 years ago

Text

Author addresses moral distress in nursing in new book

One nurse devotes her career to understanding and tackling ethics issues in nursing that threaten to undermine not only the profession, but also healthcare quality.

Cynda Hylton Rushton, RN

Meet Cynda Hylton Rushton, PhD, RN, FAAN, the Anne and George L. Bunting professor of clinical ethics at Johns Hopkins University who co-chairs the Johns Hopkins Medicine’s Ethics Consultation Service.

She co-led the first National Nursing Ethics Summit, which resulted in “A Blueprint for 21st Century Nursing Ethics.”

In her new book, “Moral Resilience: Transforming Moral Suffering in Healthcare,” Rushton takes a first-ever systematic look at moral resilience in nursing in the hope others use it as a catalyst to learn more. (Get a 30% discount on Rushton’s book by using code AMPROMD9 at checkout.)

We asked Rushton what fuels her work in ethics, how ethical issues might affect nurses professionally and personally and what nurses can do to help themselves and their profession.

You said the bedside experience has informed everything you have done professionally. What did you mean by that?

Rushton: I consider myself to be kind of a nurse’s nurse. I have always been committed to my clinical practice. And it has always been in that context that I’ve learned the most about myself and about what it means to be a nurse and … the moral adversity that comes with the role.

I started out in the pediatric ICU and often was confronted with questions about how we ought to be using our technology to sustain the lives of children who had life-threatening diseases or injuries. I worked with families to try to figure out what was the right thing to do for their children.

It was really through those roles that I became more and more interested in the ambiguity and uncertainty that was part of our work — especially as technology was expanding at a really rapid rate.

I do quite a bit of ethics consultation and, of course, that brings me right back to the bedside with patients, families and distressed staff. It’s clearly what keeps things current and real for me.

Do you have an example of an ethical dilemma in nursing?

Rushton: There are just so many. A lot of them have to do with end-of-life care.

One example is a child with a very complex congenital heart defect and the need for sometimes innovative and risky surgery that could leave the child with a high risk of death or disability and yet parents want to do everything possible to help their child.

Of course, we want every child to live well, but sometimes in our attempts what ends up happening is a very prolonged period of time where children are tethered to technology.

As a nurse, you witness how much the child is suffering, as well as people around the child — the family and often the clinicians. We struggle trying to figure out how far we should go and what amount of suffering is reasonable to endure to give a child a chance for life.

I think there are issues around how do we demonstrate respect for people whose choices are contrary to our core values? For example, a parent who intentionally harms a child and that renders the child with a devastating head injury. Yet our job is to care for both the child and the family regardless of how that child arrived in our care.

Those are the kinds of things that really call into question our core values about ourselves and our work.

What does it mean to practice ethically as a nurse?

Rushton: I think practicing ethically means that we first know who we are, what we stand for and what our core and professional values are. Then, it means having a way to recognize when ethical issues are arising that threaten those values and know how to think through and navigate them in a way that reflects the values that are most important.

Values like respect, compassion and justice are part of many people’s personal values and are very clearly part of our professional values as nurses and our code of ethics.

It’s an ongoing process of recognition and discernment. Nurses need to have the skills and tools. They need to practice in an environment that fosters their ability to do just that.

That includes having mechanisms where speaking up about concerns is an accepted response and those concerns are heard and responded to in a respectful way. That means there are recourses that can be leveraged to support nurses to do the right thing, like ethics committees and consultation services.

It also means organizations have proactive ways to recognize the patterns that create ethical challenges for people and take action to address them.

What forces in healthcare might impede ethical practice?

Rushton: I think there are many, many forces that impact nurses’ ability to practice ethically, including external forces that have to do with financial arrangements and incentives. These include insurance and how we allocate resources and budget in terms of recognizing the pivotal role that nurses play in healthcare.

There are laws and regulations that create pressures around things like documentation that influence the way nurses practice.

I also think there are issues in society — some of which I’ve already mentioned — that show up in healthcare related to social determinants of health. In many places, those include the erosion of community programs to support people to recover and to heal from illness or injury and breakdown of relationships in society.

If you look at the Future of Nursing report, one of the things they called for was for nurses to practice at the top of their license and training. I think that is still a barrier for some nurses — that they are not in environments where their authority and expertise is fully recognized and honored.

