Friday, July 25, 2008
Coding guidelines for routine HIV testingBackground
In September 2006, the Centers for Disease Control and Prevention (CDC) issued recommendations
for HIV testing in health care settings.
“The Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings” (Morbidity and Mortality Weekly Report, 2006) encourages HIV testing as a routine part of medical care. For patients in all health care settings, there are four key differences from previously published CDC recommendations:
• HIV screening—another term for broad-based testing—is recommended for patients ages 13 to 64 in all health care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
• HIV testing of people at high risk for HIV infection
is recommended at least once a year.
• Screening should be incorporated into the general
consent for medical care; separate written informed consent is not recommended.
• Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health care settings.
Laws in states differ regarding counseling and
written informed consent; check your state laws and policies (see the Resources section of this flier for more information).
Data suggests that targeted testing on the basis of risk behaviors fails to identify a substantial number
of persons who are HIV infected. A significant number of persons, including persons with HIV infection, do not perceive themselves to be at risk for HIV or do not disclose their risks. Routine voluntary HIV testing may reduce the stigma associated with assessment of risk behaviors. More patients accept recommended HIV testing when it is offered routinely to everyone, without a risk assessment. And as a health care provider, routine voluntary screening removes the step for you of identifying and assigning risk.
HIV infection is consistent with all generally accepted criteria that justify screening: (1) HIV infection is a serious health disorder that can be diagnosed before symptoms develop; (2) HIV can be detected by reliable, inexpensive and noninvasive
screening tests; (3) infected patients have years of life to gain if treatment is initiated early, before symptoms develop; and (4) the costs of screening are reasonable in relation to the anticipated
benefits.
With routine HIV screening in place, the ability to link patients who receive a diagnosis of HIV infection into care, treatment and prevention services is critical. HIV screening without such linkages confers little or no benefit to the patient. Providers should be prepared to appropriately refer people into care programs with the capacity to absorb new patients.
2008 status of testing and reimbursement:
With the latest CDC recommendations and the move toward HIV testing as a routine part of care, more providers are using rapid test kits. Effective Jan. 1, 2008, providers can bill for performing an HIV test with a rapid test kit. Providers can add modifier “92” for “Alternative Laboratory Platform Testing” to the usual laboratory procedure
code for HIV testing within the CPT® system. The following is the CPT language for this service: “When laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable
analytical chamber, the service may be identified by adding modifier 92 to the usual laboratory procedure code (HIV testing 86701–86703).”
The test does not require permanent dedicated space; hence, by its design, it may be hand carried
or transported to the vicinity of the patient for immediate testing at that site, although location of testing is not in itself determinative of the use of this modifier.
Example 1:
A private practice physician sees a 20-year-old single male for a physical examination before his senior year of college. The patient, who is not an established patient, has had multiple sexual partners, both male and female. The physician performs the HIV rapid test. To bill use:
• ICD-9-CM diagnosis codes
1. V70.0 Routine general medical examination
2. V73.89 Special screening for other
specified viral diseases
3. V69.8 Other problems related to lifestyle (since patient is asymptomatic but in a known high risk group)
4. V65.44 HIV Counseling (if counseling
is provided during the encounter for
the test or after the results are available)
5. V08 Asymptomatic HIV infection status
if the results are positive but the patient
is asymptomatic
6. 042 HIV disease, with codes for the HIV-related manifestations or conditions, if the results are positive and the patient exhibits symptoms
• CPT codes
1. Test product
86701 with modifier 92 for the antibody HIV-1 test
or
86703 with modifier 92 for the antibody HIV-1 and HIV-2 single assay
2. Office service
99385 if the patient is new for initial comprehensive preventive medicine
service evaluation and management
or
99395 if the patient is established for periodic comprehensive preventive
medicine reevaluation and management
99211–99215 for the evaluation and
management of an established patient
if the results are positive and HIV counseling
is provided
Example 2:
A 34-year-old, married female with allergy complaints
shows up at her primary care physician’s office. As a returning patient, the physician can either perform the conventional HIV test or the rapid HIV test. To bill use:
• ICD-9-CM diagnosis codes
1. V73.89 Special screening for other
specified viral diseases
2. V65.44 HIV counseling (if counseling is provided during the encounter for the test or after the results are available)
3. V08 Asymptomatic HIV infection status
if the results are positive but the patient is asymptomatic
4. 042 HIV disease, with codes for the HIV-related manifestations or conditions, if the results are positive and the patient exhibits symptoms
Note: These codes should be reported in addition to those appropriate to allergy complaints (either a confirmed diagnosis of allergy, or the specific signs or symptoms) reported by the patient.
