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Patient generated health data

“Patients have the ability to electronically submit patient-generated health information” should be part of Meaningful Use Stage 3. It suggested that PGHD could be submitted through structured or semi-structured questionnaires and secure messaging and, depending on input from the HITSC, possibly through devices.”

Click to access pghd_brief_final122013.pdf

Patient generated health data (PGHD)

  • Health history, symptoms, biometric data, treatment history, lifestyle choices, and other information—created, recorded, gathered, or inferred by or from patients or their designees (i.e., care partners or those who assist them) to help address a health concern.

Demographics data: Age, sex,race

Genomics data: Patient rights and ownership of genomic pattern data

Protocol with clinician when capturing PGHD

  • Advise that physicians have a patient-clinician agreement and consent form that is discussed with and signed by each patient before engaging in electronic communication

Secured mobile application connection: Data security

  • Enforce strong VPN encryption, authentication and granular access policies to ensure that access to data is secure. Secure on-device data with policies to allow or disallow intranet file download, and on-device file share, copy and print.
  • ———-

Motherhealth mobile health application is seeking investors, doctors, developers and collaborators to match, monitor and report patient generated health data, includes telemedicine, personalize medicine and more.. Email Connie at motherhealth@gmail.com

Address: Motherhealth at 1708 Hallmark Lane San Jose, CA 95124

WCAG 1.0 consist of 14 guidelines—each of which describes a general principle of accessible design. Each guideline covers a basic theme of web accessibility and is associated with one or more checkpoints that describes how to apply that guideline to particular webpage features.

  • Guideline 1: Provide equivalent alternatives to auditory and visual content
  • Guideline 2: Don’t rely on colour alone
  • Guideline 3: Use markup and style sheets, and do so properly
  • Guideline 4: Clarify natural language usage
  • Guideline 5: Create tables that transform gracefully
  • Guideline 6: Ensure that pages featuring new technologies transform gracefully
  • Guideline 7: Ensure user control of time sensitive content changes
  • Guideline 8: Ensure direct accessibility of embedded user interfaces
  • Guideline 9: Design for device independence
  • Guideline 10: User interim solutions
  • Guideline 11: Use W3C technologies and guidelines
  • Guideline 12: Provide context and orientation information
  • Guideline 13: Provide clear navigation mechanisms
  • Guideline 14: Ensure that documents are clear and simple

Each of the in total 65 WCAG 1.0 checkpoints has an assigned priority level based on the checkpoint’s impact on accessibility:

  • Priority 1: Web developers must satisfy these requirements, otherwise it will be impossible for one or more groups to access the Web content. Conformance to this level is described as A.
  • Priority 2: Web developers should satisfy these requirements, otherwise some groups will find it difficult to access the Web content. Conformance to this level is described as AA or Double-A.
  • Priority 3: Web developers may satisfy these requirements to make it easier for some groups to access the Web content. Conformance to this level is described asAAA or Triple-A.

Click to access HITJC_PMTF_Presentation_2016-05-17_update_2.pdf

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Lung disease: COPD among white and black women

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Change in death rate among white women in the USA:

  • Klamath, OR: +16%
  • Dallas, TX: +20%
  • SF: -29%
  • LA: -18%
  • Tulsa OK: +20%
  • Salt Lake, UT: +9%
  • Fresno, CA: +8%
  • Santa Clara: -15%

44% History of Asthma ; 38% smokers

10M white women with COPD, 1.4M Black women, 1M Hispanic women

1991-1995: Heart disease death rate: Asian, white, black and Hispanic women (shown in the pictures above)

Dr Axe wrote:

  • Eucalyptus oil can be very helpful for people with COPD. A study in Respiratory Research showed that cineole, the main constituent of eucalyptus essential oil, actually reduced exacerbations in people with COPD. It also reduced dyspnea (shortness of breath), and improved lung function as well as health status overall. Furthermore, the research suggested that cineole is an active controller and reducer of airway inflammation in COPD. To get the benefits of cineole, you can use eucalyptus oil in a diffuser and/or humidifier and breath in the anti-inflammatory air.
  • Consume Ginseng: Ginseng is an herbal supplement that improves lung function and also decrease bacteria in the lungs. Panax ginseng in particular has a long history of use in Chinese medicine for respiratory conditions, including asthma and COPD.  A recent study published in the journal Complementary Therapies in Medicine highlighted therapeutic ginseng benefits. Panax ginseng and ginsenosides (active components of ginseng) appear to inhibit processes related to the development of COPD. (10)
  • Take N-Acetylcysteine (NAC): Supplementing with NAC helps decrease the severity and frequency of asthma attacks and improves overall lung function by increasing glutathione levels and thinning bronchial mucus. Glutathione fights against oxidative stress in the respiratory tract, which can make NAC a powerful and effective natural treatment for COPD.  Inhaled Nebulized Glutathione

 

Dr. Jonathan V. Wright from the Tahoma Medical Clinic wrote about COPD in the August 2002 “Nutrition and Healing”  COPD Natural Treatments Jonathan V Wright Aug 2002.  The mainstay of his treatment for COPD is nebulized glutathione, a natural treatment which restores glutathione levels to the lung tissue.

Altered Glutathione Levels is Primary Abnormality in COPD

“Alterations in alveolar and lung GSH (glutathione) metabolism are widely recognized as a central feature of many inflammatory lung diseases including chronic obstructive pulmonary disease (COPD).”  (14)

Inhaled Glutathione: Inhaled Glutathione may be taken in a nebulizer.  Originally, the glutathione is made up by a compounding phamacy and shipped to the user.  “Inhaled glutathione requires a prescription and is available from compounding pharmacies such as McGuff Compounding Pharmacy and Wellness Pharmacy. The usual starting dose is 300 mg of glutathione (200 mg/cc, draw 1.5 cc and place in nebulizer) twice a day.  ” (7)  Quote from Julian Whitaker’s newsletter (7).

Glutathione capsules: A more practical method has been devised by Dr Bishop, using capsules.  (Glutathione  capsules from Thera Naturals ) .  Dr. Sircus wrote an article on  Glutathione & Bicarbonate Nebulization using the Glutathione capsules.

Clark T. Bishop, M.D. devised this protocol: Protocol for Augmentation of GSH Levels in Cystic Fibrosis Patients, and Related Information.  Here is a clinical study on the use of Glutathione: by Dr Alfredo Visca, and Clark Bishop, et al. Improvement in clinical markers in CF patients using a reduced glutathione Clark Bishop 2008  Journal of Cystic Fibrosis 7.5 (2008): 433-436.  (8-12)

SSKI to Liquify Secretions: 004001 SSKI (Potassium Iodide Oral Solution, USP), 1gm per mL, 240mL Dropper Bottle McGuffMedical.comThe second treatment is SSKI to liquify secretions and allow clearance of mucous,  SSKI stands for super saturated potassium iodine, an old remedy which works quite well.  Although SSKI has been available at the corner drug store for over 80 years, and is generally considered safe, iodine can suppress thyroid function with an increase in the TSH lab value on thyroid testing.  This elevation of TSH is usually temporary and returns to normal after discontinuing the SSKI. (6)    There is much misinformation or disinformation about the safety of SSKI (see this news report).  The elevation of TSH from SSKI is not life  threatening and is of little or no clinical consequence.  As with most other medical treatments, it is best to work with a knowledgeable doctor who can monitor thyroid function while under treatment.   Left image bottle of SSKI courtesy of McGuff medical Supply.

Resveratrol:  An extract from grapes, Resveratrol, is useful in COPD. see: Antioxidant and anti-inflammatory effects of resveratrol in airway disease. by Wood .   “We conclude that resveratrol has potential as a therapeutic agent in respiratory disease”.  Buy Resveratrol.