Why is it important to have a foundation of ethical practice? For example, do we know what happens when nurses feel unethical?

Rushton: Ethical practice is foundational to what it means to be a nurse. Without a moral compass, we are really rudderless in the sea of complexity that we practice in. We have to have some grounding that helps us when things are uncertain or ambiguous to sort of keep us connected to why we’re doing the work we’re doing.

For example, our code of ethics is really clear about our obligations to the promise we’ve made to the public in terms of how we will serve them with respect and compassion and fairness.

Without those values, it’s easy for us to get distracted with things that don’t really matter but are sort of propelling us in a direction that doesn’t really reflect why we’re here.

What we know from research on moral distress in nursing is that having a gap between our values and what we actually do (if we are not able to do the right thing) causes moral distress. We know there’s a relationship between moral distress and burnout, and that those situations are clearly a factor in the health and well-being of the workforce.

That has huge implications both locally and nationally, because without a healthy nursing workforce this healthcare system is unsustainable.

So, it’s really a call to action to say we have got to pay attention to the signals and data about both moral distress and burnout and to take action at a systemic level to address the causes of moral distress and burnout.

Resources to learn more about moral distress in nursing

Johns Hopkins Berman Institute of Bioethics

The American Nurses Association Center for Ethics and Human Rights

The National Academy of Medicine Action Collaborative on Clinician Well-being and Resilience

The University of Kentucky Moral Distress Education Project

Take these courses related to moral distress in nursing:

Pain Management and Ethics: What’s the Right Thing to Do? (1 contact hr) Healthcare professionals in most disciplines encounter patients with pain every day. Whether responsible for making assessments, prescribing treatment, or managing care, the professional must continuously make decisions on how to care for a patient with pain. In the current climate of escalating opioid abuse, it may seem that the struggle to determine “the right thing to do” is even more complex. Often the right answer is blurred by the subjective nature and experience of pain itself. Adding new legal restrictions and guidelines to many analgesic agents (most often opioids) further complicates how patients are scrutinized and treated for their pain. Because the treatment of pain has historically always been a moral endeavor, please join a discussion with a pain management expert to look at how ethics, values, and teamwork may contribute to better care for patients with complex pain management issues.

Everyday Ethics for Nurses (7.3 contact hrs) This course provides an overview of bioethics as it applies to healthcare and nursing in the U.S. It begins by describing the historical events and forces that brought the bioethics movement into being and explains the concepts, theories, and principles that are its underpinnings. It shows how ethics functions within nursing and on a hospital-wide, interdisciplinary ethics committee. The course explains the elements of ethical decision-making as they apply both to the care of patients and to ethics committees. The course concludes with a look at the ethical challenges involved in physician-assisted suicide, organ transplantation, and genetic testing.

End-of-Life Issues (1 contact hr) Much of the literature indicates that although most people, given the choice, would prefer to die at home, many will die in institutions. Caring for a patient approaching the end of life continues to challenge the most skilled, educated, and talented practitioners. Nurses have an obligation to address end-of-life issues with patients and families by addressing concerns, such as fear of abandonment, losing control of bodily functions, and being overwhelmed with pain or distress. This module will provide an overview for clinicians who provide comfort and support to dying patients and their families, regardless of the setting in which care is provided.

The post Author addresses moral distress in nursing in new book appeared first on Nursing News, Stories & Articles.

from Nursing News, Stories & Articles https://ift.tt/2TMr3P9

0 notes

addictionfreedom · 6 years ago

Text

Cocaine Detox Symptoms

Contents

Detox process cocaine withdrawal

Severe cocaine withdrawal symptoms — agitation

High pain threshold

Clinically observed withdrawal symptoms

Cocaine dangerous? medically-assisted

Drug treatment facilities

People are so willfully stupid, especially when it comes to areas that they themselves are culpable. Worked a crash where a teen drunk and high on cocaine (Google "cocaethylene polytoxicity"…

Now “it’s payback time … reducing cocaine use, at the lowest dose, the drug combo was able to cut drug use in compulsive rats, but not the others. Most importantly, this dose was still adequate to p…

Mar 20, 2018 … Just as with many other drugs that have addictive qualities, discontinuing cocaine use often results in cocaine withdrawal symptoms like fatigue …