• CPT codes
1. Test product
86701 antibody HIV-1 test
or
86701 with modifier 92 for the antibody HIV-1 test
or
86703 with modifier 92 for the antibody HIV-1 and HIV-2 single assay
2. Test administration
36415 collection of venous blood by venipuncture
3. Office service
99211–99215 appropriate office visit code from the office or other outpatient services code series for an established patient based upon the key components performed
99211–99215 for the evaluation and management of an established patient
if the results are positive and HIV counseling
is provided
Resources (including linkage to care)
• American Academy of HIV Medicine’s
“Find a Provider”
www.aahivm.org
• HIV Medicine Association’s HIV
Provider Listing
www.hivma.org
• CDC’s National Prevention Information Network can provide referrals
(800) 458-5231
www.cdcnpin.org
• Compendium of state laws regarding HIV
testing (last revised March 2008)
www.ucsf.edu/hivcntr/StateLaws/Index.html
• American Medical Association CPT Home Page
www.ama-assn.org/go/CPT
• For the full text of the CDC’s revised recommendations
on routine testing for HIV, visit
www.cdc.gov/mmwR/preview/mmwrhtml/rr5514a1.htm
0 eavesdropped
The classical oath
A Nova translation of the Oath runs as follows:
I swear by Apollo Physician and Asclepios and Hygeia and Panacea and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.
I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.
If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.
----------------------------------------------------------------------------------------
Original, translated from Greek.[1]
“ I swear by Apollo, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath.
To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
To please no one will I prescribe a deadly drug nor give advice which may cause his death.
Nor will I give a woman a pessary to procure abortion.
But I will preserve the purity of my life and my arts.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
Written 400 B.C.E
Translated by Francis Adams
I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!
0 eavesdropped
International Code of Medical Ethics of the World Medical Association - 1949
Adopted by the Third General Assembly of the World Medical Association at London in October 1949. (World Medical Association Bulletin, vol. 1, no. 3, October 1949, pp.109, 111).
[CIRP Note: The two most important parts of this code for the study of the ethics of child circumcision may be 1) the statement "Any act, or advice which could weaken physical or mental resistance of a human being may be used only in his interest", 2) the requirement to be "loyal" to his patient, 3) the requirement to "observe the principles of The Declaration of Geneva", because that document requires that a doctor must not use "medical knowledge contrary to the laws of humanity", and 4) the requirement that a doctor must "practice his profession uninfluenced by motives of profit."]
Duties of Doctors in General
A doctor must always maintain the highest standards of professional conduct.
A doctor must practice his profession uninfluenced by motives of profit.
The following practices are deemed unethical:
Any self advertisement except such as is expressly authorized by the national code of medical ethics;
Collaborate in any form of medical service in which the doctor does not have professional independence;
Receiving any money in connection with services rendered to a patient other than a proper professional fee, even with the knowledge of the patient.
Any act, or advice which could weaken physical or mental resistance of a human being may be used only in his interest.
A doctor is advised to use great caution in divulging discoveries or new techniques of treatment.
A doctor should certify or testify only to that which he has personally verified.
Duties of Doctors to the Sick
A doctor must always bear in mind the obligation of preserving human life from conception. Therapeutic abortion may only be performed if the conscience of the doctors and the national laws permit.
A doctor owes to his patient complete loyalty and all the resources of his science. Whenever an examination or treatment is beyond his capacity he should summon another doctor who has the necessary ability.
A doctor shall preserve absolute secrecy on all he knows about his patient because of the confidence entrusted in him.
A doctor must give emergency care as a humanitarian duty unless he is assured that others are willing and able to give such care.
Duties of Doctors to Each Other
A doctor ought to behave to his colleagues as he would have them behave to him.
A doctor must not entice patients from his colleagues.
A doctor must observe the principles of The Declaration of Geneva approved by The World Medical Association.
Cite as:
World Medical Association. International code of medical ethics. World Medical Association Bulletin 1949;1(3): 109, 111.
====================================================================================
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Principles of medical ethics
Preamble
The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.
Principles of medical ethics
A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
A physician shall support access to medical care for all people.
Adopted by the AMA's House of Delegates June 17, 2001.
0 eavesdropped
Thursday, July 24, 2008
Six Surgical MiraclesSome of the more amazing and unusual operations of modern times.
On June 11, a 6-year-old Texas girl had the entire right half of her brain removed to stop devastating seizures; amazingly, her memory and personality are expected to remain intact. But this is just one of many incredibly delicate and difficult surgeries performed in recent history. From a doctor who operated on himself to surgeons who execute complicated procedures on the tiniest fetuses while they are still in the womb, here are six of the most unusual surgical miracles in modern history.
1. Surgery to Remove Half a Child's Brain. On June 11, 6-year-old Jessie Hall of Aledo, Texas, had the entire right side of her brain removed by neurosurgeon Ben Carson at Johns Hopkins Children's Center in Baltimore. The rare procedure is called a hemispherectomy, and though drastic, it was considered the best possible treatment for Jessie, who suffers from Rasmussen's encephalitis, a progressive degeneration of the cerebral cortex that causes uncontrollable seizures. Though doctors do not fully understand how, the remaining half of the brain in such cases typically takes over many of the functions previously performed by the removed half. Jessie may be permanently paralyzed on her left side, but there is usually no effect on personality or memory. Johns Hopkins does about 12 of these surgeries each year, mostly on children between the ages of 5 and 10. When surgeons were first developing the procedure, they tried to fill the empty cavity on one side of the skull, in one case using sterile ping-pong balls, but they later realized that the brain's own cerebrospinal fluid eventually fills the space.
