Med Monthly August 2013

Med Monthly AUGUST 2013

How to Improve Efficiency and Empower Crew Members pg. 40

CodeHeart Video App Could Revolutionize Prehospital Medicine pg. 48

Varied Quality of CPR Among EMS, Hospitals Hurts Survival pg. 44

Top 9 Reasons

People Call First Responders pg. 78

the

First ers Respond

issue

contents

features

40 HOW TO IMPROVE EFFICIENCY AND EMPOWER CREW MEMBERS 44 VARIED QUALITY OF CPR AMONG EMS, HOSPITALS HURTS SURVIVAL 48 CODEHEART VIDEO APP REVOLUTIONIZE PREHOSPITAL MEDICINE

insight 10 DEATHS FROM PRESCRIPTION PAINKILLER OVERDOSES RISE SHARPLY AMONG WOMEN 12 ESTROGEN THERAPY HAS NO LONG-TERM EFFECT ON COGNITION IN YOUNGER POSTMENOPAUSAL WOMEN 16 HOW TO CARE FOR ELDERLY PATIENTS WITH DEMENTIA

practice tips 18 HOW TO AVOID THE PITFALLS OF BAD MEDICAL WEBSITES 20 CONGRESS ADVISED NOT TO DELAY ICD-10 IMPLEMENTATION 22 EASILY ADD REVENUE TO YOUR PRACTICE

ART SEARCHING TO THE HEART

50

international 26 IMPLEMENTING A COLLABORATIVE MODEL TO ACCELERATE THE DEVELOPMENT OF REGIONAL HEALTHCARE

research and technology 28 ALTERED PROTEIN SHAPES MAY EXPLAIN DIFFERENCES IN SOME BRAIN DISEASES 30 CLARIENT INTRODUCES FIRST LAB DEVELOPED TEST TO ASSESS MULTIPLE PROTEINS AT SINGLE-CELL LEVEL 32 SMBG SUPPLIERS LOOK TO TAP THE HUGE UNDERPENETRATED DIABETIC POPULATION OF ASIA-PACIFIC

legal 34 CONTINUING TO IMPLEMENT THE ACA IN A CAREFUL, THOUGHTFUL MANNER 36 WEIGHT FOR IT: How Will the American Medical Association’s (AMA) New Decision Affect Employers?

38 A SHORT-LIVED VICTORY FOR GENERIC DRUG MANUFACTURERS?

the arts 50 ART SEARCHING TO THE HEART

healthy living VARIED QUALITY OF CPR AMONG EMS, HOSPITALS HURTS SURVIVAL

44

54 CHOCOLATE CHIA PUDDING

in every issue 4 editor’s letter 8 news briefs

60 resource guide 78 top 9 list

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editor’s letter August’s issue ushers in new ways that First Responders can improve the way they work. From revolutionizing technology applications to increased efficiency to advances in basic life saving procedures, MedMonthly’s features revolve around those people who are on the front lines of medical emergencies. Every minute counts when a medically exigent situation is at hand and our articles advise First Responders how to be more efficient and successful at treating patients.

Any device that can get information to First Responders more quickly obviously will increase the odds that emergency situations will be ameliorated sooner. An application for smart phones has been invented that allows physicians to see ECG and other read-outs in real time. The feature by James Careless, “CodeHeart Video App Could Revolutionize Pre-Hospital Medicine” describes how video is sent via a cell phone to First Responders. The challenges that CodeHeart overcame had to do with transmitting such a high resolution and maintaining security.

The feature “How to Improve Efficiency and Empower Crew Members” gives us an example of how changing scheduling procedures can streamline and reduce costs for practices.

Aladtec, Inc. (www.aladtec.com) provides the software that allows employees to submit their availability and ask for vacation without going through management. Conversely, the administration can notify staff of changes. All this can be done through your smart phone.

The American Heart Association published a story “Varied Quality of CPR among EMS, Hospitals Hurts Survival” which describes the advances in cardiopulmonary resuscitation.

Five hundred thousand people go into cardiac arrest per year in the United States. The percentage of survival rates vacillate depending on the rescuers. Suggestions for resuscitation include ensuring that the number of compressions is accurate as well making sure the depth of the chest compression is correct. More precision in any medical procedure equates to more saved lives.

MedMonthly’s September issue is about the magic of referrals.

Thank you for taking the time to read our magazine. I hope you have gained some insight into ways to improve medical and administrative procedures. If you have an interesting and informative article you’d like to write, please don’t hesitate to contact us.

Ashley Austin Managing Editor

4 | AUGUST 2013

Med Monthly August 2013

Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Staff Writer Ashley Warburton Contributors Ashley Acornley, MS, RD, LDN Chuck Buck James Careless Brandon K. Johnson Amanda Kanaan Dr. Molly Leavitt, D.C. Laura Maaske Mark J. Mazur Peter S. Reichertz Nisha Salim

contributors Brandon K. Johnson is an Associate in the Louisville, KY office of McBrayer, McGinnis, Leslie & Kirkland, PLLC. Mr. Johnson practices primarily in the areas of insurance defense, employment law, and general litigation. He can be reached at bjohnson@mmlk. com or at (502) 327-5400.

Amanda Kanaan is the owner/founder of WhiteCoat Designs – an online marketing agency committed to growing doctors’ practices through costeffective and powerful online marketing solutions. Amanda regularly speaks at medical association meetings and conventions and is a published expert in the field of medical marketing. To learn more or for a free website evaluation, contact her at Amanda@whitecoat-designs. com or http://www.whitecoat-designs.com.

Molly Leavitt, D.C.

Med Monthly is a national monthly magazine committed to providing insights about the health care profession, current events, what’s working and what’s not in the health care industry, as well as practical advice for physicians and practices.

We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, check out our writer’s guidelines at medmonthly.com/writers-guidelines

P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com

is a chiropractor is Raleigh, NC and strongly advocates teaching patients the responsibility of selfcare. One of her primary areas of concern is the obesity epidemic that affects patients physically, emotionally and financially.

Laura Maaske is a medical illustrator with a Master's of Science degree in Biomedical Visualization from the University of Toronto. She launched Medimagery in 1997, specializing in the creation of patient education materials, interactive media, e-books, cellular and molecular illustrations, and design of medical education materials. For more information, please visit Medimagery.com, send a note to Laura@medimagery.com or call 262.308.1300.

Nisha Salim is a freelance writer who specializes in writing factually accurate, research-backed healthcare articles.

General science, education, social media and content marketing are her other areas of interest. Take a look at her website, NishaSalim. com, to learn more about her.

MEDMONTHLY.COM |5

designer's thoughts From the Drawing Board “Technology is dominated by two types of people: those who understand what they do not manage, and those who manage what they do not understand. “- Archibald Putt, pseudonymous of the author of Putt’s Law and the Successful Technocrat.

Several articles in this month’s issue address new technology for the better understanding and management of medical practices, hospitals and first responders.

Agfa Healthcare has developed the newest in its Direct Radiography (DR) detectors, the DX-D 35C, an 11 X 14 inch wireless panel, as recorded in our news briefs entitled, “New Small Format, Wireless Flat Panel Detector From Agfa HealthCare Fulfils Important Imaging Market Need”. This technology captures and transmits the high quality images to the workstation, increasing efficiency for the technologist, particularly in portable environments where it is intended for most frequent use.

In our Research and Technology section, “Clarient, A GE Healthcare Company, Introduces First Lab Developed Test to Assess Multiple Proteins at Single-Cell Level” explains of a new groundbreaking pathology platform, MultiOmyx, which uses proprietary methodology to assess multiple proteins from a single tissue section at a single-cell level. Christine Kuslich, PhD, Chief Science Officer, In Vitro Diagnostics at GE Life Sciences states, “MultiOmyx uniquely facilitates the ability to visualize multiple biological pathways, local immune response as well as heterogeneity of expression within regions of interest on a cell-by-cell basis from a single tissue section maintaining tissue context.”

And Laura Maaske, in our Arts section, shares her journey into the medical illustration field, combining her love for science and for art. “Art Searching to the Heart” also discusses the revolution of iPads and tablets that offer a depth and a tactile experience that takes us beyond what a traditional book could offer.

Most medical students have already made the transition and the health care profession is quickly following, with increased use by physician practices and hospitals for both obtaining medical information and keeping patient records.

If there are medical technologies or research you would like to share with us for future issues, please contact us at medmedia9@gmail.com.

Thomas Hibbard Creative Director

6 | AUGUST 2013

Med Monthly Welcomes New Staff Writer Ashley Warburton is a Limestone College alumni from Plymouth, MA. She graduated with a concentration in English, Psychology and a passion for the health and wellness industry. Growing up in a beach town she loves any activities that involve being outdoors.

Ashley’s background in Marketing and Sales has allowed her to travel across the country from all over the Northeast to Las Vegas and New Orleans. In the past she worked for Underwriters Laboratories, an independent safety science company, where she was an intricate part of their Global Marketing team responsible for brand awareness. She relocated to Raleigh, NC early in 2013 where she is now part of the team at Physician Solutions Inc., in charge of Marketing & Physician Recruiting.

As a staff writer for Med Monthly, Ashley will be writing articles pertaining to the future of medical products and services. There are some major changes coming down the pipeline concerning the Healthcare Reform Act and how it will be crucial for health providers to prepare themselves for the drastic change. She will be keeping her ear to the ground for the latest updates on how this will affect practices and the industry as a whole. Ashley will also be conducting interviews with influential companies around the country that are changing our perspective of the medical world as we know it. Keep an eye out for upcoming contributions from our newest addition.

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news briefs

Large-Scale Switch to Digital Pathology Systems Anticipated Evolving technologies and market forces reveal that digital pathology is poised to radically affect the daily workflow and activities of pathologists and diagnostic laboratories.

Attracted by the prospect of improved connectivity and reduced overall healthcare costs, most laboratories are anticipated to switch over to digital pathology systems over the next 7-8 years.

New analysis from Frost & Sullivan (connectedhealth. frost.com), U.S and European Digital Pathology Market, estimates the market in Europe to expand from $62.23 million in 2012 to reach $143.59 million in 2019, while the market in the United States is projected to increase from $77.23 million to $205.67 million over the same time period. During this time, a spurt in anatomic pathology will result in the U.S. digital pathology market enjoying a faster compound annual growth rate (CAGR) 17% than Europe which will chalk up a slower CAGR of 12.7%.

“In Europe and the United States, pathology laboratories and academic departments have recognised the importance of adopting digital pathology,” notes Frost & Sullivan Senior Research Analyst Divyaa Ravishankar. “They are looking to replace traditional microscopes with digital scanners and create the necessary IT infrastructure to support this move.”

An escalating workload in many clinical laboratories anticipated to increase by 8 to 10% each year is motivating greater demand for digital pathology systems. On their part, vendors are designing high throughput scanners that will meet these ever heavier workloads.

SOON COMING ONTHLY IN MED M

coming In the up sue, er 2013 is b m te p e S me thly’s the Med Mon e will be th Referrals Magic of

8 | AUGUST 2013

Digital pathology will enable academicians and professionals to have access to a wide range of databases, while saving on the cost of preparing new histological slides.

“Medical images have become increasingly important to surgeons and digital image formats ensure that information is integrated and easily available for diagnosis,” explains Ravishankar. “Unlike radiology, surgeons and pathologists make diagnostic decisions with the help of pathology images, which are critical to studying disease progression and monitor and select therapy options.”

While the market is promising, several major challenges still loom. The lack of FDA approval for primary diagnosis and a shrinking pool of skilled pathologists are slowing the adoption of digital pathology. Further, despite successes in some parts of Europe, true interoperability and standardisation in digital pathology have been hard to achieve due to the image formats and complex workflows involved.

Strategic partnerships will be essential to pushing market growth. Vendors who provide one or two components for the entire digital pathology portfolio will need to identify the right partner to devise a more robust and complete offering.