The following symptoms during cocaine detox add to your general lack of physical well-being Symptoms during cocaine detox can be difficult to cope with unless you are prepared for what it…

4 days ago … Cocaine withdrawal symptoms include fatigue, depression and agitation. Using cocaine increases the amount of the “feel-good” chemical …

4 days ago … Withdrawal from certain substances, like alcohol and benzodiazepines, can involve severe physical withdrawal symptoms; however, cocaine …

Although the way modafinil affects patients is not well understood, several clinical trials suggest that modafinil is a potential anti-relapse medication for treating impulsive gambling, cocaine use d…

In most cases, depression is a symptom of cocaine withdrawal. Cocaine addicts in rehab must But like any other drug-addiction detox, cocaine addicts should start by getting intensive support to…

Cocaine withdrawal syndrome is a group of symptoms commonly experienced after stopping taking the drug. There is a lot you can do to feel better.

Psychological withdrawal symptoms associated with cocaine detox are highlighted by intense and overwhelming cravings for cocaine as well as a general agitation, anxiety and irritability…

Cocaine is often used in a binge and crash pattern, so withdrawal symptoms are often …

"only those that are used to treat the symptoms of cocaine withdrawal, which are largely ineffective at preventing relapse." The effects of propranolol were long-lasting and could be permanent, he say…

An astounding 5-6% of people who began using cocaine 24 hours ago will become long-term users, according to a paper in the journal Neuropsychopharmacology. Addiction varies with … of ailments and a …

4. Remedies for Cocaine Withdrawal Symptoms 5. The Cocaine detox process cocaine withdrawal Symptoms. Addiction can happen to anyone, at any time.

Extein said cocaine addicts go through about two weeks of withdrawal symptoms that include depression, fatigue, irritability and insomnia. “And, most importantly, they`re craving cocaine,“ he said. …

The secondary objective is to investigate whether NS2359 provides a reduction in craving for more cocaine, a reduction in withdrawal symptoms, a reduction in alcohol consumptions and smoking and wheth…

Cocaine Abuse Symptoms Often times cocaine abuse symptoms go unnoticed because cocaine abuse symptoms are subtle and hard to identify.

People with more severe cocaine withdrawal symptoms — agitation, restless behavior, and depressed mood — appeared to have benefited most from topiramate, according to the researchers. “Cocaine depende…

Other symptoms include a high pain threshold, speech difficulties and poor temperature regulation. Source: Prader-Willi Foundation Australia. Eventually, a doctor at the Steve Biko Academic Hospital in…

For example, Miller and colleagues (1993) reported self-described and clinically observed withdrawal symptoms among a group of 150 cocaine-dependent …

Addiction Treatment Games “I missed a penalty in the first half but I scored a goal in the second half and we went on to win the game. I got the majori… We offer personalized & effective addiction treatment for behavioural addictions like video games. Our programs are personalized to maximize effectiveness. The proliferation of digital devices has

Mar 31, 2017 … Cocaine withdrawal occurs when someone who has used a lot of cocaine cuts down or quits taking the drug. Symptoms of withdrawal can …

Table of Contents How Long Does It Take to Detox From Cocaine? Cocaine Detox Symptoms and Effects The withdrawal symptoms often subside within 3 to 5 days, though sometimes the symptoms…

Cocaine detox is unlike other medical detox treatments because cocaine is water-soluble and does Some of these symptoms can last for months after detox especially the cravings which are often very…

cocaine, “bath salts,” Ecstasy and prescription drugs. Stimulants, especially meth, are cheaper than opioids, widely availabl…

Understand the cocaine withdrawal timeline—length, treatment, symptoms, medication, severity and how to care for someone during withdrawal.

Addiction Treatment Centers In New Jersey New Jersey health officials say a 10th child has died in a viral outbreak at a pediatric rehabilitation center. The state Department of Health on Wednesday night confirmed the latest death at the Wana… Recovery CNT is one of the best ambulatory Detoxification (Detox) centers providing withdrawal treatment for people (Outpatient) dealing with Opiates like …

Read about detoxing from cocaine—symptoms of withdrawal, where to get treatment, how to recover from cocaine abuse and addiction.