2. The Four-Day Operation. From Feb. 4 to Feb. 8, 1951, Gertrude Levandowski of Burnips, Mich., underwent a 96-hour procedure at a Chicago hospital to remove a giant ovarian cyst. It is believed to be the world's longest surgery. Levandowski weighed 616 pounds before the surgery and had a girth of 9 feet. After the growth was removed, the 58-year-old weighed a more manageable 308 pounds. During the operation, surgeons tapped the cyst to slowly drain the fluid from it, wanting to prevent a rapid drop in pressure that could affect her already strained heart. It took four days to get about 200 pounds of fluid out of her body. They then removed the cyst, which weighed about 150 pounds.
3. Surgery in Utero:Kylie Bowlen was 22 weeks pregnant when doctors at Melbourne's Monash Medical Centre in Australia operated on her unborn child to repair a very rare condition in which amniotic bands had wrapped around the baby's ankles, cutting off blood supply to the lower legs (the web-like bands are part of the amniotic sac). Normally doctors wait until 28 weeks to do surgery on a fetus, but without intervention, the baby would have lost both her feet. Surgeons inserted a 2-millimeter operating telescope into Kylie's womb and used a laser and electric current to cut the bands on the baby's left leg, thereby saving it. Unfortunately, the right leg was already infected and inoperable. At the time, the baby, later named Leah, was only approximately 7 inches long. Leah was born Jan. 24, 2008, eight weeks after the operation and two and a half months premature. When she was 4 days old, doctors operated to repair her right leg, which had been dangling from a tiny artery. The procedure is believed to be the earliest in-utero surgery of its kind ever performed. Doctors are hopeful that Leah will be able to walk.
4. Surgeon, Operate on Thyself. In 1921, Evan O'Neill Kane of Kane, Penn., wanted to prove that ether—the primary general anesthetic at the time—was being used far too often when less-dangerous local anesthetics could be substituted. As his test case, the good doctor used himself, removing his own appendix using only local anesthetic by propping himself up on the operating table with a mirror over his abdomen. With three other doctors in the operating room as backup, Kane made the large incision needed to remove the appendix and his assistants sutured him up. (This was before new techniques allowed doctors to make small 'Band-Aid'-size incisions for appendix removal). The doctor recovered nicely. Then, in 1932, at age 70, Dr. Kane performed an even more complicated surgery on himself to repair an inguinal hernia. Because of the close proximity to the femoral artery, it was a particularly delicate operation—Kane performed it in just under two hours. Reportedly, he was relaxed and joking even as he sutured within millimeters of the important blood vessels.
5. Saving Face. A French man suffering from a rare condition that causes extremely disfiguring tumors got a new face and a new lease on life in January of 2007. Thirty-year-old Pascal Coler had had dozens of previous operations to reduce massive tumors caused by a disorder called neurofibromatosis, yet he could barely eat and had become a recluse because of the bulbous deformities. The disorder is a rare genetic condition called Von Recklinghausen's Disease; experts have speculated that Joseph Merrick, nicknamed 'The Elephant Man,' was suffering from it 100 years ago.
After a 16-hour operation, Laurent Lantieri, head of plastic surgery at Henri-Mondor Hospital near Paris, reported that the surgical team had replaced "almost all" of Coler's face (lips, cheeks, nose and mouth), with that of a donor. Coler, who has recovered well, does not look like the anonymous donor because his underlying facial bone structure remains intact. This is the third face transplant ever done, and doctors at Henri-Mondor say it is the most extensive. (In 2005, a French woman received a partial transplant—new lips, a nose and a mouth—after the lower half of her face was mauled by a dog. In 2006, a Chinese man had a partial face transplant to repair damage done during a bear attack.)
6. Twice Born. Six months into her pregnancy, Keri McCartney and her husband, Chad McCartney, of Laredo, Texas, found out that their baby had an enormous and deadly tumor growing out of her tailbone. An ultrasound revealed the noncancerous, grapefruit-sized growth, which was draining the baby's blood supply and would have killed her. In a risky and rare procedure, surgeons at Texas Children's Hospital in Houston anesthetized McCartney to relax her womb, moved her uterus entirely outside her body, opened it, and then lifted about 80 percent of the baby's tiny body out, leaving just the head and upper torso inside. During the four-hour procedure, surgeons had to remove the tumor as quickly as possible, because too much exposure to air could have sent the baby into cardiac arrest. They then returned the fetus, which weighed about a quarter of a pound, to the womb and closed the amniotic sac, hoping to retain as much of the precious amniotic fluid as possible. The baby was born 'again' 10 weeks later, on May 3 of this year. Doctor's say she's perfectly healthy and her parents have named her Macie Hope McCartney.
Note: We did not include the many extraordinary operations performed to separate conjoined twins, but you can read about some of them here.