“Additionally, vendors should evaluate models that optimally spread financial risk between lab departments or between the manufacturer and the laboratory,” concludes Ravishankar. “ROI case studies that highlight the value of integrated digital pathology solutions should also be showcased to end users.”  Source: http://www.newswiretoday.com/news/130001/

ACIPHEX CAN EASE HEARTBURN PAIN FROM BECOMING AN ISSUE Most of us see heartburn as a minor inconvenience rather than a serious health problem. While this may be true in some cases, in others, heartburn is an early sign of gastroesophogeal reflux disease (or GERD). A simple symptom like heartburn can be a warning sign for peptic or gastric ulcers that cause intense pain as well as erosion of stomach lining. Over-the-counter medications for heartburn only serve to give relief from symptoms; they do little to solve the underlying problem. Since so many Americans have difficultly affording their prescriptions, Aciphex coupons can be life saving to patients in need. That’s why AffordRx offers prescription discount cards that provide savings of up to seventy-five percent off many popular prescriptions.

About one-in-six adults in America do not have health insurance coverage of any kind. Of these, over eighty-five percent report difficulty in paying for prescriptions. They resort to paying other bills late, buying fewer or less expensive groceries (often leading to increasing carbohydrate consumption over fresh fruits and vegetables), cutting pills in half, or taking prescribed medications less frequently than directed. Clearly, these are serious problems for many patients. That’s why AffordRx makes it their mission to offer Aciphex coupons and other prescription discount cards for FREE. These cards are available to patients without insurance, or whose insurance does not cover all prescriptions.

Applying for a prescription discount card from AffordRx is easy, and free. Patients simply request their card from the AffordRx website. There is no physical exam or medical questionnaire required. Cards may be sent via postal mail, or printed at home for immediate use at any of thousands of participating pharmacies across the United States. All chain pharmacies will accept AffordRx’s Aciphex discount cards, such as Cub, Winn-Dixie, Walgreens, Rite-Aid, Albertsons, Kmart, CVS, Target, Safeway, and more. AffordRx has helped thousands of patients afford the prescriptions they need.

They are standing by to help thousands more.  Source: http://www.pressreleasepoint. com/aciphex-can-ease-heartburn-painbecoming-issue

New Small Format, Wireless Flat Panel Detector From Agfa HealthCare Fulfils Important Imaging Market Need Agfa HealthCare announced the availability of its newest Direct Radiography (DR) detector, the DX-D 35C, an 11x14 inch sized wireless panel. Orthopaedic imaging can particularly benefit from the high spatial resolution for detail, and the excellent dose quantum efficiency (DQE) for potential dose reduction offered by this small DR panel.

Potential for dose reduction Agfa HealthCare’s DX-D 35C uses a Cesium Iodide (CsI) scintillator with twice the DQE of gadolinium-based detector technologies, and delivers the potential for lower dose.

Combined with Agfa HealthCare’s NX workstation and MUSICA2 image processing, the panel produces enhanced contrast detail across the entire dynamic range. For orthopaedic imaging, the DX-D 35C with NX and MUSICA2 is an excellent solution for extremity exams, enabling superb contrast and detail of hands and feet.

Increased efficiency in portable environments “At Agfa HealthCare, we are always striving to improve healthcare technology to make diagnostic imaging an even more powerful tool to aid the overall treatment of the patient, and the DX-D 35C combined with MUSICA2 is an excellent example of our ability to successfully do this,” said Greg Cefalo, U.S. Digital Radiography Business Unit Manager, Agfa HealthCare. “From the smallest, most fragile patients through the spectrum of imaging needs, we are focused on delivering high quality imaging solutions that support the highest level of care.”

In addition to the numerous image quality benefits of the system, the DX-D 35C immediately captures and transmits the image to the workstation, increasing efficiency for the technologist, particularly in portable environments where it is intended for most frequent use. It is an ideal complement for the Agfa HealthCare DX-D 100, a portable imaging system designed for bedside imaging, and immediate image availability to PACS. The detector is also available with Agfa HealthCare’s DX-D Retrofit and soon with DX-D 400 and DX-D 600.

The DX-D 35C is currently available for sale throughout North America.  Source: http://www.pressreleasepoint.com/ahra-2013-newsmall-format-wireless-flat-panel-detector-agfa-healthcarefulfils-important-imaging-ma MEDMONTHLY.COM |9

insight

Deaths From Prescription Painkiller Overdoses Rise Sharply Among Women CDC study shows emergency department visits also on the rise among women 10 | AUGUST 2013

T

he number of prescription painkiller overdose deaths increased five fold among women between 1999 and 2010, according to a Vital Signs report released today by the Centers for Disease Control and Prevention.

While men are more likely to die of a prescription painkiller overdose, since 1999 the percentage increase in deaths was greater among women (400 percent in women compared to 265 percent in men). Prescription painkiller overdoses killed nearly 48,000 women between 1999 and 2010.

“Prescription painkiller deaths have skyrocketed in women (6,600 in 2010), four times as many as died from cocaine and heroin combined,” said CDC Director Tom Frieden, M.D., M.P.H. “Stopping this epidemic in women – and men – is everyone’s business. Doctors need to be cautious about prescribing and patients about using these drugs.”

The study includes emergency department visits and deaths related to drug misuse/abuse and overdose, as well as analyses specific to prescription painkillers. The key findings include: l About 42 women die every day from a drug overdose. t Since 2007, more women have died from drug overdoses than from motor vehicle crashes. t Drug overdose suicide deaths accounted for 34 percent of all suicides among women compared with 8 percent among men in 2010. t More than 940,000 women were seen in emergency departments for drug misuse or abuse in 2010. l Prescription painkillers have been a major contributor to increases in drug overdose deaths among women. t More than 6,600 women, or 18 women every day, died from a prescription painkiller overdose in 2010. t There were four times more deaths among women from prescription painkiller overdose

than for cocaine and heroin deaths combined in 2010. t In 2010, there were more than 200,000 emergency depart- ment visits for opioid misuse or abuse among women; about one every three minutes.

For the Vital Signs report, CDC analyzed data from the National Vital Statistics System (1999-2010) and the Drug Abuse Warning Network public use file (2004-2010).

Previous research has shown that women are more likely to have chronic pain, be prescribed prescription painkillers, be given higher doses, and use them for longer time periods than men. Studies have also shown that women may become dependent on prescription painkillers more quickly than men and may be more likely than men to engage in “doctor shopping” (obtaining prescriptions from multiple prescribers).

“The prescription painkiller problem affects women in different ways than men and all health care providers treating women should be aware of this,” said Linda C. Degutis, Dr.P.H., M.S.N., director of CDC’s National Center for Injury Prevention and Control. “Health care providers can help improve the way painkillers are prescribed while making sure women have access to safe and effective pain treatment.”

Steps that health care providers can take when treating women include: l Following guidelines for responsible opioid prescribing, including screening and monitoring for substance abuse and mental health problems. l Using their states’ prescription drug monitoring program; this can help identify patients who may be improperly using opioids and other drugs. l Discussing pain treatment options, including ones that do not involve prescription drugs. l Discussing the risks and benefits of taking prescription painkillers including when painkillers are taken for chronic conditions, and

especially during pregnancy. l Avoiding prescribing combinations of prescription painkillers and benzodiazepines unless there is a specific medical indication.

Women can take steps to help stay safe from prescription painkiller overdoses, including: l Using prescription drugs only as directed by a health care provider. l Discussing all medications they are taking with their health care provider, including over-thecounter medications (such as for allergies). l Discussing pregnancy plans with their health care provider before taking prescription painkillers. l Disposing of medications properly, as soon as the course of treatment is done. Not keeping prescription medications around “just in case.” l Helping prevent misuse and abuse by not selling or sharing prescription drugs. Never using another person’s prescription drugs. l Getting help for substance abuse problems (1-800-662-HELP and calling Poison Help (1-800222-1222) with questions about medicines.

CDC’s Injury Center works to protect the safety of everyone, every day. For more information about prescription drug overdoses, please visit www.cdc.gov/Homeand RecreationalSafety/Poisoning.

Vital Signs is a CDC report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report, or MMWR. The report provides the latest data and information on key health indicators. These are cancer prevention, obesity, tobacco use, motor vehicle passenger safety, prescription drug overdose, HIV/AIDS, alcohol use, health care–associated infections, cardiovascular health, teen pregnancy, food safety and viral hepatitis.  Source: http://www.cdc.gov/media/ releases/2013/p0702-drug-overdose.html MEDMONTHLY.COM |11

insight

Estrogen Therapy Has No Long-term Effect on Cognition in Younger Postmenopausal Women

A randomized clinical trial of estrogen therapy in younger postmenopausal women, aged 50–55, has found no long-term risk or benefit to cognitive function. The National Institutes of Health-supported study, reported in JAMA Internal Medicine on June 24, 2013, looked at women taking conjugated equine estrogens, the most common type of postmenopausal hormone therapy in the United States.

The earlier Women’s Health Initiative Memory Study (WHIMS) linked the same type of hormone therapy to cognitive decline and dementia in older postmenopausal women.

The new findings come from the Women’s Health Initiative Memory Study of Younger Women (WHIMSY) trial and were reported by Mark A. Espeland, Ph.D., Wake Forest School of Medicine, Winston-Salem, N.C., on behalf of the academic research centers involved in the study.

The study was funded primarily by the National Institute 12| AUGUST 2013

on Aging (NIA), along with the National Heart, Lung, and Blood Institute (NHLBI), both components of the NIH. “The WHIMS study found that estrogen-based postmenopausal hormone therapy produced deficits in cognitive function and increased risk for dementia when prescribed to women 65 and older,” said NIA Director Richard J. Hodes, M.D. “Researchers leading the WHIMSY study wanted to expand on those results by exploring the possibility of a window of opportunity whereby hormone therapy might promote or preserve brain health when given to younger women.”

“In contrast to findings in older postmenopausal women, this study tells women that taking these types of estrogenbased hormone therapies for a relatively short period of time in their early postmenopausal years may not put them at increased risk for cognitive decline over the long term,” said Susan Resnick, Ph.D., chief of the Laboratory of Behavioral Neuroscience, in NIA’s Intramural Research

NIH-funded study finds neither benefit nor risk to cognitive function years after treatment

Program and a co-author of the study. “Further, it is important to note that we did not find any cognitive benefit after long-term follow-up.”

Neither WHIMSY nor WHIMS was designed to assess the reasons that hormone treatments had different effects on cognition in older and younger postmenopausal women.

WHIMSY is an extension of WHIMS, which was conducted as part of the Women’s Health Initiative (WHI). WHI enrollment took place from 1993–1998 at 40 academic research centers. Participants were randomized to one of two groups: women who had had a hysterectomy received conjugated equine estrogens alone; women with a uterus received estrogens plus a synthetic progestin (medroxyprogesterone acetate). There were companion control groups which received placebos. WHIMSY enrolled 1,326 women who started WHI treatment when they were between 50 and 55 and continued it for an average of

seven years. The women were approached to participate in a telephone assessment of cognition an average of seven years after that.

Phone interviews on cognitive function were conducted with 1,168 women. The primary outcome was global cognitive function, which includes measures of memory, problem-solving skills and other cognitive abilities. The researchers also measured specific cognitive functions—verbal memory, attention, executive function, verbal fluency and working memory. The first cognitive assessment was performed when participants’ average age was 67.2 years and the second at an average age of 68.1 years.

The researchers found no meaningful difference in the average global cognitive function scores between women who had been assigned to hormone therapy vs. placebo. continued on page 14 MEDMONTHLY.COM |13

continued from page 13

This finding applied to women regardless of whether their treatment included the synthetic progestin.