Is Detox from cocaine dangerous? medically-assisted Detox and Withdrawal. Cocaine withdrawal symptoms are often flu-like in nature, and while not life threatening as such, can sometimes lead to…

Addiction Treatment Cape Town Health workers in Cape Town have warned of a possible … HIV counselling, testing and treatment with ARVs, and medically assisted treatment of opioid dependence. Shaun Shelly, Program Manager: Addict… Heroin Addiction Treatment Methods The most effective treatment is opioid replacement therapy. … For the treatment of heroin addicts a wide range of psychosocial and

(PhysOrg.com) — Two separate discoveries by researchers at the University of Wisconsin-Milwaukee (UWM) offer potential for development of a first-ever pharmacological treatment for cocaine addiction …

Symptoms of cocaine withdrawal include While cocaine detox can often be completed on an outpatient basis, medical detox is recommended in some instances.

Cocaine detox involves withdrawal symptoms that can be influential in the addict's psychological wellbeing. The following, are 10 cocaine detox symptoms treated in rehab

Symptoms of cocaine detox. Cocaine is a powerfully addictive drug and regular user can begin to experience tolerance to the euphoric high it produces after regular use.

Those reporting symptoms of depression after critical illness appear to be at a greater risk of death. When patients with dependence on alcohol, cocaine or nicotine are shown drug cues, or images…

Albanian cocaine smugglers. (Sensitive to singling out nationalities, Owens used the term "western An explosion in counterfeit goods and drugs – particularly cocaine – and an eased flow of money…

Alcohol withdrawal symptoms will vary depending on the individual’s history and include tremors, anxiety, hallucinations, nausea, sleeplessness, sweating and rapid pulse. Cocaine, grown from the coca …

Addiction Treatment Wichita Ks Substance Abuse and Addiction Treatment Resources in Wichita. Table of contents. 1.0 Drug & Alcohol Rehab Centers. There are several Wichita drug treatment facilities for the community members struggling with alcohol and substance misuse in a bid to reduce overdose cases and severe… Heroin Addiction Treatment Methods The most effective treatment is opioid replacement therapy. Addiction Treatment Types There are different types of drug addiction and it is said to influence multiple brain circuit like memory, control of your behaviour and learning. Drug addiction treatment is very complex and it will … Research studies on addiction treatment typically have classified programs into several general types or modalities. Treatment approaches and individual programs continue

0 notes

isaacscrawford · 7 years ago

Text

Consider This Speculative Amazon Scenario

By TORY WOLF

Amazon has many puzzled about its plans for healthcare. Arguably, Amazon is just as puzzled, but is – in effect — running a massive Delphi process to sort out the plan. Amazon is, after all, the Breaker of Industries, Destroyer of Margins. Allow rumors to float, hire some people, have meetings, seek a few regulatory approvals, start a vaguely missioned non-profit with other business titans. Fear and greed do the rest.

Stock prices gyrate as investors bet and counter bet on who is vulnerable, incumbent CEOs promise cooperation or competitive hostility, analysts speculate, “old hands” pontificate, and consultants send megabytes of unsolicited slide decks to South Lake Union. All that information gets exposed without any material commitment.

Disrupting the roadblocks to healthcare innovation

Proper strategic planning requires consideration of a few disruptive (if less likely) scenarios. Amazon getting into hospital supply or creating yet another benefits buying group is easy to imagine but conservative in scope. And we know Bezos thinks long-term and that profits are secondary to platform building.

We also know that the biggest target for disruption–complex, opaque, and inefficient care delivery – remains largely undisturbed despite wave after wave of innovations: ACO and bundle payment models, transparency initiatives (e.g., Castlight), private exchanges, direct contracting models, telemedicine, alternative primary care models (concierge, medical home) – all have all fallen short of their promise.

Why is that? Healthcare is a goldmine of textbook market failures thriving on (1) incentive misalignment (2) information asymmetry and (3) a system frozen by byzantine contracting and regulatory structures, highly scaled incumbents operating highly scalable processes and local market entry barriers which ensure that share shifts are glacial. Innovation is kept comfortably on the margins.

How could Amazon fix this?