© 2008
0 eavesdropped
The Institute for Healthcare Improvement estimates there are 15 million instances of medical harm in America every year, and more than 238,000 hospital deaths among Medicare patients between 2004 and 2006 were due to medical mistakes that might have been prevented, according to a recently released study of patient safety in American hospitals by the healthcare rating organization HealthGrades. In California alone, more than 100 incidents of preventable medical harm occur every month, according to the state department of public health. Patient-advocacy groups and regulatory agencies agree that by assuming a more active role in their healthcare, patients can help doctors and other healthcare providers avoid unnecessary errors.
Here are the four most common ways medical care goes awry, and some risk-reducing suggestions.
1. Medication Errors:Four out of every five U.S. adults use over-the-counter drugs, prescription medications or dietary supplements in a given week, and medication errors injure 1.5 million people a year, according to the Institute of Medicine of the National Academies. The causes range from messy handwriting to confusion over similar drug names. The Institute of Medicine recommends that patients maintain complete lists of the medications and vitamins they take and have the lists reviewed regularly by medical practitioners. Ask physicians to explain prescribed medications and their side effects, and have physicians write down dosage information, purpose and how often to take all prescribed drugs.
2. Poor Doctor-Patient Communication:Susan Sheridan co-founded Consumers Advancing Patient Safety in 2003 after her family experienced two medical errors that left her son with cerebral palsy and her husband dead from a malignant tumor that wasn't properly reported to his doctor. Sheridan, who is also a lead member of the World Health Organization's World Alliance for Patient Safety, says that after the mass was removed from her husband's head, it was diagnosed as malignant, but the information never made it back to her husband's doctor, who assumed it was benign. Her son's cerebral palsy stemmed from jaundice, says says, a common condition among newborns but one for which he was not treated.
The Institute of Medicine estimates that patients receive only half the tests and procedures recommended for their conditions. Sheridan emphasizes following up on tests with your doctor and requesting extra copies of lab reports, test results and prescriptions. Electronic record-keeping systems can help patients and doctors better aggregate information and keep personal files. "I collect all my documents and my children's documents and keep their whole history together," she says.
3. Hospital Errors: Bed sores, falls, hospital-acquired infections and failure to aid patients in distress make up the bulk of avoidable errors that occur in hospitals. These errors are often related to an inability on the healthcare provider's part to recognize the patient's need for medical attention. Sheridan recommends that a family member or friend act as an advocate to look out for the patient's best interests. Patient advocates can stay alert for everything from medication errors to patient falls, and in some hospitals, they can also utilize what's known as "Condition H" to alert a quick-response team to the patients' deteriorating condition. The protocol allows patients and their family members to call for immediate help if they feel their condition is not being addressed quickly enough.
4. Surgical Errors: Surgical complications range from known risks to avoidable mistakes, such as transfusing the wrong blood type or administering an incorrect amount of anesthesia. More horrifying, though more rare, are the administrative mistakes: The National Center for Patient Safety reports that 36 percent of mistaken surgeries were performed on the incorrect patient, and up to 2,700 wrong-site surgeries—where doctors bypass the wrong artery or operate on the left ear instead of the right—are performed in America each year, according to the Archives of Surgery. The Joint Commission, an independent healthcare accrediting organization, recommends that patients discuss the operation in detail with their doctors and ask to have the surgical site marked with a permanent marker.
As for healthcare providers themselves, the Joint Commission has issued National Patient Safety Goals that recommend that providers identify and regularly review lookalike and sound-alike drugs and make every effort to distinguish them from each other, identify patients in at least two ways to help prevent mix-ups, and require read-backs of telephone orders and telephone reporting of critical test results.
© 2008
0 eavesdropped
From cut fingers to electrical burns—what you should and shouldn't do in a home health emergency.
Thank heavens for emergency rooms. But sometimes the first aid measures taken on the scene before a patient arrives at the hospital can make all the difference, especially if the ER is crowded. (On average you'll wait 45 minutes before seeing a doctor, according to the Centers for Disease Control, and longer in urban centers.)
We asked two experts, Dr. Tom Scaletta, the outgoing president of the American Academy of Emergency Medicine, and Denise King, president of the Emergency Nurses Association, to identify the 10 most common first aid mistakes—and what you should do instead.
1. Cut finger.It's surprisingly easy for a person to amputate part of a finger—for instance, while chopping vegetables or using an electric saw. Don't try to preserve the loose part by placing it directly on ice.
Do wrap the severed part in damp gauze (saline would be ideal for wetting the cloth), place it in a watertight bag and place the bag on ice. Then be sure to bring the bag and ice to the emergency room. The patient will be going into surgery, so he's best off with an empty stomach. As for the wound on the hand or body, apply ice to reduce swelling and cover it with a clean, dry cloth.
2. Knocked-out tooth.
Don't scrub the tooth hard even if it's dirty (a gentle rinse is OK)
Do put the tooth in milk and go straight to the ER; there's a chance the tooth could be reimplanted.