The WHIMSY research team will continue to follow the women in the study with annual telephone interviews to learn whether previous hormone therapy has longer term effects on how cognitive function changes over time. Women considering hormone therapy should consult their physician about how best to treat or prevent menopause symptoms or diseases for which they are at risk.

In addition to NIH support for the study, the hormone therapy used in the WHI hormone trials was provided by WyethAyerst Laboratories, now part of Pfizer, Inc. The NIA leads the federal government effort conducting and supporting research on aging and the health and well-being of older people. The Institute’s broad scientific program seeks to understand the nature of aging and to extend the healthy, active years of life. For more information on research, aging, and health, go to http://www.nia.nih. gov.

Part of the NIH, the NHLBI plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at http:// www.nhlbi.nih.gov.  About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Source: http://www.nih.gov/news/health/ jun2013/nia-24.htm 14| AUGUST 2013

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insight

HOW TO CARE FOR ELDERLY PATIENTS WITH DEMENTIA

By Nisha Salim NishaSalim.com

Life expectancy in the United States today is 76 years for men and 81 years for women. As people live longer, their chances of developing dementia also increases. Age is one of the most significant risk factors for developing dementia. According to a recent study led by Dr. Brenda L. Plassman at the Duke University, almost 1 in 7 adults in the US have dementia. That makes an estimated 3.8 million individuals whose suffer from the disorder.

16 | AUGUST 2013

The term dementia covers a group of cognitive disorders that are characterized by memory impairment, problems with language, mood changes, difficulty managing daily tasks, getting confused easily etc. The signs and symptoms emerge gradually.

Caring for an elderly loved one with dementia is not easy. Caregivers may experience emotions ranging from sadness and frustration, to resentment and even guilt for having those feelings. Caregivers may even experience feelings of loss and associated grief though the loved one is still with them.

CARING FOR A LOVED ONE WITH DEMENTIA

In order to be able to provide adequate care, it is important for the caregiver to understand what the loved one is experiencing, prepare them for routine medical visits, and also put a plan in place to make life manageable.

The following information can help take care of a loved one suffering from dementia.

1. Create a daily routine and follow it religiously People suffering from memory loss thrive on the familiar. Dementia patients experience difficulty and confusion when they attempt to do new things. A predictable daily routine will help keep the patient grounded and prevent them from getting distracted or confused. Include routine activities that your loved one used to enjoy before they developed dementia.

Did they have a favorite TV show which they liked to watch at a certain time? Did they read the Sunday newspaper? Include these activities in the care routine; at some level, it will give them a sense of familiarity and calm them.

2. Elder-proof the house Dementia patients suffer from impaired central processing which affects balance and gait. They are at high risk for falls. As age causes the bones to become brittle, the risk

of fractures also looms high. Elderproof the home to minimize the risk of injuries that patients may suffer due to falls. Replace rugs with nonskid mats, rearrange furniture, install grab-handles and railings next to the toilet seat, skid-proof the bathroom, fix bed-rails and also put an additional mattress on the floor beside the bed to ensure a soft landing even if they fall out of the bed. A height-adjustable bed would also be a good idea, because at a very low position, even if they do fall, the distance is short.

to be well-prepared. Patients with early-stage dementia may be able to handle the discussion on their own with some help, but advanced-stage dementia patients will need the help of a caregiver. To get ready for the appointment, check with the doctor if there is anything that needs to be done before the visit. Write down all symptoms, recent life stresses, and a list of all the medications and supplements that are being taken by the patient. Prepare a list of questions that you want to ask the doctor as well.

3. Communicating with your loved one Dementia patients may struggle with the language and keep repeating the same things over and over again.

Be patient. Speak calmly, clearly and simply. Avoid criticism, instead lavish the patient with praise. Place identifying signs on doors and drawers and keep the surroundings well-organized. Do not talk about the patient to another person as though the patient is not there.

Communication is not just about words, a touch can convey a lot more than words can. Hug the patient and hold their hands. This will let them know that they are still valued and cared for.

6. Care provided by medical staff Along with the caregivers at home, the medical staff at hospitals must also be specially prepared to care for dementia patients. A great amount of patience, empathy and understanding are called for to care for a patient with dementia, who may apparently be unable to understand you or follow instructions. Medical staff must take the initiative to talk to family members about dementia-specific tools and services that could make their lives easier. Medical staff must also ask the caregivers about the unique challenges faced by the patient, for example, the propensity to fall, confusion, inability to communicate etc. Regular doctors who usually care for the patient can provide crucial information about the patient, so initiate communication if required. If the patient is admitted at the hospital for any procedure, the staff must update the charts with all the relevant information and also communicate clearly amongst each other to ensure that there are no lapses in care.

4. Helping the patient use the bathroom Advanced-stage patients may become incontinent of urine and stool.

It is important for the caregiver to address the emotional and physical needs of the patient at this point.

Learn to recognize behaviors before incontinence occurs. Look for cues such as the inability to sit still, agitation etc., which may indicate that the patient needs to go to the toilet.

5. Preparing the patient for medical visits Visiting the doctor after diagnosis can be a time of apprehension for the patient. Appointments are usually brief, so it is a good idea

Caring for a patient with dementia can be challenging, to say the least. But remember that if we live long enough, we are also at risk to develop the same disorder. Treat your loved one just as how we would wish to be treated if that happens. Follow a routine with gentleness, kindness and patience.

Help them live the rest of their life with dignity.  MEDMONTHLY.COM |17

practice tips

S

o your practice has a website.

That’s a good start. But if it’s no more than an online brochure, than you may not be reaping much of a return on your investment.

According to a study by MedCity News of several hundred urologists, orthopedic surgeons and other practices: • 69% of physicians have websites but only 33% of them have anything more than biographical and practice information on it; • Only 4% made at least one blog post in the past 12 months to inform patients of trends and research.

This means that a good number of medical practices are ignoring the well-documented fact that most prospective patients search online for health care information – including provider resources. Some even chose their doctors online by forming an impression about your practice merely based on the quality of your website.

The online brochure approach is grossly inadequate for today’s educated, involved and computer-centric health care consumer. Even worse, the “set-it-and-forget-it” mentality of practices who rarely update their website content means their site is likely to appear low on search engine results and certainly doesn’t compel the reader to trust or even contact the provider.

Five ideas to help you avoid the pitfalls of an outdated website are to: 1. Update your website regularly: The easiest way to

keep your website up to date is to write regular blogs (weekly or monthly). The word “blog” may conjure up ideas of online posts about life experiences. Don’t worry, in the case I mean brief (400 word) educational articles that keep patients up to date with the latest trends or advances in your specialty. It’s the same information you share with patients every day but just in written form. Implementing the blog (or a “News” section) directly on your website gives you the most benefit for your search engine rankings.

2. Present an attractive, updated design: Your website

doesn’t have to be overdone with flashing images and music playing in the background, it just needs to look updated (aka not like it was designed during the start of the online revolution in the early 90s). An attractive, yet simple design is most effective because it gives

18 | AUGUST 2013

patients the sense that the site is updated yet keeps the navigation user-friendly.

3. Include patient education: You’ve probably had a

patient ask you about health information they read on WebMD. There’s no denying that patients search for health information online. And who better to give it to them than their own doctor? Including patient education on your website will not only keep prospective patients on your website longer but it also positions you as the expert in your specialty. At the end of the day, you want patients and even referring physicians looking to you for advice, not WebMD.

4. Offer online tools: Online tools such as patient portals, online bill pay, and the ability to download forms has

How to Avoid The Pitfalls of Bad Medical Websites

By Amanda Kanaan President, WhiteCoat Designs

become more than convenient patient perks. They are now the expectation. These tools are simple ways to set your website a part from your competitors’ and they can ultimately increase patient satisfaction.

5. Participate in social media: Physicians still have

mixed reactions when it comes to social media. Most practices agree that patient-to-patient referrals are one of their largest sources of referrals, and social media is essentially an online megaphone for these interactions.

The use of social media graphics also makes your website look more up to date since this is still a relatively new trend that patients view as progressive.

Social media is also a great way to share blogs, patient education and practice news with current patients, prospective patients and referring practices alike.

If you want to set your practice a part online and really use your website to its full benefit then make sure your website is more than a stagnant source of simple contact information. Websites can be a powerful marketing tool that can attract patients and boost patient satisfaction when utilized to their full benefit.  About Amanda Kanaan: Amanda Kanaan is the President of WhiteCoat Designs – a Raleigh-based medical marketing agency providing doctors with online marketing services as medical website design, search engine optimization (SEO), social media management, blog writing, graphic design, referring physician outreach and more. To contact Amanda or to learn more about WhiteCoat Designs, visit www.whitecoat-designs.com.

MEDMONTHLY.COM |19

practice tips

Congress Advised Not to Delay ICD-10 Implementation

by Chuck Buck Publisher, ICD10monitor.com

20| AUGUST 2013

Citing a research study conducted by the American Hospital Association (AHA) reporting that nearly 95 percent of surveyed hospitals are on track to implement ICD-10 by the mandatory compliance date of October 2014, the AHA and Blue Cross and Blue Shield told Congress in a joint letter that they oppose any action to delay implementation of the new code set.

The letter was posted on the AHA website on Friday, July 10. It was signed by Rick Pollack, executive vice president of the AHA, and Alissa Fox, senior vice president of the Blue Cross and Blue Shield Association.

“Any delay in implementation threatens to increase costs, as investments already made will not be fully leveraged and may need to be duplicated,” the letter read.

“Insurers and hospitals will spend the next several months readying their information systems for the installation of ICD-10 vendor software.”

The letter noted that of the 750 hospitals participating in the AHA survey, 94 percent “felt fairly confident” that they could meet the mandatory compliance date. The letter also referenced a competing priority identified in the survey — meaningful use of electronic health records (EHRs).

“The adoption of ICD-10 is seen as an integral part of the EHR and will provide solid and detailed information to guide the innovations taking place in the delivery of health care services, such as patient-centered medical homes and accountable care organizations,” it stated. “The more detailed information will support additional advances, such

as development of quality measures that target outcomes of care and targeted disease management approaches.”

The AHA letter to Congress comes nearly two months after a similar letter was issued by a coalition of healthcare associations and vendors on May 17. Industry observers had hoped that the AHA would have been a signatory to that letter, joining several healthcare associations and the American Health Information Management Association (AHIMA).

In that letter, the coalition warned congressional leaders that delaying the adoption of ICD-10 further would make it more difficult for the U.S. to track “new and emerging public health threats.”

Copies of the earlier letter were sent to leaders in both the U.S. House of Representatives and the Senate. Coalition members said “the transition to ICD-10 is time-sensitive” and noted that relying on ICD-9 is not an option.

The latest letter comes on the heels of last month’s meeting of the American Medical Association’s (AMA) House of Delegates, during which the AMA issued a policy statement demanding a two-year “grace period” -– during which private and commercial payers would not deny medical claims because of coding errors.  Reproduced with permission from ICD10monitor http://icd10monitor.com/index.php?option=com_content&v iew=article&id=968:congress-advised-not-to-delay-icd-10implementation&catid=48:icd10-enews&Itemid=168

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practice tips

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By Dr. Molly Leavitt, D.C.

22 | AUGUST 2013

C

hiropractors know that a decrease in body weight helps with musculoskeletal issues. We have always advised our patients that any amount of weight lost will be beneficial but over the years we’ve had to acknowledge that our admonitions to lose weight did not bring about the results we wanted for our patients. Simply lecturing a patient to lose weight is ineffective and any primary care physician will likely agree. Losing weight is just plain hard work, the options available are confusing, and most patients basically do not know how to lose weight. They go from one fad diet to another without any long lasting success.

But with the obesity epidemic and an increase in numbers of patients attempting to lose weight, more and more patients on our office were coming to us frustrated that their efforts were not bringing about the changes that they sought. Countless times we heard “I’m doing everything right but I’m not losing. What should I do?”

One can’t help but be alarmed as the levels of obesity steadily increase.