Starting point: Amazon’s progressive iteration strategy and partner set

First, keep in mind how Amazon worked in the past: it started a pure commodity (books where copies are completely interchangeable), added in products with lots of different versions to choose from (like toothbrushes or shirts and used versions of books) and different suppliers to choose from (Amazon Marketplace) and finally opened the platform infrastructure to be used by other companies (Amazon Web Services). It has failures along the way but kept experimenting until it figured out what worked.

Also, keep this new joint venture in mind. Besides over 1M employees as a test bed and lure for collaborators, the three organizations are outsiders with “creative destruction” mindsets and capabilities well suited to stimulating markets in risk-ridden domains: Amazon is good at creating highly liquid consumer markets supported with efficient, transparent logistics (rapidly working towards near real-time); Berkshire-Hathaway (BH) is a huge reinsurer which, by allowing players to offload risk they cannot manage, enables value delivery on the portion they can; JPMorgan (JPM) has experience using highly liquid markets to innovate entirely new contract classes and target risk allocations by splitting up and reassembling risks in ways that attract more customers (financial engineering).

Our scenario starts with using Amazon getting started in a way much like it did with books (commodity care), then using its initial critical mass of customers to expose more complicated slices of healthcare to its markets, and then layers in BH and JPM capabilities to support product and risk model innovation which will allow share to shift faster to top performing providers. It will take many years – a decade at least – but could upend the system.

Step 1: Start with the healthcare equivalent of books with an Orbitz for minor acute

Bookshop owners wax poetic about the feel, smell and sound of cracking open a new book. Bezos recognized that this romanticism is not shared by buyers seeking bargains and convenience. Hippocratic sentimentality aside, there are several classes of healthcare that many patients are ready to shop for (and payers have been trying to get them to shop for): minor acute care (sniffles and coughs to simple fractures), basic diagnostic services (labs and imaging) and some preventative care (e.g. flu vaccines).

Amazon could start there: Focus on some specific metro regions (ones where Amazon, BH and JPM have employees), target PPO (which allow for more self-direction vs. HMO) and ASO (to avoid state regulatory frictions) and require plan administrators to create interfaces to pump network and benefit information to an Amazon Health website; cut deals with telehealth, retail and urgent care clinics, primary care and free-standing imaging centers; require them to build interfaces with their scheduling systems. And finally, employees save their benefit information into this “Orbitz” for healthcare.

“Alexa, I have a sore throat…” Options inside the Venn diagram of benefit design, network and convenient availability populate: one clinic is nearby, affiliated with the member’s primary care but no slots until tomorrow; one urgent care center is on the way to work and has immediately availability but Tier 2 so a higher co-pay. TDOC has Dr. Jones ready for a call in fifteen minutes. There’s also the ED downtown with Harvard trained doctors but that’s a $200 co-pay and current wait time is 4 hours. Once a choice is made, patient intake forms pre-populate and co-pays are collected in advance.

Market share – made fluid as lower search and transaction costs melt the constraints of habit – will shift faster in response to better value. New ideas are innovated, tested, copied: hours and capacities adjusted; more telemedicine options; experienced physicians offered as alternatives to extenders. Providers who initially opted out will revise their decision. With additional market depth, new navigation tools can be added: Customers ratings become more credible thanks to the compelling power of “n = a lot”; Amazon links with claims clearinghouses and CMS to get data on provider experience (“This provider has treated sore throats 500 times in the last 2 years”).

Step 2: Grow the market and expand care domains (Orbitz for specialty consults)

Big ASO groups – always looking for the latest gadgetry – will push plan administrators to incorporate Amazon Health into benefit designs. Indeed, those plans may not need to be pushed given medical cost improvement as members respond more fully to co-pays differentials designed to lure them to more appropriate sites of care.

Game theory’s iron logic will induce providers to expand their offer on the Amazon marketplace to care where their brands will be more compelling: primary care, more complicated procedures (e.g., colonoscopies) and, the biggest step, specialist consults[1].

Specialist consults are the front door to expensive arcs of care, often involving highly profitable procedures. The economic stakes if this kind of share becomes more fluid are much higher than minor acute care. High quality providers whose differentiated performance is not reflected in copays and availability will protest. And payers will agree. Copays will have become too crude a tool to support decision-making where clinical quality can have a much bigger impact on outcomes and costs.