3. Burns.
Don't apply ice or butter or any other type of grease to burns. Also, don't cover a burn with a towel or blanket, because loose fibers might stick to the skin. When dealing with a serious burn, be careful not to break any blisters or pull off clothing stuck to the skin.
Do wash and apply antibiotic ointment to mild burns. Head to the hospital for any burns to the eyes, mouth, or genital areas, even if mild; any burn that covers an area larger than your hand; and any burn that causes blisters or is followed by a fever.
4. Electrical burns.
Don't fail to get medical attention for a jolt of electricity (for instance, from lightning, a power line, or home electrical cords), even if no damage is evident. An electrical burn can cause invisible (and serious) injury deeper inside the body. More than 500 Americans die every year from electrical burns.
Do go to the ER immediately.
5. Sprained ankle.
Don't use a heating pad.
Do treat a sprain with ice. Go to the ER if it is very painful to bear weight. You might have a fracture.
6. Nosebleed.
Don't lean back. And after the bleeding has stopped, don't blow your nose or bend over.
Do sit upright and lean forward and pinch your nose steadily (just below the nasal bone) for five to 10 minutes. If the bleeding persists for 15 minutes (or if you think you are swallowing a lot of blood) go to the ER.
7. Bleeding.
Don't use tourniquets! You could cause permanent tissue damage.
Do apply steady pressure to the wound with a clean towel or gauze pack and wrap the wound securely. Go to the ER if the bleeding doesn't stop, or if the wound is gaping or caused by an animal bite. To help prevent shock, keep the victim warm.
8. Ingestion of poison.
Don't induce vomiting or use Ipecac syrup (unless instructed to do so by emergency personnel).
Do call poison control, and bring the ingested substance with its container to the ER.
9. Being impaled.
Don't remove the object; you could cause further damage or increase the risk of bleeding.
Do stabilize the object, if possible, and go to the ER.
10. Seizures.
Don't put anything in the victim's mouth.
Do lay the victim on the ground if possible in an open space and roll the victim onto his or her side. Call 911.
And when else should you call 911? Whenever you see or experience chest pain, fainting, confusion, uncontrollable bleeding or shortness of breath. The medics can get to work on arrival.
© 2008
0 eavesdropped
To help children get a good night's rest, learn what you can change - and what you can't
1 | 2 | 3
Sleep is one of the most talked-about topics among parents. We quickly learn just how important sleep is for everyone's wellbeing. For a start, it means the difference between a cheery or grumpy baby, between a calm or frazzled parent.
The importance of sleep doesn't end when a baby grows out of the cot. It's equally vital for school-aged children. A good night's sleep sets a child up for the day. It helps kids deal with the social stresses and pressures of a busy school environment and also promotes learning. Sleep is essential for growing brains.
Children have long rebelled against set bedtimes, but today there are more and more distractions to keep them awake and alert and out of bed for longer. TV, the internet, talking on the phone and playing video games all compete for their bedtime attention.
And while it may seem that your kids are the only ones still up and about at 10 pm, the reality is that many children struggle to get a good night's rest. Difficulty in falling asleep, unrefreshing sleep, trouble staying asleep, early morning awakening and nightmares are among the most common problems affecting our kids.
HOW MUCH IS ENOUGH?
All children differ in the amount of sleep they require. Throughout his childhood and adolescence, my son seemed to function perfectly well on a fraction of the sleep his two sisters needed. My wife and I came to realise that there isn't a mandatory number of hours for children at certain ages. Instead, there is a range for each age.
Most preschoolers need ten to 12 hours a day. At age nine, it's closer to ten hours. When puberty hits, kids still need between eight and nine hours of sleep, yet most of them get less than this. And for teenagers, just at the time when their schedules typically overflow with activities, the developing body and brain place extra demands on their systems and sleep needs ramp up again.
Lack of sleep can lead to bad temper, inattentiveness at school, inconsistent performance, poor memory and even use of stimulants as a sleep substitute.
TEENS AND TIME
An interesting fact about adolescents' physiology is that their sleep-wake cycle gets delayed by up to two hours. This means they don't become sleepy until later in the night and, subsequently, wake up later in the morning.
Children under 13 begin to secrete melatonin - the hormone that makes them sleepy - at around eight or nine o'clock at night. Most teenagers secrete melatonin at around 11 pm. So, essentially, any time before this is a no-sleep zone for teens; they physically cannot fall asleep.
At the other end of the sleep zone is cortisol, the chemical responsible for waking us up. Cortisol isn't secreted in teenagers until around 8.15 am, and that's usually too late to make it to school on time.
So if your teenage son is dreamily vague and rubbing the sleep out of his eyes over breakfast, remember this: if his brain had its way, he'd still be tucked up in bed.
For parents who are trying to get the household out the door on time each morning, this sleepiness can easily be misconstrued as laziness. Instead of giving angry admonitions or well-meaning motivational lectures, try to realise that your teenager is just battling his or her physiology. It may be better to try to be his brain for a time - do the thinking for him.