Just going to a local middle school or high school and observing the numbers of our children suffering from too much weight is enough to shock anyone. It’s no surprise that this is the first generation of children with a shorter life expectancy than their parents.

We wanted to address this need in our practice and we began researching the options available to us. We have 4 criteria we insist on before implementing any program in our office. The program had to be easy, effective, affordable and backed by science. We value every patient who walks through our doors and if we are going to put our reputation on the line, we want to make very sure we have the best to offer.

We found a program that has clinical studies backed by Johns Hopkins Bloomberg School of Public Health. It is likely the easiest plan available and is affordable by being cost-neutral for most participants. What’s more, our patients lost weight as promised by the program.

We use portion controlled meal replacements in conjunction with a coaching service to help patients understand the issues associated with weight gain and weight loss. With understanding comes compliance. Our goal is not to offer a ‘diet’. Our goal is to guide and teach patients, so our program be the last ‘diet’ they will ever need. We instruct our patients on how to use the program to lose weight, to educate themselves along the journey, and to make lifestyle choices and habits that they can maintain after losing weight. One of our key goals is to help our patients learn how to keep their weight off for good. We show patients that making the right life-style choices will impact their health now and in the future. The ripple effects of their success will have a positive effect on their family and friends.

We started our program two years ago and with a little advertising and word of mouth, we continue to assist patients in weight loss. Countless patients have been able to discontinue their medications with their MD’s approval. A Type II Diabetic who can discontinue their insulin injections makes for a happy patient.

We are able to add thousands to our bottom line and use the funds for salaries and bonuses. We’ve added to our practice because the public is searching for a solution. If we don’t help our patients, they will seek help elsewhere.

We’ve had such success that we produced a video of Tracy, one of our program’s participants, to show potential clients just how enormously helpful this program can be. The video can be viewed at: http://www. youtube.com/watch?v=AAFtRzseRrc&feature=youtu.be  MEDMONTHLY.COM |17

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international

C

isco and the United Foundation for Children’s Health (UFCH) have jointly announced the launch of a “Connected Healthy Children China Program.” In addition to a cash donation of RMB 1 million to the program, Cisco has also deployed its collaboration and Cisco WebEx® technology solutions in support of the initiative.

Cisco and UFCH have committed the expertise and resources of both parties. Specifically, Cisco has helped UFCH to design, develop and utilize advanced healthcare information and communication technologies in order to enable effective collaboration among all parties involved in delivering care to underserved children in China.

The “Connected Healthy Children China Program” incorporates four aspects: remote diagnosis, improving the professional skills of physicians in remote areas, providing training for special education teachers, and health information exchange. UFCH is currently collaborating with its sister organizations and is inviting senior doctors from UFCH to participate in remote diagnosis and medical examinations, to provide support for the corresponding medical services, and to handle a series of administrative activities including project operation, all on a volunteer basis. Through the Cisco® collaboration platform, senior doctors from UFCH will be able to connect with regions in need -- such as Chengdu -- and this kind of collaborative care, training and health education will be facilitated with junior doctors or caregivers in local orphanages. Cisco and UFCH believe that more children will be able to benefit from professional diagnosis and treatment as well as a higher quality of service provided by this program, thereby raising the healthcare-provision level in local regions. In addition, Chengdu’s special education teachers and caregivers

26| AUGUST 2013

will be able to receive systematic and professional training via Cisco’s collaboration platform, which will help to narrow the gap between local regions and developed areas, and elevate local special education levels.

UFCH has also been able to collaborate with Chengdu Women and Children’s Hospital and Huaxi Hospital via WebEx®, a collaborative network platform. WebEx is able to bring together physicians from a variety of regions and/or subject fields for discussion, in addition to sharing of physical examination reports, and medical images.

The Chengdu Children’s Welfare Institute is the initial pilot site for the “Connected Healthy Children China Program”. The Chengdu Children’s Welfare Institute is a provincial children’s welfare house, which adopts orphans, abandoned babies and homeless children with disabilities. The institute also provides special education, healthcare and rehabilitation for children in need. As one of the largest welfare houses in China, the Chengdu Children’s Welfare Institute has adopted approximate 600 orphans, from newborns to children 14 years old. So far, 15 children have received medical diagnosis via the “Connected Healthy Children China Program.” These diagnoses and treatment involve three separate parties - the patients, local physicians in Chengdu and experts in Beijing - through Cisco’s collaborative network platform. The medical services provided by this program have included treatments for such conditions as complex congenital heart diseases, liver tumors, skin diseases and lymphatic malformations.

“Today children in many remote areas of China are suffering from congenital diseases but may not have a timely cure due to high diagnosis and treatment costs, as well as the unbalanced distribution of healthcare

resources,” said Roberta Lipson, CEO of Chindex International and chairman of the Board of United Family Hospitals. “The objective of this joint program is to help as many underserved children as possible to receive quality diagnoses and treatment, enable local healthcare doctors and caregivers to receive more targeted professional trainings and to ensure that patients’ parents obtain relevant information and advice. I believe that our collaboration with Cisco will definitely help to advance the cooperation between different levels of medical experts and institutions to provide better medical care and life-saving surgeries for disadvantaged children.”

Corporate Social Responsibility (CSR) has been the foundation of Cisco’s corporate culture and global strategies. As Dr. Yu Yi, senior director of Cisco Corporate Affairs, said: “The Cisco and UFCH ‘Connected Healthy Children China Program’ is an important aspect of Cisco’s ‘Connected Healthy Children’ global CSR program.

Our relationship with UFCH and other Chinese institutions is another example of Cisco’s contribution to public welfare and Cisco’s long-term commitment to China.”

“Cisco’s ‘Connected Healthy Children’ CSR program is designed to utilize innovative technologies to improve the health of the next generation. While helping underserved children to gain access to quality healthcare resources, providing professional training and guidance for doctors and caregivers in remote areas, we also hope to increase the efficiency of healthcare delivery system in local regions. Cisco’s technologies for ‘Connecting the Unconnected’ make this hope possible,” Dr. Yu added.  Source: http://www.pressreleasepoint. com/cisco-cooperates-ufch-launchconnected-healthy-children-chinaprogram

Implementing a Collaborative Model to Accelerate the Development of Regional Healthcare, While Benefitting Underserved Children MEDMONTHLY.COM |27

research & technology

Altered Protein Shapes May Explain Differences in Some Brain Diseases NIH-funded study finds that various strains of alpha-synuclein have diverse effects in neurons It only takes one bad apple to spoil the bunch, and the same may be true of certain proteins in the brain. Studies have suggested that just one rogue protein (in this case, a protein that is misfolded or shaped the wrong way) can act as a seed, leading to the misfolding of nearby proteins.

According to an NIH-funded study, various forms of these seeds — originating from the same protein — may lead to different patterns of misfolding that result in neurological disorders with unique sets of symptoms.

“This study has important implications for Parkinson’s disease and other neurodegenerative disorders,” said National Institute of Neurological Disorders and Stroke (NINDS) Director Story Landis, Ph.D. “We know that among patients with Parkinson’s disease, there are variations in the way that the disorder affects the brains.

This exciting new research provides a potential explanation for why those differences occur.”

An example of such a protein is alpha-synuclein, which 28 | AUGUST 2013

can accumulate in brain cells, causing synucleinopathies, multiple system atrophy, Parkinson’s disease, Parkinson’s disease with dementia (PDD), and dementia with Lewy bodies (DLB). In addition, misfolded proteins other than alpha-synuclein sometimes aggregate, or accumulate, in the same brains. For example, tau protein collects into aggregates called tangles, which are the hallmark of Alzheimer’s disease and are often found in PDD and DLB brains. Findings from this study raise the possibility that different structural shapes, or strains, of alpha-synuclein may contribute to the co-occurrence of synuclein and tau accumulations in PDD or DLB. Accumulations of alpha-synuclein (red) and tau (green) were found in mouse brain cells that had been treated with strain B. Overlap of the two proteins is shown in yellow. Courtesy of Dr. Virginia M.Y. Lee, University of Pennsylvania School of Medicine.

In the new study, published in Cell, Jing L. Guo, Ph.D.,

and her colleagues from the University of Pennsylvania Perelman School of Medicine, Philadelphia, wanted to see if different preparations of synthetic alpha-synuclein fibrils would behave differently in neurons that were in a petri dish as well as in mouse brains. They discovered two strains of alpha-synuclein with distinct seeding activity in cultured neurons: while one strain (strain A) resulted in accumulation of alpha-synuclein alone, the other strain (strain B) resulted in accumulations of both alphasynuclein and tau.

The researchers also injected strain A or strain B into the brains of mice engineered to make large amounts of human tau, and then monitored the formation of alphasynuclein and tau aggregates at various time points. Mice that received injections of synuclein strain B showed more accumulation of tau — earlier and across more brain regions — compared to mice that received strain A. The researchers also examined the brains of five patients who had PDD, some of whom also had Alzheimer’s. In this small sample, there was evidence of two different structural forms of alpha-synuclein, one in PDD brains and a distinctly different one in PDD/Alzheimer’s brains, supporting the existence of disease-specific strains of the protein in human diseases.

“We are just starting to do work with human tissues,” said Virginia M.Y. Lee, Ph.D., senior author of the study.

“We are planning to look at the brains of patients who had Parkinson’s disease, PDD, or DLB to see if there are differences in the distribution of alpha-synuclein strains.”

Although the two strains used in this study were created in test tubes, the authors noted that in human brains, where the environment is much more complicated, the chances of forming additional disease-related alpha-synuclein strains may be greater.

“These different strains not only can convert normal alpha-synuclein into pathological alpha-synuclein within one cell, they also can morph into new strains as they pass from cell to cell, acquiring the ability to serve as a template to damage both normal alpha-synuclein and other proteins,” said Dr. Lee. “So certain strains, but not all strains, can act as templates to influence the development of other pathologies, such as tau tangles.”

She commented, “We are just beginning to understand some of these strains and there may be many others. We hope to find a way to identify strains that are relevant to human disease.”  This study was supported by grants from NINDS (NS53488) and the National Institute on Aging (AG17586).

Additional funding was provided by the Marian S. Ware Alzheimer Program, Philadelphia, PA; the Dr. Arthur Peck Fund, Philadelphia, PA; The Jeff and Anne Keefer Fund, Philadelphia, PA; and the Parkinson Council, Bala Cynwyd, PA. NINDS is the nation’s leading funder of research on the

brain and nervous system. The NINDS mission is to reduce the burden of neurological disease — a burden borne by every age group, by every segment of society, by people all over the world.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

References: Jing L. Guo et al. “Distinct α-Synuclein Strains Differentially Promote tau Inclusions in Neurons.” Cell, July 3, 2013. DOI: 10.1016/j.cell.2013.05.057 For more information about Parkinson’s disease and dementia with Lewy bodies, please visit: http://www.ninds.nih.gov/disorders/parkinsons_disease/ parkinsons_disease.htm http://www.ninds.nih.gov/disorders/ dementiawithlewybodies/dementiawithlewybodies.htm Source: http://www.nih.gov/news/health/jul2013/ninds-03. htm

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MEDMONTHLY.COM |29

research & technology

Clarient, A GE Healthcare Company, Introduces First Lab Developed Test To Assess Multiple Proteins at Single-Cell Level

30 |AUGUST 2013

GE Healthcare today announced the introduction by Clarient Diagnostic Services, a GE Healthcare Company, of the first lab developed test using MultiOmyx™, a groundbreaking new pathology platform which uses proprietary methodology to assess multiple proteins from a single tissue section at a single-cell level. This test, now available, offers an aid to a pathologist’s diagnosis of CD30-positive lymphoma cases with difficult morphology or otherwise insufficient tissue to adequately evaluate the case.