Step 3: Innovate the product (from appointments to episodes)

Markets are great engines for figuring out new pricing mechanisms. High performing providers will develop bundles which show their value and payers will relax benefit designs to test uptake. Have a new chronic disease? This specialist will take care of you and all your disease-related needs for one annual co-pay. Need some fairly complex cardiac procedure? A local community/tertiary provider uses Mayo Clinic protocols and guarantees recovery in half the time or your co-pays back. Not all combinations will work, not all ideas will be allowed by plans (though Amazon’s IT support will help ensure that clunky claims and contracting systems are not the roadblock) but bad ideas will fail quickly and winning ideas copied and enhanced.

This is the point where BH will be a critical enabler: Some providers may be cautious about taking on the risk of consumer-appealing bundles (especially when these are being iterated much faster than the lengthy cycles of CMS). But the prospect of not only gaining on the risk (by managing care costs better) but also on market share will be hard to pass up. What will be needed is a partner who can help slice up the risk of any bundle, and take those risks which are beyond the providers’ control off their hands – the sort of thing a reinsurer should be great at doing.

With share shift and volume concentration among able specialty care providers, there will emerge more opportunities to specialize operating models (Herzlinger’s “focused factories”). Less capable providers – particularly those whose economics depend on complicated webs of cross-subsidization – will struggle.

Step 4: A parallel B2B market in episodes emerges – An Alibaba for Episodes

Today, big provider systems generally “make” rather than “buy” service lines. Referring care out of system is limited to very specialized, high-end care (e.g. specialty pediatrics, complicated cancer, transplant) where there was not much prospect for acquiring the physicians and equipment needed. Provider systems insource for a wide variety of reasons: better coordination on clinical strategy, less risk of losing the patient, ambiguity about cost and outcomes, cross subsidization opportunities (who gives up “knees”?)

A liquid market for specialty episodes could eliminate some of these reasons: the market-driven definition of bundles will make a more modular approach to care collaboration easier; provider systems will a lot more visibility into their relative performance; and, the incentives for focused factories to hand back the patient at the end of the episode (vs. stealing them for other care needs) will be very strong.

Thus, a B2B market for specialty care could emerge among providers operating HMOs (in parallel to the B2C market for PPO). Population health managers (HMOs or other models) negotiate with focused factories for portions of care where they have stronger performance. The PCP would refer patients to recommended specialists as usual, but instead of generally guiding the patient towards in-system specialists, might refer more to third party providers and thereby benefiting from better value delivered.

At this point in the scenario, JPM can become a critical enabler: Risk tracking would get complicated as an accountable provider is taking risk at the population level, then handing out targeted portions of that risk to focused factory providers. JPM’s know-how in building markets around complicated derivatives deals could become important to making this aspect of the B2B market work. Derivative contracts set up complicated chains of financial flows across multiple parties in response to highly customized event triggers all of which are settled via true-ups across parties at specified periods of time. The process could look very similar for healthcare providers.

Step 5: Private exchanges become real benefit design innovation engines

As accountable providers – whether they are today’s integrated delivery systems or clinically integrated networks or emerging national ambulatory systems (like a matured OptumCare) – revise service portfolios and operating models to take advantage of focused factories, they will have more options to vary the value proposition they offer patients: different combinations of focused factories for specific conditions, a primary care panel weighted with expertise in certain conditions, concierge features, etc.

There’s no reason prospective patients shouldn’t participate in the cost of those features through private exchanges (where members are offered a defined contribution towards selecting among various benefit structures). When a member first signs up for HMO coverage, they could be offered choices: a standard model and then extra features and pricing for specific accountable providers. Want care provided exclusively by the academic medical center and medical school team? Willing to have your health and care managed by the local OptumCare team but with access to Cleveland Clinic for cardiac care? You will see the impact on your premiums and co-pay structures.

And with that, the Amazon will have gone full circle from market making in commodity acute care to exposing more and more slices of delivery system operating models and cost structures to market forces, thereby tearing them down and supporting their reassembly into more efficient models winning on more liquid markets, to changing the way healthcare coverage is itself purchased.