Establish good habits
Sleep experts stress that while adults may not have --control over children's biology, we can assist them to develop good sleep patterns. Here are five simple ways to help ease kids into healthier bedtime and sleep habits:
1. Establish a regular bedtime. Kids may fight this, but stick to a regular bedtime during the week. They can stay up a little later on the weekend.
2. Have some wind-down time. Up to 45 minutes prior to bed should do the trick. This can involve switching off the TV and other distractions, calming the children down and cutting out snacks and caffeine.
3. Establish a bedtime routine. This might include a bath, brushing their teeth and sharing a bedtime story.
4. Reserve bedrooms for sleep. Remove the TV and computer from the bedroom. Instead, create a calm, cave-like atmosphere, the darker the better.
5. Induce drowsiness with the three sleep cues. This means maintaining a dark room, lowering body temperature and acknowledging the role melatonin plays, so work within the child's sleep cycle. A better knowledge of the biology of sleep and sleep patterns will go a long way to helping your kids get a better night's sleep.
0 eavesdropped
You may be surprised at how little effort it takes to make a difference to your muscle health. Here's what you can do now:
Increase your calcium intake
A calcium-rich diet (including dairy foods) during childhood and adolescence will protect your bones for life. In later years, a good intake will reduce the effects of bone loss.
Try strength-training exercises
These help build strong bones and can be easily done at home using light weights or even your own body weight.
Avoid fizzy drinks
Colas contain phosphoric acid that can take calcium out of the body. Just two cans per day can have an effect.
Take a walk in the park
Walking is a great low-impact exercise. Aim for a moderate brisk pace for 30 minutes at least five times a week - you'll soon see results.
Build up your vitamin D levels
Vital for calcium absorption, your body can get enough vitamin D to last a year simply by enjoying 15 to 20 minutes of sunlight a day on your face and arms.
Watch your alcohol intake
Drinking alcohol to excess not only damages the cells that make new bone but also interferes with calcium absorption.
Visit a chiropractor
Persistent shoulder stiffness or back problems may be due to misaligned vertebrae. A chiropractor may be able to help realign your spine.
Give up smoking
Osteoporosis research has found that smoking lends to greater bone loss and increases the risk of fractures.
0 eavesdropped
The Centers for Disease Control and Prevention recommend these ten vaccines for adults. Some we should all get; others are for people with certain conditions or risk factors. Ask your doctor for more information
Hepatitis A
Those who share needles, travel to certain countries, or have chronic liver disease.
2 doses over 12 to 18 months
Hepatitis B
HIV patients; health care providers; those who travel to certain countries or have multiple sex partners, chronic liver disease, failing kidneys, or renal disease.
3 doses over 6 months
HPV
Girls and women who haven't been infected.
3 doses over 6 months
Influenza
Everyone, especially those ages 50 and up and those with weakened immune systems.
Yearly
Measles, mumps, rubella (MMR)
Those under 50 (except pregnant women); some HIV patients; people with diabetes, failing kidneys, or chronic lung, heart, or liver disease; those who've had their spleen removed or work in a health care facility.
1 or 2 doses, as needed
Meningococcal (meningitis)
Those who live in a college dorm, travel to certain countries, or have had their spleen removed.
1 or more doses, as needed
Pneumococcal (pneumonia)
Those 65 and older and people with diabetes or chronic heart, liver, or lung disease (but not asthma).
Once; twice if you have certain risk factors
Tetanus, Diphtheria, Pertussis (whooping cough)
Everyone needs protection from tetanus and diphtheria; 19- to 64-year-olds also need the pertussis vaccine.
2 doses over 4 to 8 weeks
Varicella (chicken pox)
Anyone who has never had the illness or never been vaccinated (but not pregnant women).
Zoster (shingles)
People ages 60 and up.
Once
0 eavesdropped
Tuesday, July 15, 2008
Field Guide to the People-Pleaser: May I Serve as Your Doormat?
Why are some people so focused on pleasing others that they sacrifice their own needs?
For Brooke Ray, saying no feels as uncomfortable as turning her back on a family member. A youth minister from Memphis, Tennessee, Ray is ever eager to curry the favor of her friends and colleagues—and bends over backward to accommodate their requests. "People ask me to do things like serve on committees, and I'll accept without evaluating whether I'm really passionate about it," she says. "Because I say yes a lot, I'm too busy. I'm too stressed, and my attention is divided."
Ray is a self-admitted "people-pleaser"—someone committed to bolstering the well-being of others even at the expense of her own. Responding to the needs of others, of course, is a crucial part of normal social functioning. But people-pleasers are so invested in outside approval that they set their own wants and needs aside. They find it almost impossible to say no—even when saying yes wreaks havoc on their own best-laid plans.
What makes someone so anxious to fulfill other people's expectations that they end up sabotaging themselves? The typical people-pleaser is someone who lacks an internal compass to gauge the value of their own actions, explains Linda Tillman, a psychologist at Emory University. "As a result, they spend their lives looking for validation from others."
The seeds of people-pleasing are usually planted in childhood, according to Jay Earley, author of Finding Your Life Purpose. "Often, parents will simply tell kids what to do and never encourage them to assert themselves," he says. "When the kids obey, the parents give them conditional love."