“In many instances, suspected lymphoma cases are not straightforward, and sample tissue size inadequacy issues further complicate the matter,” said Lawrence Weiss, MD, Medical Director of Clarient. “In difficult to call diagnoses, MultiOmyx gives me great confidence in making the diagnosis and relieves me from the concern of running out of tissue. If I only have a small amount of tissue, I do not have to sacrifice or choose between important markers – I can assess them all.”

The Hodgkin Lymphoma (HL) Profile by MultiOmyx helps to assess nine unique antibodies (CD30, CD15, CD20, CD45, PAX5, OCT2, BOB1, CD3, and CD79A) on a single formalin fixed paraffin embedded tissue section to aid in differential diagnosis of Classical HL. In clinical validation, this single slide assay called the Hodgkin Lymphoma Profile by MultiOmyx demonstrated high levels of accuracy, diagnostic reproducibility and repeatability, and high sensitivity of all immunofluorescent stains in comparison to traditional immunohistochemistry performed on the same samples. The correlation study identified unique cases where MultiOmyx demonstrated improved performance.

“Traditional pathology uses multiple slices from paraffin-fixed tumor samples and examines them slide by slide, which is less efficient and effective,” said Carrie Eglinton Manner, CEO, Clarient. “Using a single slide may save time, uses significantly less tissue and may provide a more consistent result. Since different parts of a tumor sample can act differently and because less tissue is required, pathologists can access the most accurate and broad tumor analysis available, while eliminating today’s need to prioritize tests due to limited tissue availability.”

The relevance of the MultiOmyx technology was recently confirmed in a clinical paper written by a team of scientists from GE Global Research published in Proceedings of the National Academy of Sciences (PNAS).

The paper details the different ways GE is using image data to visualize cancer and the relationship between different biomarkers and the tumor environment and suggests the technology could be broadly applicable to problems in basic biological research, drug discovery and development and companion and clinical diagnostics.

“MultiOmyx provides clinicians and researchers with a novel biomarker multiplexing method to understand biological context in a way that is not possible with other technologies that disrupt the tissue histology.

Once cells are removed from the context of their overall microenvironment with other methods valuable information is lost.” said Christine Kuslich, PhD, Chief Science Officer, In Vitro Diagnostics, GE Life Sciences.

“MultiOmyx uniquely facilitates the ability to visualize multiple biological pathways, local immune response as well as heterogeneity of expression within regions of interest on a cell-by-cell basis from a single tissue section maintaining tissue context.”

The platform uses fluorescence to provide quantitative analysis of antibodies and allows for up to 60 proteins to be examined on a single tissue sample. It creates a “digital map” of the tumor, giving each cell an “address” and allowing for a clear graphic representation of protein expression. Matching this map to known biosignatures gives researchers a more accurate representation of the exact characteristics of the tumor and may provide clinicians with a clearer view to aid the diagnosis. It also allows them to identify patterns in the tissue by analyzing each cell and biomarker individually, or as a cluster, and thus get a level of understanding of the biological process that could not be achieved via traditional methods.  Source: http://www.pressreleasepoint.com/clarient-gehealthcare-company-introduces-first-lab-developed-testassess-multiple-proteins-single-c

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research & technology

SMBG Suppliers Look to Tap the Huge Underpenetrated Diabetic Population in Asia-Pacific Three quarters of the population of China and India are diabetic. This translates to a patient pool of nearly 200 million for the self monitoring of blood glucose (SMBG) market.

However, not more than 45 percent of these patients have been diagnosed, which represents a vast underserved market.

New analysis from Frost & Sullivan (medtech.frost.com), APAC Self Monitoring of Blood Glucose (SMBG) Market, finds that the meter segment earned US$222.7 million in 2012 market and is expected to reach US$358.7 million in 2017. The strip segment earned revenues of US$1212.7 million 2012 and expects this to grow to US$2081.2 million in 2017.

Less than 10 percent of the diabetic population in Asia-Pacific use SMBG products due to inadequate education and awareness, as well as a lack of affordability and strict regulations.

To improve patient awareness, SMBG original equipment manufacturers (OEMs), several governmental and non-governmental organizations, and hospitals conduct patient awareness camps and drives throughout the year.

32 |AUGUST 2013

“The high costs of frequent testing also deter patients from investing in SMBG devices thus lowering compliance,” said Frost & Sullivan Healthcare Senior Industry Analyst Nitin Dixit. “SMBG devices are mostly an out-of-pocket expense in Asia-Pacific, as the meters and strips are reimbursed only in a handful of countries in the region. While onetime cost of buying a meter is relatively low, buying test strips for frequent testing can prove very expensive, especially for patients on “intensive diabetes management therapy”, unless reimbursed.”

Market participants can leverage the ubiquity of the Internet and smartphones in Asia-Pacific to gain a competitive edge by launching diabetes data management software as a valueadded service. Data from individuals’ SMBG meters can be shared with consulting doctors over the Internet, who can then suggest changes in medication/diet accordingly. “Roche, for instance, experienced higher sales with the recent launches of products enabled with data management software,” noted Dixit.

Differentiating from competition

will become even more vital as SMBG gradually becomes a low-value, high-volume segment due to intense competition and the resultant price wars. It is important to maintain adequate shelf space (availability) in the retail segment, as patients may switch brands if the prescribed brand is unavailable.

“There are many non-invasive or painless meters in the later stages of clinical trials, and some are already commercially available,” said Dixit.

“The introduction of these products with novel features will go a long way in helping OEMs shed their commodity status and stand out in the market.”  About Frost & Sullivan Frost & Sullivan (frost.com), the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today’s market participants.

Source: http://www.newswiretoday. com/news/131618/

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legal

Continuing to Implement the ACA in a Careful, Thoughtful Manner

By Mark J. Mazur Assistant Secretary for Tax Policy, U.S. Department of the Treasury 34 | AUGUST 2013

Over the past several months, the Administration has been engaging in a dialogue with businesses - many of which already provide health coverage for their workers - about the new employer and insurer reporting requirements under the Affordable Care Act (ACA). We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively. We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so. We have listened to your feedback. And we are taking action.

The Administration is announcing that it will provide an additional year before the ACA mandatory employer and insurer reporting requirements begin. This is designed to meet two goals. First, it will allow us to consider ways to simplify the new reporting requirements consistent with the law. Second, it will provide time to adapt health coverage and reporting systems while employers are moving toward making health coverage affordable and accessible for their employees. Within the next week, we will publish formal guidance describing this transition. Just like the Administration’s effort to turn the initial 21-page application for health insurance into a three-page application, we are working hard to adapt and to be flexible about reporting requirements as we implement the law.

Here is some additional detail. The ACA includes information reporting (under section 6055) by insurers, self-insuring employers, and other parties that provide health coverage. It also requires information reporting (under section 6056) by certain employers with respect to the health coverage offered to their full-time employees. We expect to publish proposed rules implementing these provisions this summer, after a dialogue with stakeholders - including those responsible employers that already provide their full-time work force with coverage far exceeding the minimum employer shared responsibility requirements - in an effort to minimize the reporting, consistent with effective implementation of the law.

Once these rules have been issued, the Administration will work with employers, insurers, and other reporting entities to strongly encourage them to voluntarily implement this information reporting in 2014, in preparation for the full application of the provisions in 2015. Realworld testing of reporting systems in 2014 will contribute to a smoother transition to full implementation in 2015.

We recognize that this transition relief will make it impractical to determine which employers owe shared responsibility payments (under section 4980H) for 2014. Accordingly, we are extending this transition relief to the employer shared responsibility payments. These payments will not apply for 2014. Any employer shared responsibility payments will not apply until 2015.

During this 2014 transition period, we strongly encourage employers to maintain or expand health coverage. Also, our actions today do not affect employees’ access to the premium tax credits available under the ACA (nor any other provision of the ACA).  Mark J. Mazur is the Assistant Secretary for Tax Policy at the U.S. Department of the Treasury.

Source: http://www.treasury.gov/connect/blog/Pages/Continuing-toImplement-the-ACA-in-a-Careful-Thoughtful-Manner-.aspx

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legal

Weight For It: How Will the American Medical Association’s (AMA) New Decision Affect Employers?

By Brandon K. Johnson McBrayer, McGinnis, Leslie and Kirkland, PLLC

In a press release issued on June 18, 2013, the American Medical Association (“AMA”) declared obesity as a “disease.” The decision was met with sharp controversy, as it automatically classified millions of overweight Americans as diseased. Critics of the classification believe that obesity is not a disease and that there is no way to determine one’s health based on a number on the scale.

The AMA hopes the new label will lead to better coverage and treatment for those who suffer from obesity.

36 | AUGUST 2013

Obesity affects approximately one in three Americans. And the AMA’s decision may be affecting 100% of employers, as it once again raises the question of what should be considered as a disability under the Americans with Disabilities Act (“ADA”). The ADA prohibits discrimination against a qualified employee or applicant with a disability, provided that he can perform essential functions of the job with or without reasonable accommodation. A person is considered “disabled” if he: • Has a physical or mental condition that substantially limits a major life activity (such was walking, talking, learning, seeing); or, • Has a history of a disability; or, • Is perceived to have a physical or mental impairment that is not transitory and minor.

The ADA Amendments Act of 2008 (“ADAAA”) specifically provided that “disability” for purposes of the Act “shall be construed in favor of broad coverage of individuals under [the ADA] to the maximum extent permitted by the terms of [the ADA].”

In 2010, the Equal Employment Opportunity Commission (“EEOC”) filed its first-ever lawsuit on an employee’s behalf asserting that “severe” obesity was a protectable disability under the ADA. The case, EEOC v. Resources for Human Development, Inc., provided no clear guidance on what level of obesity is severe enough to warrant ADAprotected disability status. In 2012, The EEOC publicly stated that “the law protects morbidly obese employees and applicants from being subjected to discrimination because of their obesity.” (emphasis added). The EEOC defines morbidly obese as weighing twice the normal body weight. This came after the case EEOC v. BAE Systems, Inc., wherein BAE Systems, a global security and defense company, fired an employee who weighed over 600 lbs. The EEOC claimed the employee was able to perform the essential duties of his job and received

‘‘

“The AMA’s new position on obesity illustrates the current cultural shift in viewing obesity as more than just a sign of weak willpower...”

good performance reviews and was only terminated because of his size.

The case settled, with BAE paying the employee $55,000 in damages.

While it is obvious that morbidly obese employees may require reasonable accommodations, it is harder to know at what point a mildly obese person will require the same.

Additionally, under the ADAAA, it does not matter if a person is actually limited by their disability; if an employer perceives impairment (and the impairment is not minor nor transitory), any adverse action on the basis of the impairment can be grounds for a discrimination claim.

The AMA’s new position on obesity illustrates the current cultural shift in viewing obesity as more than just a sign of weak willpower; a “disease” is something beyond an individual’s control. There may be legitimate reasons why an employer is wary to hire or promote an obese person, such as increased insurance premiums, the business’s image, or the heightened possibility for a severely overweight person to have other serious health problems. However, employers must be careful not act on this conscious (or sometimes unconscious) bias. The “obesity as a disease” announcement can only work to bolster an employee’s weight-based discrimination claim.

With one in three Americans being obese, the potential for these claims is exponentially high.  Source: http://mcbrayeremploymentlaw. com/2013/07/17/weight-for-it-howwill-the-amas-new-decision-affectemployers/ MEDMONTHLY.COM |37

legal

A Short-Lived Victory for Generic Dru

O

n June 24, 2012, the U.S. Supreme Court handed down its decision in Mutual Pharmaceutical Co. Inc. v. Bartlett, 570 U.S. _ (2013), finding that design-defect claims against generic drug companies are pre-empted where federal law prohibits an action required by state law. The Supreme Court had previously held in Pliva v. Mensing, 564 U.S. _ (2011) that failure to warn claims against generic drug manufacturers are pre-empted by the Federal Food Drug and Cosmetic Act since generic drug makers must copy innovator drug labeling precisely in order to obtain approval of their products by the U.S. Food and Drug Administration (“FDA”). The Court in Mutual rejected the argument of lower courts that the generic manufacturer could comply with both federal and state law by choosing not to make and distribute the product at all.