Dr Wright’s List of recommended treatments for COPD

  • 120-200 milligrams of nebulized, inhaled Glutathione, two times per day
  • 500 milligrams of N-acetylcysteine, three times per day
  • 30 milligrams of Zinc Picolinate per day
  • Three to six drops of potassium iodide (SSKI) per day
  • 200-400 milligrams of Goldenseal twice a day
  • 2 grams of vitamin C twice a day
  • 300-400 milligrams of Magnesium per day (in the form of magnesium citrate, aspartate, taurate, or glycinate)
  • 50,000 units of vitamin A per day
  • 1 1/2 tablespoons of lecithin per day
  • 1 1/2 tablespoons of flaxseed oil per day
  • 400-600 units of vitamin E per day
  • 2 milligrams of copper glycinate per day
  • multiple vitamin-mineral supplement

Serrapeptidase: mucolytic enzyme shown to be useful in COPD.  see:

Effect of the proteolytic enzyme Serrapeptase in patients with chronic airway disease. by Nakamura S Department of Respiratory Medicine, Tokyo. Respirology. 2003 Sep;8(3):316-20.

Oregano Oil Joy of the Mountains Oregano Oil: Oregano Oil has antimicrobial and anti-inflammatory qualities, and is of use in COPD to prevent pulmonary infection and reduce pulmonary inflammation.

The Oregano oil may be diluted in juice or mixed with olive oil to dilute further.  Start with one drop and gradually work up as tolerates.  Some people report good results with inhaled organo oil in a steamer or nebulizer.  However use with caution as the oil may be very strong undiluted.

Useful Books on Natural Treatments for COPD

  • Natural Therapies for COPD and Emphysema: Natural Therapies for Emphysema and COPD: Relief and Healing for Chronic Pulmonary Disorders April 4, 2007, by Robert J. Green Jr.

Credit and Thanks goes to Dr. Jonathan Wright and Dr Julian Whitaker for much of the information in this article.

Jeffrey Dach MD

7450 Griffin Road Suite 190

Davie, Fl 33314

954-792-4663

Links and References

  • 2001 Jun;119(6):1661-70. Salmeterol plus theophylline combination therapy in the treatment of COPD. ZuWallack RL1, Mahler DA, Reilly D, Church N, Emmett A, Rickard K, Knobil K.

Salmeterol

Patients with COPD often require multiple therapies to improve lung function and decrease symptoms and exacerbations. Salmeterol and theophylline are indicated for the treatment of COPD, but the use of these agents in combination has not been extensively studied.

OBJECTIVES:  To compare the efficacy and safety of salmeterol plus theophylline vs either agent alone in COPD.

METHODS:  Randomized, double-blind, double-dummy, parallel-group trial in 943 patients with COPD. After an open-label theophylline titration period (serum levels, 10 to 20 microg/mL), patients were randomly assigned to receive salmeterol (42 microg bid) plus theophylline, salmeterol (42 microg bid), or theophylline for 12 weeks. Serial pulmonary function tests were completed on day 1 and treatment week 12. Patients kept diary cards and noted their peak flow rates, symptom scores, and albuterol use, and periodically completed quality-of-life and dyspnea questionnaires.

RESULTS:  All three groups significantly improved compared with baseline. Combination treatment with salmeterol plus theophylline provided significantly (p < or = 0.045) greater improvements in pulmonary function; significantly (p < or = 0.048) greater decreases in symptoms, dyspnea, and albuterol use; and significantly fewer COPD exacerbations (p = 0.023 vs theophylline). In general, treatment with salmeterol provided greater improvement in lung function and satisfaction with treatment compared with theophylline. Salmeterol treatment was also associated with significantly fewer drug-related adverse events (p < or = 0.042) than either treatment that included theophylline. The safety profile (adverse events, vital signs, and ECG findings) of the two treatments that included theophylline were similar.

CONCLUSION:  Patients with COPD may benefit from combination treatment with salmeterol plus theophylline, without a resulting increase in adverse events or other adverse sequelae.