Such an environment sends a subconscious message to children: The only way to feel valuable is to comply with others' demands, give others what they need, and "go with the flow." The pattern only solidifies as children grow up, fearing that if they do not strive to please, people will not love them. They respond to this perceived threat by becoming obsessed with meeting others' needs. Because girls are typically trained from an early age to accommodate and defer to others, a disproportionate number of people-pleasers are women.
Once established, such behaviors become self-reinforcing which makes them difficult to uproot. They get rewarded by bosses, co-workers, and friends just as they do by parents, prompting pleasers to assume doormat postures over and over again in hopes of receiving more kudos.
But despite the fleeting high of adulation, relentless praise-seeking exacts a heavy toll, warns Hap LeCrone, a psychologist in Waco, Texas. People-pleasers expend so much energy meeting others' needs that they lose sight of what they want from life. They're often seized by the disorienting feeling that they're not in control of their own lives, which leads them to lash out. "People please, please, please, please, and then they explode," says Earley—as when a woman who's catered to the needs of a self-centered partner for years finally goes ballistic and throws him out. "If you've been a pleaser for a long time, you're going to get more and more resentful of the person you're pleasing, and that can lead to passive-aggressive behavior," Earley says.
So how does a people-pleaser end the cycle? While perpetual pushovers often lack self-worth and clear direction in their lives, breaking the cycle is complicated. The cure is not abstinence—neglecting others' needs entirely means crossing the border into narcissism. Rather, the key is a well-thought-out policy of temperance. Retain positive people-pleasing traits like friendliness and sensitivity, but clarify your own needs and assert them more. If someone asks you for something, ask yourself if it's feasible and consider your own needs, too. You might say, "I can help you later in the day, but first I need to meet my own deadlines. If it's urgent, maybe we can find someone else to help you right away."
Take a close look at what situations trigger your pleasing behavior and why. "People-pleasing behavior comes from fear, from an assumption that others are in control of you. Healthy behavior comes from genuinely wanting to be connected to people," Earley says. "Ask yourself, 'Why am I doing this? Is it because I really care about this person, or because I'm afraid I'm going to lose them?' " This kind of questioning can help you uncover the source of the fears underlying your people-pleasing bent. Did your parents' conditional love lead you to dread abandonment? Did the pain of a past heartbreak make you overly anxious about offending or disagreeing with your new partner? Consider the answers and discard fears that don't make sense anymore.
LeCrone likes to make people-pleasers role-play standing up for themselves in uncomfortable situations—such as talking to a principal who's pushing them to join a school booster club. "I let them choke it out," he says. "Just the thought of saying no can cause a lot of anxiety at first. But after a while, they get a feel for it." Even if you cave on the spot, there's still time to set things right, says Abby Sernoff, an artist from Havertown, Pennsylvania, who describes herself as a recovering people-pleaser. "If I say yes too quickly, I'll call the person back and tell them I can't do it after all."
Brooke Ray's watershed moment came when she adopted a child. "My husband and I decided that we wanted to be the only ones to hold our daughter for the first eight weeks," she says. "People would say, 'She's so sweet, can I hold her?' I felt guilty saying no, but I knew I had to." —Elizabeth Svoboda
Keeping People-Pleasing Under Wraps
Be receptive to others' concerns, but don't leave your own by the wayside. How to make sure you're the one manning the controls.
Stall for time. If someone puts you on the spot, politely defer: "I'll check my calendar and get back to you tomorrow." Then you can assess whether the request fits in with your schedule and goals.
Examine your motivations. People-pleasing seems like the epitome of niceness, but pleasers may assume their submissive postures because of what they expect in return. If you grant someone a favor, do it because it fulfills you—not to get something back.
Role-play to practice asserting your needs. Get a friend to play a pushy boss, parent, or acquaintance—whoever triggers your people-pleasing. Then practice saying no to unreasonable requests until it starts to feel natural.
Psychology Today Magazine, May/Jun 2008
Last Reviewed 8 Jul 2008
Article ID: 4593
0 eavesdropped
Your personality isn't necessarily set in stone. With a little experimentation, the ornery and bleak can reshape their temperaments and inject pluck and passion into their lives.
Call it the cult of the ugly duckling. We devour stories of personal transformation: the uptight guy who learns to cut loose, the wallflower who becomes the life of the party. It's the staple of self-help books and romantic comedies—as well as the primary reason that people drag themselves to high-school reunions. ("Can you believe that guy who never talked is now a real estate mogul?") But psychologists have long believed that major personality makeovers are impossible. In fact, the big themes of personality—whether you are shy or outgoing, relaxed or a worrywart—seem to be scripted at a very young age.
However, personality researchers have begun looking more closely at the smaller ways we can and do change. Positive psychologists, who investigate human talents, have identified 24 character strengths—familiar qualities we admire, such as integrity, loyalty, kindness, vitality—and are limning them to find out why these faculties come so naturally to some people. What they're discovering is that many of these qualities amount to habitual ways of responding to the world—habits that can be learned.