The case in question involved the drug sulindac, a non-

38 |AUGUST 2013

steroidal anti-inflammatory drug product marketed by the innovator as Clinoril®. The plaintiff in the case had been prescribed sulindac for treatment of shoulder pain. She subsequently developed a case of toxic epidermal necrolysis following taking an FDA approved generic product equivalent to Clinoril®, which resulted in significant and permanent disability (including blindness) and disfigurement. Subsequent to the event, the FDA required a more specific warning as to this possible side effect on sulindac products. A jury found the generic manufacturer liable under a theory that there was a design defect with the product, and the First Circuit affirmed, holding that the generic manufacturer could have complied with both federal and state law by not manufacturing and distributing the product. This was the method by which the lower courts overcame prior precedent that a state law may be impliedly pre-empted when it is not possible to comply

ug Manufacturers?

By Peter S. Reichertz, Partner With Sheppard, Mullin, Richter & Hampton, LLP with both federal and state law.

The Supreme Court in Mutual noted that the generic manufacturer could not comply with the state law, since federal law requires that the active ingredient, the amount of the active ingredient, the dosage form, and the labeling had to be identical to the innovator product. In this case, it was not possible to redesign the product, and the only way, under New Hampshire law, to remedy the design defect would have been to strengthen the product’s warnings. That too could not be done, as FDA rules require the labeling of the generic to be identical to that of the innovator. The Court ruled that in such a case the state law is without effect, and relevant New Hampshire warning-based design defect cause of action was pre-empted with respect to FDAapproved generic drugs sold in interstate commerce.

The scope of the Mutual decision may be limited to those states where design-defect claims allow for a risk-

utility approach such as that the New Hampshire requires.

The New Hampshire standard requires, among other things in determining whether there is a valid cause of action for a design defect, a determination as to whether there is a possible warning to avoid unreasonable risk of harm from the design defect and the efficacy of such warning. So not every design-defect claim may be pre-empted, depending on each state’s laws are interpreted. But given the Court’s reasoning, even state laws that do not take into effect the presence of and efficacy of a warning, may be pre-empted, as the generic must copy the formula of the innovator in all respects, except for the inactive ingredients in the product.

(It should be noted that generics of some dosage forms – ophthalmic products and injectable products – must, in most cases, contain the same inactive ingredients as in the innovator product in the same amounts).

Furthermore, the FDA may amend its rules to permit ANDA holders to make changes in labeling. See “FDA Rule Could Open Generic Drug Makers to Suits,” The New York Times, Business, July 4, 2013, at B2. As stated in the posting on the OMB website (RIN 0910-A694): Abstract: This proposed rule would amend the regulations regarding new drug applications (NDAs), abbreviated new drug applications (NDAs), abbreviated new drug applications (ANDAs), and biologics license applications (BLAs) to revise and clarify procedures for changes to the labeling of an approved drug to reflect certain types of newly acquired information in advance of FDA’s review of such change. The proposed rule would describe the process by which information regarding a “changes being effected” (CBE) labeling supplement submitted by an NDA or ANDA holder would be made publicly available during FDA’s review of the labeling change. The proposed rule also would clarify requirements for the NDA holder for the reference listed drug and all ANDA holders to submit conforming labeling revisions after FDA has taken an action on the NDA and/or ANDA holder’s CBE labeling supplement. These proposed revisions to FDA’s regulations would create parity between NDA holders and ANDA holders with respect to submission of CBE labeling supplements.

The expected date for a Notice of Proposed Rulemaking is September 2013. It could, of course, take FDA quite some time to propose a rule, and put it into effect, given the requirements of the Administrative Procedure Act. And Congressional action is also a possibility.

For the present, however, generic drug manufacturers appear to be shielded from liability under the doctrine of pre-emption from most, if not all, failure to warn and design defect claims under state law. Whether that victory is short-lived or not remains to be seen.  Source: http://www.natlawreview.com/article/short-livedvictory-generic-drug-manufacturers MEDMONTHLY.COM |39

features

HOW TO IMPROVE EFFICIENCY AND EMPOWER CREW MEMBERS

By EMSWorld.com

40 | AUGUST 2013

This medical air transport agency, in three Northwest U.S. states, has taken its employee scheduling and workforce management abilities to new heights

continued on page 42

MEDMONTHLY.COM |41

W

continued from page 41

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ith multiple locations and over 200 employees covering thousands of miles throughout Oregon, Washington and Idaho, Life Flight Network says that they had outgrown the usefulness of spreadsheet crew scheduling.

“The spreadsheet did not allow for individual employee schedule changes without involving managers/ schedulers. The option of empowering the employee to self-submit availability, make trades, and request vacation/ time off makes EMS Manager the best system for our company,” indicates Dominic Pomponio RN, CFRN Region 3 Director, Life Flight Network.

Life Flight Network selected EMS Manager after testing demos from a number of online scheduling companies. The company operates multiple bases with ground EMS, helicopter, and fixed-wing operations.

They sought a scheduling and workforce management system that was more efficient, and more fitting, for their entire operation. Life Flight Network states the system capabilities, customer service and ease of setting up EMS Manager fit their company’s needs and expectations.

“EMS Manager has allowed Life Flight Network to review availability and schedule accordingly. We utilize a 12-week schedule, so there is a greater likelihood in changes of availability throughout the scheduled period. EMS Manager allows the employee to submit their availability and take ownership in the scheduling process, thus making for a more consistent and fair schedule for all,” adds Pomponio. “Administrators and staff value the ability to access the system from our smartphones. Admin staff can also page out (notify) members about any schedule changes and alert them of open positions. EMS Manager’s customer service is very responsive. As an administrator, I know I can call or email and get an answer immediately.”

Life Flight Network, named the 2009 Air Medical Program of the Year by the

‘‘

“The option of empowering the employee to selfsubmit availability, make trades, and request vacation/ time off makes EMS Manager the best system for our company.”

Association of Air Medical Services, provides life-saving transport for seriously ill or injured patients from the scene of an emergency or from one hospital to another. Much of the area Life Flight Network services is remote; making a flight-based option pivotal for residents and visitors needing medical attention. Life Flight Network’s unique combination of air and ground ambulances and highly skilled personnel, represents an integral part of local emergency medical systems.  Aladtec, Inc. is a proud provider of web-based software solutions for online employee scheduling and workforce management applications.

The company’s flagship products, EMS Manager and FIRE Manager, are leaders in the public safety sector.

Together with their newest product, Zanager, they serve nearly 1,000 EMS agencies, fire departments, police departments and other businesses.

Over 60,000 employees use Aladtec’s online employee scheduling and workforce management products.

Aladtec is headquartered just outside the Minneapolis/St. Paul metro area in Hudson, Wisconsin. For more information, visit www.aladtec.com.

Source: http://www.emsworld.com/ press_release/10951181/how-toimprove-efficiency-and-empower-crewmembers

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features

Varied Quality of CPR Among EMS, Hospitals Hurts Survival By the American Heart Association

Co-authors are Bentley J. Bobrow, M.D.; Mary E. Mancini, R.N., Ph.D., N.E.-B.C.; Jim Christenson, M.D.; Allan R. de Caen, M.D.; Farhan Bhanji, M.D., M.Sc.; Benjamin S. Abella, M.D., M.Phil.; Monica E. Kleinman, M.D.; Dana P. Edelson, M.D., M.S.; Robert A. Berg, M.D.; Tom P. Aufderheide, M.D.; Venu Menon, M.D. and Marion Leary, M.S.N., R.N. on behalf of the CPR Quality Summit Investigators.

44 | AUGUST 2013

The quality of CPR (cardiopulmonary resuscitation) you receive may vary, depending on the EMS department or hospital administering it, according to the American Heart Association.

In a statement published in its journal Circulation, the association calls for a renewed focus on improving resuscitation techniques and tracking.

“There have been huge advances in CPR and there’s no question that high-quality CPR saves lives,” said Peter Meaney, M.D., M.P.H., lead author of the statement and assistant professor of anesthesia and critical care at Children’s Hospital of Philadelphia. “However, right now there is wide variability in the quality of CPR -- and we can do better.”

Each year in the United States, more than a half-million children and adults suffer cardiac arrest, but survival rates vary significantly: 3 percent to 16 percent for arrests outside of hospitals and 12 percent to 22 percent in hospitals, authors said.

In the statement, the association urges professional rescuers to: • Minimize interruptions to chest compressions. Compressions generate blood flow and should be delivered more than 80 percent of the time the patient doesn’t have a pulse.

• Provide the right rate of compressions — 100 to 120 per minute are optimal for survival.

• Give deep enough compressions — at least 2 inches for adults and at least 1/3 the depth of the chest in infants and children.

• Allow the chest to bounce back completely so the heart can refill.

• Give no more than 12 rescue breaths a minute, with the chest just visibly rising, so pressure from the breath doesn’t slow blood flow.

“Cardiac arrest is a chaotic event and sometimes we lose track of the fact that high-quality CPR is the cornerstone of resuscitation,” Meaney said.

To help ensure that CPR providers stay focused on quality of care, the statement also advises: • Health and emergency care providers gather data on the quality of CPR delivery and patient response at the scene.

• If possible, an experienced team leader should oversee and evaluate the quality of CPR to ensure guidelines are followed, patient needs addressed and other problems limited (such as rescuer fatigue).

• To ensure quality improvement, providers, managers, institutions and systems of care should do debriefings, follow CPR delivery checklists, measure patient response measurements; provide frequent refresher courses and participate in CPR data registries.

Organizations that provide CPR need quality improvement programs, and can start by monitoring one measurement, Meaney said.

“If we focus on improving CPR quality we can save lives. We always need to be better, always need to be pushing the needle, because lives are at stake,” he said.

The CPR Improvement Working Group (Laerdal Medical, Philips Healthcare, Zoll Corporation) funded the CPR Quality Summit, which contributed to the statement’s development.  For the latest heart and stroke news, follow us on Twitter: @HeartNews.

For updates and new science from Circulation, follow @CircAHA. The American Heart Association/American Stroke Association receives funding mostly from individuals. Foundations and corporations donate as well, and fund specific programs and events.

Strict policies are enforced to prevent these relationships from influencing the association’s science content. Financial information for the American Heart Association, including a list of contributions from pharmaceutical companies and device manufacturers, is available at www. heart.org/corporatefunding.

Additional resources, including multimedia, are available in the right column of this link: http://newsroom.heart.org/news/varied-quality-of-cpr-among-ems-hospitals-hurts-survival?prev iew=947961b64b4a75ca1a9c35caa7a0c3e1 Source: http://newsroom.heart.org/news/varied-quality-of-cpr-among-ems-hospitals-hurts-survival continued on page 46 MEDMONTHLY.COM |45

continued from page 45

GPS-like Technology for CPR More than Doubles Survival from Leading Cause of Death in the US ZOLL Medical Corporation, a manufacturer of medical devices and related software solutions and a member of the CPR Improvement Working Group, announced that survival from one of the leading causes of death in the United States, out-of-hospital cardiac arrest, more than doubled from 26% to 56% when paramedics in Mesa, Arizona utilized ZOLL’s CPR feedback technology in combination with scenariobased training. The findings also showed that highquality CPR was associated with significantly improved neurologically intact survival.

A remarkable 56% of witnessed cardiac arrest victims in Mesa survived with good functional outcomes in this study, which used ZOLL’s defibrillators with Real CPR Help®. The GPS-like technology allows rescuers to “see” and receive realtime audiovisual feedback on the quality of their CPR, including the depth and rate of their chest compressions.