Links and References

  • Medications for COPD: A Review of Effectiveness. GIL C. GRIMES, MD; JOHN L. MANNING, MD; PARITA PATEL, MD, and R. MARC VIA, MD Texas A&M University Health Science Center, Temple, Texas Am Fam Physician. 2007 Oct 15;76(8):1141-1148.
  • James F. Donohue “Combination Therapy for Chronic Obstructive Pulmonary Disease“, Proceedings of the American Thoracic Society, Vol. 2, SYMPOSIUM: THE SCIENCE OF COPD: OPPORTUNITIES FOR COMBINATION THERAPY (2005), pp. 272-281.
  • Thorax 1999;54:730-736 doi:10.1136/thx.54.8.730
  • Long acting β2 agonists and theophylline in stable chronic obstructive pulmonary disease Mario Cazzola, Claudio Ferdinando Donner, Maria Gabriella Matera
  • Nebulized Glutathione for Emphysema Davis Lamson Alt Med Review 2000: a Case Report Davis W. Lamson, ND, Matthew S. Brignall, ND
  • Alternative Medicine Review. 2000;5(5):429-431)
  • JUBIZ, WILLIAM, SHIRLEY CARLILE, and LYNN D. LAGERQUIST. “Serum thyrotropin and thyroid hormone levels in humans receiving chronic potassium iodide.” The Journal of Clinical Endocrinology & Metabolism 44.2 (1977): 379-382.
  • Natural Treatments for COPD by Dr. Julian Whitaker:
  • Inhaled glutathione requires a prescription and is available from compounding pharmacies such as McGuff Compounding Pharmacy and Wellness Pharmacy. The usual starting dose is 300 mg of glutathione (200 mg/cc, draw 1.5 cc and place in nebulizer) twice a day.
  • Help for COPD Julian Whitaker, MD ; http://www.drwhitaker.com/natural-treatments-for-copd/
  • http://www.glutathioneexperts.com/glutathione-copd-3.html Glutathione Articles – COPD (Chronic Obstructive Pulmonary Disease) & Lung Disorders
  • Glutathione & Bicarbonate Nebulization Posted by Dr Sircus on December 9, 2010 | Filed under Glutathione, Medicine, Sodium Bicarbonate (Baking Soda) ; Reduced L Glutathione Plus Thera Naturals
  • Clark T. Bishop, M.D.: Protocol for Augmentation of GSH Levels in Cystic Fibrosis Patients, and Related Information
  • Visca, Alfredo, et al. Improvement in clinical markers in CF patients using a reduced glutathione Clark Bishop 2008 “Improvement in clinical markers in CF patients using a reduced glutathione regimen: an uncontrolled, observational study.” Journal of Cystic Fibrosis 7.5 (2008): 433-436.
  • Leonard Nimoy, Also Known As Dr. Spock Dies of COPD 30 Years After Giving UP Smoking –
  • Lung glutathione and oxidative stress: implications in cigarette smoke-induced airway disease. Irfan Rahman , William MacNee
  • American Journal of Physiology – Lung Cellular and Molecular Physiology Published 1 December 1999 Vol. 277 no. 6, L1067-L1088
  • Alterations in alveolar and lung GSH metabolism are widely recognized as a central feature of many inflammatory lung diseases including chronic obstructive pulmonary disease (COPD).

Link to this page:  http://wp.me/p3gFbV-2Iu

Source:  Jeffrey Dach

What is the best tool (website, app, etc.) that will accurately grade or assess each grocery store food product on its health quality lev…

My answer to What is the best tool (website, app, etc.) that will accurately grade or assess each grocery store foo…

Answer by Connie b. Dellobuono:

If we assume that all produce came from one source, it is in how you clean (wash them with diluted vinegar) and prepare them (cook them or eat raw) that you can effect good health outcomes. You can have a veggie garden to depend less on grocery store produce. Avoid all canned foods. And ensure to buy organic tomatoes, cherries, strawberries and salad greens as these are the heaviest produce with pesticides. Eat wild fish instead of farmed fish.

What is the best tool (website, app, etc.) that will accurately grade or assess each grocery store food product on its health quality lev…

How can I start my journey to better my health and fitness?

My answer to How can I start my journey to better my health and fitness?

Answer by Connie b. Dellobuono:

  • Strengthen your goal by envisioning yourself healthy and waking up each day as if it is your last to be healthy and happy.
  • Connect with healthy people and follow their regimens/routines. Join a dance class, gym or meetups for hiking/exercise.
  • Visit a farmer’s market weekly.
  • Empty your kitchen cupboards, freezer and refrigerator.
  • Buy a peanut butter, raw nuts, sushi wrapper, beans (soak overnight before cooking), whole foods (celery,cilantro,greens), eat yogurt and pickled veggies and share your food with others.
  • Eat when hungry.
  • Sleep more.
  • Exercise.
  • De-clutter your space.
  • Learn more from others and the internet.