"The evidence is good that most of these things can be changed," says Christopher Peterson, professor of psychology at the University of Michigan. "That doesn't mean it's easy. It doesn't come in a flash." Psychologists talk about personality change the way doctors talk about the biological set point for weight: Nature designed some of us to be heavy, and others to be slim. It's not impossible to alter your weight, but it requires going against your own grain.
But eventually, the new way of being can come to feel like second nature. Peterson cites himself as an example. Inherently introverted, he realized early on in his career as an academic that his reticence would prove disastrous in the lecture hall. So he learned to be more outgoing, to crack jokes, and to entertain big classes full of psychology students. "Do I still have an introverted temperament? Yes, in that if I'm in a big crowd, I get anxious," he says. "But my behavior is consistently extroverted, because I've worked to make it that way. Now, it's very spontaneous."
Whether Peterson's personality has truly changed is almost beside the point. He may not be an extrovert, technically speaking, but he behaves like one, and is treated like one. Tweaking the way you interpret and react to the world can be a transformative experience, freeing you up to act in new ways. At first, it feels awkward, even bizarre. But with new behaviors come new experiences, creating a feedback loop that, over time, reinforces the transition.
Some sought-after qualities are easier to develop than others. Courage, joy, passion, and optimism are among the more amenable to cultivation, but each requires mastering a different—and sometimes surprising—set of skills. To bring more joy and passion into your life, you must paradoxically be more open to experiencing sadness, anxiety, and fear. Learning to think like an optimist, it turns out, is less important than acting like one. And being courageous has nothing to do with how afraid you are: It's a matter of how strongly you feel about your goals. Cultivating these characteristics puts you on the road to that blend of happiness, satisfaction, and purpose that is the height of human functioning, what positive psychologists call "the good life."
18 eavesdropped
Sunday, July 06, 2008
Romantic Personality Test" You will find as you look back upon your life that the moments when you have truly lived are the moments when you have done things in the spirit of love. "
Henry Drummond
" Romance is about the little things. "
Gregory J. Godeck
" Romance, like the rabbit at the dog track, is the elusive, fake, and never attained reward which, for the benefit and amusement of our masters, keeps us running and thinking in safe circles. "
Beverly Jones
" When one is in love, one always begins by deceiving oneself, and one always ends by deceiving others. That is what the world calls a romance. "
Oscar Wilde
To bask in the delights of idealized love is, in essence, to be a romantic. Hollywood, it seems, has personified romance as candlelit dinners in fancy French restaurants or giggly chases in slow-motion through daisy-filled meadows. The truth is that expressions of love and affection don’t have to be expensive or overwhelming. Holding hands, casual walks, or a simple “I love you” are those little things which can really go a long way. If you aren't comfortable with the traditional romantic protocol, you can come up with your own ways of letting someone know how much you care. The truth is that there are no rules.
It is important to note that romance is not a component of love that appeals to everyone; nor is it necessary to keep passion alive. Passion can be stirred by simply being respectful and honest with the one you love. Whether you’re a romantic at heart or a more pragmatic lover, as long as you’re willing to put your heart and soul into a relationship there is no amount of roses, candlelit dinners or four-string quartets than can measure up or compare to that.
Romance index 89
According to your score, you are romance typified! Rose petals, poignant poetry, tall glasses of wine, touching moments, and sweet words are all loving gestures that you love to receive as well as offer. Romance is very important to you, and quite likely an aspect that you consider fundamental in relationships. Keep in mind however, that problems may arise if you are with someone who really isn’t the romantic type. If you look forward to Valentine's Day to express your love and your partner doesn't even acknowledge it as a special day, you might end up feeling neglected or your efforts unappreciated. Nevertheless, even if your partner isn't as romantically inclined as you are, try to be appreciative of his/her efforts when she/he does try to woo you. Some people aren’t comfortable displaying their affection in screamingly obvious ways, but this doesn’t mean that they don’t care – they simply prefer to be more subtle. Whether it’s you or your partner who is doing the romancing, check out the ideas in the Advice section for some simple and sweet romantic gestures that aren’t tough on the wallet or too overwhelming.
0 eavesdropped
Traditional IQ tests ask (and attempt to answer) the question, "How smart am I?” Multiple Intelligence theory, on the other hand, explores, "How am I smart?” The theory of multiple intelligences was developed in 1983 by Dr. Howard Gardner, Professor of Education at Harvard University. His theory suggests that the traditional notion of intelligence, based on I.Q. testing, is limited. Instead of summarizing a person's intelligence in one numerical score, Dr. Gardner proposes identifying what kind of intelligences each individual possesses.
Your main intelligence type: Linguistic
Individuals with linguistic intelligence have a highly developed capacity to use words effectively in writing or in speech, as well as the ability to persuade, remember information, and explain. If this is one of your principal intelligences, you likely possess excellent writing skills, are good at expressing yourself to others, and may have a knack for learning languages.
0 eavesdropped