Fully integrated provider systems as today’s department stores

You may not find this scenario particularly feasible. We are not fully convinced either and continue to puzzle about how it might work. But many objections seem to depend on differing assumptions about patients (e.g. “patients do not want to shop for healthcare”) or Amazon (e.g. “they won’t wait x years to make money”) or providers (“branded systems won’t play”) each of which can be challenged (for example, patients are already being asked to shop via high deductible plans but lack the tools and don’t see the value to doing so, Amazon can make money with a lot of supporting transactions – their recent deal to sell Amazon’s brand of OTC medications made by Perrigo will complement any foray into scheduling minor acute visits).

One assumption which is not challenged – that there is a lot of waste in healthcare delivery driven by lack of clarity on what the market really wants (which needs a real market with real pricing for everyone to figure out) and by lack of opportunity to capture share if you deliver it – is what defines the size of the opportunity.

An Amazon model could start small but will become a powerful engine fed by adding clinical adjacencies. Shifting share and more focused factories will expose operating models and cost structures–layered with complicated cross-subsidies – to market forces. As those cross-subsidies are removed, the value for the Amazon enabled shopper will be attractive. And entrepreneurial energy and capital will be attracted by the opportunity to gain share. The adoption curves on new technologies and processes will be faster, raising the ROI on many ideas.

I suspect many imagine some version of this scenario happening at some point — just well beyond any reasonable planning horizon. Amazon is moving up the timeline. A lot of questions which might have seemed academic and deferrable a year or so ago should be put back in the front of the queue: what value are we creating? Where are we differentiated? What do we really need to own? How can we become both leaner and more nimble and innovative? How can we win in a more transparent, fluid, value-seeking market?

Many book store owners, department store executives, consumer electronics retailers wish they had good answers to those questions a few decades ago.

Article source:The Health Care Blog

0 notes

kristinsimmons · 4 years ago

Text

Dental Sealants: What are they, are they safe, and do they work?

What are dental sealants?

Dental sealants are thin, plastic coatings that seal over the narrow grooves found on the chewing surfaces of back teeth (molars and premolars).

When placed perfectly on these deep pits, sealants can prevent a significant amount of tooth decay (cavities) by protecting sensitive tooth surfaces from acid that causes cavities.

Sealants are not generally placed on baby teeth but on the tooth enamel of permanent teeth (“adult” teeth).

Source: CDC

Application of sealants may be appropriate for some pediatric dental patients to prevent tooth decay in kids. However, they are not a substitute for brushing, flossing, and a healthy diet.

How are sealants applied to teeth?

Sealant placement is a relatively easy process.

First, the teeth are cleaned of plaque or food particles and then thoroughly examined for tooth decay.

Each tooth is dried and surrounded by absorbent material so it remains dry throughout the procedure.

The tooth is cleaned with a mild etchant (acid etch solution) to roughen the tooth surface and encourage bonding of the sealant material.

The etchant is rinsed and the teeth are dried again.

Depending on your material of choice, a thin layer of bonding agent may be used prior to the placement of the very viscous sealant material.

The sealant is painted directly onto the chewing surface of each tooth.

Finally, a curing light may be used to harden the dental sealant.

The teeth must be nicely isolated so no contaminants, such as saliva, affect the bond. Ozone gas can be applied to ensure bacteria on or around the tooth is reduced or eliminated prior to sealing.

If a small cavity is detected, air abrasion or a dental laser or drill can be used to clean out the infection prior to any material placement.

Can a sealant be placed over existing tooth decay?

Technically, clear sealants can be used over small cavities to prevent major spread of the decay.

However, it’s best to treat any existing decay (or take steps to reverse it, depending on the extent of the decay) before placing a dental sealant.

How long do dental sealants last?

Depending on the techniques used, sealants can last from 3-10 years or more.

Sealants may not last as long for patients who:

Clench/grind their teeth

Have acid reflux

Eat a highly acidic diet

How do I care for my sealants?

Dental sealants are easy to care for and can be brushed and flossed as normal. Use a toothbrush with soft bristles and a toothpaste using a remineralizing agent like hydroxyapatite.

They may stain with diets high in berries, coffee, teas, and red wine. Sealants may “pop” off if you are eating sticky, gummy, chewy foods.

Do dental sealants work?

Do dental sealants prevent cavities? Yes, sealants do work to prevent cavities (tooth decay) if placed perfectly and at the right time.