How can I start my journey to better my health and fitness?

Build low cost housing in under-utilized land

Displacement from specific homes happens when low-income housing is literally knocked down to build high-end towers. A good amount of new supply in cities, though, can rise on under-utilized land (former industrial plots, surface parking lots, abandoned properties, etc.). And the cumulative effect of all that new supply can hold down rents across neighborhoods and cities, including for the poor.

Airbnb rent in Palo Alto for one room is $80 per night and $132 in Mt View whenever there is a tech conference. Most garage in the bay area are turned into a room, even a storage shed in the backyard.  Email motherhealth@gmail.com if you want to join forces in turning all under-utilized lands into affordable rental properties.

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1099 is better than W2 for middle class Americans

Many corporations have to find ways to save on taxes. Working Americans can also find ways to save on taxes. Have your own business and/or use 1099 instead of W2.

Apple is an example of a smart company. We thank Apple for the many jobs it created. We should encourage more enterpreneurs and job creation business.  We should upgrade our educational system to incorporate important job skills sets for the global and technical workforce to be competitive. We have to learn another language, learn computer data analysis, and learn new technologies.

As a parent of two young adults in college, I cannot influence my children to be a doctor or software computer engineers. I can only hope that they have goals and ambitions to compel them to strive for the better.  I can show them the standard of living in other developing countries.  I am happy that they wanted to pursue their passions, be an art teacher and an environmental engineer and that they are working students, saving money anyway they can. In other countries, there is not enough opportunities for internships and college students to work part time.  In Canada, there is 4 months of college days and 4 months of internships. In India, the BS in Computer Science and MS in Computer Science can be completed in less years compared to other countries.

————Apple’s Taxes for its business in Ireland———–

FACT CHECK The European Commission makes clear, and tax experts agree, that Ireland let Apple determine how much of the income that it generated in the country would be recognized and taxed there.

The rest of Apple’s income that was not recognized and taxed in Ireland could be put in other corporate structures that were effectively stateless. That meant the money in those structures was not taxable anywhere — not even in Ireland — and thus not subject to Ireland’s 12.5 percent tax rate.

While other companies have also had the right to negotiate with Ireland, the commission considers these sorts of loopholes a no-no.

“In the U.S., states can fall all over themselves to offer subsidies and loopholes, but that is exactly what is illegal in Europe,” said Edward D. Kleinbard, professor at the Gould School of Law at the University of Southern California and a former chief of staff to the congressional Joint Committee on Taxation.

In the United States, politicians, lawmakers and officials have derided “inversion deals,” which allow an American company to move its headquarters overseas to cut its tax bills. In Ireland, they are celebrating them.

The Irish government on Tuesday revised the country’s economic growth rate in 2015 to 26.3 percent from a preliminary estimate of 7.8 percent. While Ireland’s economy has been on the upswing since the country repaid its bailout, it wasn’t that the Celtic Tiger suddenly came roaring back in an unexpected way. Rather, it was the magic of those inversion deals and other sleights of finance.

Under a typical inversion deal, a United States company takes over a foreign counterpart and, in the process, shifts its headquarters overseas. The takeover targets for such deals are typically based in countries with low corporate taxes — like Ireland, with its 12.5 percent rate.

The combined company’s global profits are then reported in its new home base, regardless of where they are earned. In essence, Ireland’s G.D.P. is artificially inflated.

Inversions have drawn the ire of the Obama administration, since they put a greater burden on American taxpayers.

Last year, the medical device maker Medtronic bought its rival Covidien, reincorporating in Ireland. More recently, Johnson Controls of Milwaukeeagreed to join up with Tyco of Cork, Ireland. (Tyco itself has hopped from locale to locale, having been in Bermuda, then Switzerland, before ending up in Ireland.)

Maternal and newborn outcomes in planned home birth vs planned hospital births

We included English-language peer-reviewed publications from developed Western nations reporting maternal and newborn outcomes by planned delivery location. Outcomes’ summary odds ratios with…

Source: Maternal and newborn outcomes in planned home birth vs planned hospital births

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