“We believe that CPR is the most important factor in cardiac resuscitation. But it’s not just about doing CPR, it’s about doing CPR right,” said study author Ben Bobrow, MD, who is the Medical Director for the Arizona Department of Health Services’ Bureau of EMS and Trauma System and Professor of Emergency Medicine at Maricopa Medical Center, University of Arizona College of Medicine Phoenix.

“The fact that more than twice as many people returned home to their families shows the great importance of CPR quality and the huge potential CPR feedback technology has in improving outcomes from sudden cardiac arrest,” Bobrow added. “These results clearly demonstrate how critical it is to measure CPR quality during each and every cardiac resuscitation.”

ZOLL’s Real CPR Help uses audio and visual prompts to guide the rescuers to the actual depth of 2 inches and rate of 100 chest compressions per minute as recommended in the 2010 American Heart Association (AHA) Guidelines. The Mesa study validates the consensus statement published by AHA this week, of which Dr. Bobrow is a co-author, which recommends the use of some means to measure CPR quality during all resuscitations both inside and outside the hospital.

“Providing consistent, manual CPR is not easy for anyone, even the most experienced rescuer. Manual 46 |AUGUST 2013

CPR without any feedback is often very poor with lots of interruptions and suboptimal compressions.

Using real-time CPR feedback is like having a GPS for resuscitation; it guides the rescuer to where he needs to be and encourages corrections if he goes off course,” said A.J. Heightman, EMT-P, Editor-in-Chief, Journal of Emergency Medical Services.

Results of the Arizona study, which were recently published in the Annals of Emergency Medicine, are the findings of the four-year endeavor called the Arizona Pre-hospital CPR Quality Improvement Project that was undertaken by the Mesa Fire/Medical Department in conjunction with the Save Hearts in Arizona Registry & Education (SHARE) Program.

The analysis included 484 cardiac arrests patients; the median age was 68 years and 66.5% were men.

About Sudden Cardiac Arrest SCA, an abrupt disruption of the heart’s function, which causes a lack of blood flow to vital organs, occurs an estimated 380,000 times each year in the United States and claims more than one million lives globally each year. SCA is the leading cause of unexpected death in the world and often strikes without warning. Survival varies widely among communities, yet overall averages around 8% in the U.S. Implementing a system of care including early recognition, 9-1-1, CPR instructions, early defibrillation, and high-quality professional CPR, along with guideline-based, post-arrest care could save as many as half of these victims.

About ZOLL Medical Corporation ZOLL Medical Corporation (zoll.com), an Asahi Kasei Group company, develops and markets medical devices and software solutions that help advance emergency care and save lives, while increasing clinical and operational efficiencies. With products for defibrillation and monitoring, circulation and CPR feedback, data management, fluid resuscitation, and therapeutic temperature management, ZOLL provides a comprehensive set of technologies that help clinicians, EMS and fire professionals, and lay rescuers treat victims needing resuscitation and critical care.

Source: http://www.newswiretoday.com/news/130752/

features

CODEHEART VIDEO APP COULD REVOLUTIONIZE PREHOSPITAL MEDICINE

By James Careless EMSWorld.com 48 | AUGUST 2013

CodeHeart app allows users to shoot high-quality video of charts, instruments, patients or indeed anything else that is relevant to a medical diagnosis.

CodeHeart is the name of a wireless app that allows physicians to see ECG and other EMS instrument read-outs in real-time, using live video transmitted over secure cellular telephone channels. The app, which was developed by cardiologists at Washington Hospital Center working with AT&T, is designed to improve heart attack diagnoses in the field. But the technology that underlies could be adapted to serve all aspects of medical treatment by EMS providers on location and experts in remote locations. In fact, such is the scope of CodeHeart, that it literally could revolutionize the administration of first response medical care.

time. As well, older smartphones didn’t provide enough visual resolution to make their charts easy to read.

The second hurdle was security: Sending patient records by wireless video is not secure in itself, and is by no means HIPAA compliant. (The HIPAA Act of 1996 lays out privacy standards for protecting patient medical information. Sending it by conventional cellular channels is not allowed.)

Finally, just getting the CodeHeart concept to work was a challenge in itself. “This is why we joined with AT&T, who helped us tremendously in meeting the various challenges encountered,” says Satler.

Genesis

Today’s Version, and What It Means for EMS

CodeHeart was borne out of a desire to get ECG and other readings to physicians quickly says Dr. Lowell Satler, director of interventional cardiology at Washington Hospital Center, and one of the driving forces behind the app’s development.

“It has been the practice to fax ECG readouts to remote specialists from ER rooms,” Satler told EMS World during an online Webex videoconference, during which he demonstrated the CodeHeart app. “The trouble is that this can take up to 10 minutes to send.

Given that camera-equipped mobile phones are everywhere, it made sense to see if such information could be sent live by cameraphone: Just hold it up, shoot the chart and then send it in for quicker diagnosis and response.”

On paper, this sounds simple, but there were a number of hurdles that had to be cleared to make CodeHeart possible. The first was the technology: It has taken a while for cellular data rates to achieve the necessary speeds to send high resolution video in real-

Today, the CodeHeart app meets all necessary speed and privacy standards.

Whether used on a smartphone or loaded onto a tablet or personal computer, the app allows users to shoot high-quality video of charts, instruments, patients or indeed anything else that is relevant to a medical diagnosis. Moreover, people at both ends of the transmission can consult in real-time about what is being sent. Finally, the CodeHeart content is automatically archived by the system, so that the video can be reviewed after the fact as required for follow-up and training purposes.

Based on the examples Dr. Satler showed to EMS World, the CodeHeart video app is robust, highly detailed and extremely flexible. Meanwhile, the system’s automatic archiving function is both medically and legally useful.

“Currently we are just starting to get CodeHeart into the field,” says Satler.

“There’s still some reluctance by some EMS organizations to use it, simply

because they are leery of how new it is. But I have no doubt that, in a few short years, CodeHeart apps will be in widespread use across North America, if not the world.”

In saying this, Dr. Satler is vastly understating CodeHeart’s possibilities.

The reason: CodeHeart is a video app that turns every smartphone, wireless-connected tablet and laptop (CodeHeart works over WiFi as well as cellular) into a real-time telemedicine terminal.

Consider the possibilities: With this app installed, every first responder will be able to link medical experts to emergency cases anywhere in the world, using real-time voice, video and data. Members of the public providing first aid will be able to provide this service as well.

Moreover, because CodeHeart runs on consumer-grade technology and cellular networks, using it does not require substantial purchases of proprietary videoconferencing technology. This puts telemedical support within the reach of the smallest, most remote and least equipped first responders.

In this sense, CodeHeart is the ‘missing link’ between EMS in the field and the world’s most knowledgeable, best-equipped medical professionals.

This is why this app will have uses far beyond its original intent, and why Dr. Satler and his team will one day be included among the medical greats of history.  James Careless is a freelance writer with extensive experience covering computer technologies.

Source: http://www.emsworld. com/article/10627550/productreview-codeheart-video-app-couldrevolutionize-prehospital-medicine MEDMONTHLY.COM |49

the arts

Art Searching to the Heart

By

Laura Maaske is a gifted medical illustrator who has been a featured writer in Med Monthly for the past year, with several very informative articles on visual applications for medical practices, patients, and students. She has written articles on apps for women’s health, dental, medical education, and health care practices, to name a few. In this month’s issue she shares with us her personal journey and insights into the profession of medical illustration and her vision for the future, combining science and art.

50 | AUGUST 2013

When I tell people I am a medical illustrator, I might hear a response such as, “I didn’t know there was such a specialized profession,” or, “where do you find enough work for that?” For me, though, being in the middle of it, I rarely feel a sense of specialization or obscurity.

There is a broad reach to the edges of science and of art.

It’s a stretch and a wonderment at how I might possibly capture both, to think like an artist and to think like a scientist, in one reach. Continuing in my practice, this reach becomes broader with time, at both edges.

Laura’s Website - www.medimagery.com

Science is Beautiful and Art is Process While I had always loved art, as a child, it occurred to me only as something for fun. The scientific method is a remarkable process, and I discovered its power in those early years. In a world where so many people had so many ideas, I had deep admiration for a process that might offer consistent and repeatable answers when nothing else could.

At the end of a great venture in careful methodical evaluation and observation, there might be a truth worth sharing with others, a truth worth claiming, “This is for us all.” “Objectivity” is the aim there, the hopeful claim, and it reaches everything we know, everything but the heart.

But as individuals, relating in our lives and relating to people, we rarely believe in this. We hold to our hearts.

We, in fact, hold few truths to be self-evident. Particularly, when we are standing with art, we will say, “Truth is subjective.” But although this truth is not provable or repeatable, when we pursue it we find at the heart of it who we are. There is self-expression and the source of bring the self into the world. And this is often enough, truth enough.

In the early years before college, I knew biology, life science was what I would explore, in my future. I enjoyed it so much in college years that I had almost abandoned my love of art altogether.

But then a visit, as a college senior, to the University of Toronto, I discovered incredible work in the hallways by artists like Ian Suk, Stephen Gilbert, Eilla Hoppa Ross, and David Mazierski. Their art opened the door to a new world, where I could explore art and science at the same time. It hadn’t even occurred to me that I could have both. And I didn’t realize either what a great challenge it would be to

hold both science and art in my everyday work. But I knew immediately that this is what I wanted to do. I enrolled in courses at the Toronto School of Art to build a portfolio, and I applied to the Biomedical Communications program at University of Toronto.

The love of science was making way to offer a mixture of both. I thought of it more narrowly then. I thought of an illustrator as someone who did work others needed. I did not think of an illustrator so much as an artist who is revealing their own heart in their work. If I had observed the work of other masters more closely, if I had seen more there, I would have understood that for them, scientific and medical illustration was revealing the deeper truths, just as any art is capable to do.

As a medical illustrator, I wrap myself around both these ends, ends of a string concerned with truth. I care as much about objective truths as subjective truths. I am pushing, in myself, to understand both ends.

Medical illustration students take their first year or two of coursework with the medical students. When I began to draw what we had seen in the microscope or in the dissecting room, I cared about reality. And yet, we knew as students we were performing something beyond reality.

We learned to offer what the non-selective eye of the camera cannot offer. We cross lines to create focal points, we vignette to de-emphasize the outlying tissues or the background ephemera. We warm up the tones to bring objects forward. continued on page 52 MEDMONTHLY.COM |51

continued from page 47

But then we take another step, a step I didn’t want to accept when I was a student. We create a world of our own.

When I was a student, I believed in the body as an ideal, even in the “reality” of a disease state. I painted it that way.

I didn’t even realize I was painting a belief about the world.

In recent years, I have moved beyond my simple fascination with physical processes to a recognition of the beauty in the structure itself. What is the state of the body telling me and what should I reveal about that when I draw or paint it? If I am drawing a surgical scene, there is a process there. The surgeon is making a repair. But even as the repair is occurring, there is a deliberate break-down of tissues as vessels, nerves and connective tissues are severed.

As a younger artist, I overlooked this. I drew the surgical scene in its more pristine ideal. More recently, though, it is important to me that the subtlety of this change should not be ignored in representing the events unfolding.

Science cares about the truth. But so does the artist.

One searches outside, for something universal. The other searches inside, for something real to the heart.

As a master’s student, I explored interactivity in medical education and health promotion. Digital learning offers so much more now than it did then. I see the iPad as a revolutionary device. It’s more personal than the computer.

It is responsive. It offers depth and a tactile experience which takes us beyond any book. With time it will become thinner and lighter and there will be more and more 52 | AUGUST 2013

resources there at our fingertips, in our pockets and always at hands reach. Expectations from us as learners for deeply revealing visual information will be highly demanding.

Medical students are already making this transition. And for me, as a medical illustrator, exploring this, it is the most exciting time of my life. 