Most research shows that sealants do reduce cavities, but more long term follow-ups are needed.

The same study stated that dental sealants can prevent 80% of cavities in permanent molars (where 9/10 cavities develop).

Why does this matter? It’s possible that confounding variables — such as diet, dental visits, or dental hygiene habits — may have artificially inflated these numbers.

These statistics should be examined with a hefty grain of salt.

Risks of Dental Sealants

Dental sealants are painless and scientific research has not revealed any adverse effects likely to happen when dental sealants are placed.

However, there are risks if the teeth are not thoroughly examined for dental caries (tooth decay) prior to placement.

Many parents are concerned about the adverse reactions/effects of dental sealant material.

Most dental sealants contain BPA (bisphenol A) and/or bis-GMA. These are both known endocrine disruptors and should generally be avoided in growing and developing children.

According to the American Dental Association (ADA), there is “not enough [BPA] to cause you or a loved one any harm” in dental sealants.

However, this has never been tested using blood (serum) BPA or bis-GMA levels, which may present a concern.

Who should get dental sealants?

Children who benefit most from dental sealants include those:

With very deep grooves in their molars

At a high risk for cavities

Who eat a diet high in processed foods, refined flours and sugars, and sugary drinks

With special needs that make dental hygiene and/or a healthy diet more challenging

Sealants in Adults

In general, dental sealants are not used on adults, though some sources like the CDC and ADA claim they can help prevent decay. (This has not been tested in clinical trials.)

Can dental sealants be removed?

Dental sealants can usually be removed in a quick and easy procedure involving either a laser or a dental drill to carefully remove the material used.

This leaves the healthy tooth structure intact, after which it can be resealed if desired.

Removing dental sealants is done to:

Reseal the tooth with a ceramic sealant (which is considered “cleaner” than traditional sealant)

Correct chips or cracks in existing dental sealants

Eliminate poorly placed sealants

Expose buried decay that can then be restored

Once a sealant is placed, it’s generally not removed unless a dentist spots a problem or the patient (or parent) requests it for other reasons, such as to change the materials being used.

How much do dental sealants cost?

Dental sealants cost $30-60 per tooth before insurance or discount plans.

Sealants placed on adult teeth may be billed as a one surface, posterior resin. This may cost $200-300 before insurance.

Are sealants covered by dental insurance?

Yes, dental insurance almost always covers dental sealants for people under 18.

Some insurance companies will only cover sealants on specific teeth or after a dental exam.

Are sealants right for my family?

You and your dentist can use the information here to make an informed decision — there is no “right” answer that applies to every person for dental sealants.

Simply put, you know your child.

If your dental hygiene routine is average at best, they should probably get sealants.

If you really trust your dentist and their materials and their techniques, you should consider getting dental sealants.

I generally advise them in higher risk patients, including children with special needs or sensory disorders, simply because homecare and hygiene can be such a challenge.

Ultimately, of course, it is a parental decision and your advocacy for your child is unparalleled.

Not only will your smiles be happier, but your whole-body health will shine!

How to Prevent Cavities without Dental Sealants

If you trust the process your dentist uses, they can be an effective way to prevent decay even with a clean diet.

To prevent cavities:

Eat real, nutrient-dense, whole foods.

Practice good oral hygiene, including flossing, tongue scraping, brushing teeth, and oil pulling.

Try oil pulling, which can also help to dislodge sneaky bacteria in nooks and crevasses.

Use hydroxyapatite toothpaste to benefit the remineralization and strengthening of our teeth.

Avoid “grazing” eating patterns and eat at specific times during the day.

Note and address any mouth breathing, which can cause dry mouth and disrupt the oral microbiome.

Don’t skip dental check-ups where your dentist can closely monitor any new signs of tooth decay.

Foods that support healthy teeth include those high in:

Protein

Healthy fats

Fiber

Antioxidants

Vitamins

Minerals like phosphorus, magnesium, and calcium

For more on how to prevent and reverse cavities during childhood (from prenatal development through high school), check out Dr. B’s Guide.

6 References

The post Dental Sealants: What are they, are they safe, and do they work? appeared first on Ask the Dentist.

Dental Sealants: What are they, are they safe, and do they work? published first on https://wittooth.tumblr.com/

0 notes