Laura Maaske is a medical illustrator with a Master’s of Science degree in Biomedical Visualization from the University of Toronto. She launched Medimagery in 1997, specializing in the creation of patient education materials, interactive media, e-books, cellular and molecular illustrations, and design of medical education materials. Her art has been published in the Journal of Biocommunication and the University of Toronto Medical Journal.

She is a member of the Association of Medical Illustrators, AMI. For more information, please visit Medimagery.com, or send a note to Laura@medimagery.com or call 262.308.1300.

Laura is also accomplished in sumi-e as illustrated on the right

Medimagery Medical Illustration & Design info@medimagery.com http://www.medimagery.com/ http://www.linkedin.com/in/lauramaaske http://twitter.com/#!/Medimagery http://www.facebook.com/Medimagery http://www.facebook.com/laura.maaske http://medillsb.com/ArtistPortfolioThumbs. aspx?AID=4115 MEDMONTHLY.COM |53

healthy living

Chocolate Chia Pudding Servings: 2 servings

Ingredients:

By Ashley Acornley, MS, RD, LDN

• 1 cup unsweetened non-dairy milk (soymilk, almond milk) • 1 tsp vanilla extract • 2 teaspoons cocoa powder • sweetener of choice, to taste (stevia, agave) • 3 tablespoons chia seeds • 1/2 to 1 cup raspberries, cherries, or other fruit, plus additional for garnish

Nutritional Facts: Preparation: 1. Place the milk, vanilla, and cocoa into the blender and add sweetener to taste (about 2 servings worth). Blend until cocoa is completely incorporated.

2. Pour milk mixture into a bowl and add the chia seeds. Stir well, making sure that all the seeds are moistened. Leave out on the counter and stir periodically (about every 15 minutes or so), breaking up any clusters that form. Allow it to stand until the pudding has thickened and all liquid has been absorbed, at least an hour.

3. Refrigerate. Just before serving, stir in fruit. Serve topped with additional fruit.

Preparation time: 5 minute(s) | Cooking (standing) time: 1 hour(s)

54 | AUGUST 2013

Per Serving

123 calories 52 calories from fat 6.2g total fat 0mg cholesterol 17.9mg sodium, 243.3mg potassium 12.2g carbohydrates 8.8g fiber 2g sugar 7g protein

U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.dced.state.ak.us/occ/pdop.htm

Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 www2.state.id.us/dhw

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 www.obo.state.or.us

Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov

Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296 http://bod.ky.gov

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847

Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339 http://1.usa.gov/zbJVt7

Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 http://sos.ri.gov/govdirectory/index.php? page=DetailDeptAgency&eid=260

California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 www.medbd.ca.gov Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 http://www.dora.state.co.us/optometry/ Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.dph.state.ct.us/ Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 doh.state.fl.us Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 www.sos.state.ga.us Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 optician@dcca.hawaii.gov

Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 http://nvbdo.state.nv.us/ New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 www.state.nh.us New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 http://www.njconsumeraffairs.gov/ ophth/ New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944 http://www.op.nysed.gov/prof/od/ North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 http://www.ncoptometry.org/ Ohio 77 S. High St. Columbus, OH 43266 (614)466-9707 http://optical.ohio.gov/

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 http://health.state.tn.us/boards/do/ Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 www.roatx.org Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 http://vtprofessionals.org/opr1/ opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 www.state.va.us/licenses Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/LicensesPermitsand Certificates/ProfessionsNewReneworUpdate/DispensingOptician.aspx

MEDMONTHLY.COM |55

U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 http://bit.ly/uaqEO8 Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 http://www.dora.state.co.us/dental/ Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://bit.ly/w1m4MI 56 | AUGUST 2013

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 http://sos.georgia.gov/plb/dentistry/ Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://1.usa.gov/s5Ry9i Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://bit.ly/svi6Od Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 http://www.state.ia.us/dentalboard/ Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 http://www.accesskansas.org/kdb/ Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 http://dentistry.ky.gov/ Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574 http://www.lsbd.org/

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/ dentist/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd.

P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 http://pr.mo.gov/dental.asp Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 http://bsd.dli.mt.gov/license/bsd_ boards/den_board/board_page.asp

Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 http://dhhs.ne.gov/publichealth/Pages/ crl_medical_dent_hygiene_board.aspx

Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580 http://www.dental.ohio.gov/

Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044 http://www.nvdentalboard.nv.gov/

Oklahoma 201 N.E. 38th Terr., #2 Oklahoma City, OK 73105 (405)524-9037 http://www.dentist.state.ok.us/

New Hampshire 2 Industrial Park Dr. Concord, NH 03301 (603)271-4561 http://www.nh.gov/dental/

Oregon 1600 SW 4th Ave. Suite 770 Portland, OR 97201 (971)673-3200 http://www.oregon.gov/Dentistry/

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405 http://bit.ly/uO2tLg

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://bit.ly/s5oYiS

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://www.rld.state.nm.us/boards/Dental_Health_Care.aspx

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB

New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/

North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/

South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/

North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/

Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://health.state.tn.us/boards/dentistry/

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/ Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp MEDMONTHLY.COM |57

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://www.dchealth.dc.gov/doh 58 | AUGUST 2013

Florida 2585 Merchants Row Blvd.

Tallahassee, FL 32399 (850)245-4444 http://www.stateofflorida.com/Portal/ DesktopDefault.aspx?tabid=115

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820 http://www.lsbme.la.gov/

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913 http://bit.ly/vPJQyG

Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601 http://bit.ly/hnrzp

Hawaii DCCA-PVL P.O. Box 3469 Honolulu, HI 96801 (808)587-3295 http://hawaii.gov/dcca/pvl/boards/medical/

Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777 http://www.mbp.state.md.us/

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000 http://bit.ly/orPmFU

Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200 http://www.mass.gov/eohhs/gov/departments/borim/

Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820 http://www.idfpr.com/profs/info/Physicians.asp

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27541-58914-,00.html

Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 (317)233-0800 http://www.in.gov/pla/ Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 (515)281-6641 http://medicalboard.iowa.gov/ Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 (785)296-7413 http://www.ksbha.org/ Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY 40222 (502)429-7150 http://kbml.ky.gov/default.htm

Minnesota University Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 http://www.msbml.state.ms.us/ Missouri Missouri Division of Professional Registration 3605 Missouri Blvd.

P.O. Box 1335 Jefferson City, MO 65102 (573)751-0293 http://pr.mo.gov/healingarts.asp

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bit.ly/obJm7J p

North Dakota 418 E. Broadway Ave., Suite 12 Bismarck, ND 58501 (701)328-6500 http://www.ndbomex.com/

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010 http://bit.ly/rFyCEW

Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 http://www.mdpreferredservices.com/ state-licensing-boards/nebraska-boardof-medicine-and-surgery

Ohio 30 E. Broad St., 3rd Floor Columbus, OH 43215 (614)466-3934 http://med.ohio.gov/

Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628 http://www.dopl.utah.gov/

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh

Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/

Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK

Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://bit.ly/w5rc8J New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://www.dos.state.pa.us/portal/server. pt/community/state_board_of_medicine/12512 Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 http://1.usa.gov/xgocXV South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 http://www.llr.state.sc.us/pol/medical/ South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 http://www.sdbmoe.gov/ Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111 http://health.state.tn.us/boards/me/

Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.medlicense.com/washingtonmedicallicense.html West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 http://www.wvbom.wv.gov/ Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 http://drl.wi.gov/board_detail. asp?boardid=35&locid=0 Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

MEDMONTHLY.COM | 59

medical resource guide ACCOUNTING

Ajishra Technology Support

Boyle CPA, PLLC 3716 National Drive, Suite 206 Raleigh, NC 27612 (919) 720-4970 www.boyle-cpa.com

ADVERTISING

PO Box 15130 Scottsdale, AZ 85267 (602)370-0303 www.findurgentcare.com

MedMedia9

www.medmedia9.com

Ring Ring LLC

6881 Maple Creek Blvd, Suite 100 West Bloomfield, MI 48322-4559 (248)819-6838 www.ringringllc.com

ANSWERING SERVICES Corridor Medical Answering Service

3088 Route 27, Suite 7 Kendall Park, NJ 08824 (866)447-5154 www.corridoranswering.net

Docs on Hold

14849 West 95th St. Lenexa, KS 66285 (913)559-3666 www.soundproductsinc.com

BILLING & COLLECTION Advanced Physician Billing, LLC

PO Box 730 Fishers, IN 46038 (866)459-4579 www.advancedphysicianbillingllc.com

60 | AUGUST 2013

Applied Medical Services 4220 NC Hwy 55, Suite 130B Durham, NC 27713 (919)477-5152 www.ams-nc.com

Sweans Technologies 501 Silverside Rd. Wilmington, DE 19809 (302)351-3690 www.medisweans.com

VIP Billing

PO Box 1350 Forney, TX 75126 (214)499-3440 www.vipbilling.com

Axiom Business Solutions

Find Urgent Care

PO Box 98313 Raleigh, NC 27624 (919)747-9031

3562 Habersham at Northlake, Bldg J Tucker, GA 30084 (866)473-0011 www.ajishra.com

4704 E. Trindle Rd. Mechanicsburg, PA 17050 (866)517-0466 www.axiom-biz.com

Frost Arnett 480 James Robertson Parkway Nashville, TN 37219 (800)264-7156 www.frostarnett.com

CAREER CONSULTING Doctor’s Crossing 4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545 http://doctorscrossing.com/

Gold Key Credit, Inc. PO Box 15670 Brooksville, FL 34604 888-717-9615 www.goldkeycreditinc.com

Horizon Billing Specialists 4635 44th St., Suite C150 Kentwood, MI 49512 (800)378-9991 www.horizonbilling.com

CODING SPECIALISTS The Coding Institute LLC 2222 Sedwick Drive Durham, NC 27713 (800)508-2582 http://www.codinginstitute.com/

Management Services On-Call 200 Timber Hill Place, Suite 221 Chapel Hill, NC 27514 (866)347-0001 www.msocgroup.com

Marina Medical Billing Service 18000 Studebaker Road 4th Floor Cerritos, CA 90703 (800)287-8166 www.marinabilling.com

Mediserv 6451 Brentwood Stair Rd. Ft. Worth, TX 76112 (800)378-4134 www.mediservltd.com

Practice Velocity 1673 Belvidere Road Belvidere, IL 61008 (888)357-4209 www.practicevelocity.com

COMPUTER, SOFTWARE American Medical Software

1180 Illinois 157 Edwardsville, IL 62025 (618) 692-1300 www.americanmedical.com

CDWG

300 N. Milwaukee Ave Vernon Hills, IL 60061 (866)782-4239 www.cdwg.com/

Instant Medical History

4840 Forest Drive #349 Columbia, SC 29206 (803)796-7980 www.medicalhistory.com

medical resource guide CONSULTING SERVICES, PRACTICE MANAGEMENT

Dental Management Club

4924 Balboa Blvd #460 Encino, CA 91316 www.dentalmanagementclub.com

2600 Garden Rd. #112 Monterey, CA 93940 (800)458-2486 www.integritas.com

The Dental Box Company, Inc.

Medical Credentialing

(800) 4-THRIVE www.medicalcredentialing.org

PO Box 101430 Pittsburgh, PA 15237 (412)364-8712

www.thedentalbox.com

Medical Practice Listings

8317 Six Forks Rd. Suite #205 Raleigh, NC 27624 (919)848-4202 www.medicalpracticelistings.com

DIETICIAN

myEMRchoice.com

24 Cherry Lane Doylestown, PA 18901 (888)348-1170 www.myemrchoice.com

Physician Wellness Services 5000 West 36th Street, Suite 240 Minneapolis, MN 55416 888.892.3861 www.physicianwellnessservices.com

Synapse Medical Management

18436 Hawthorne Blvd. #201 Torrance, CA 90504 (310)895-7143 www.synapsemgmt.com

Urgent Care America

17595 S. Tamiami Trail Fort Meyers, FL 33908 (239)415-3222 www.urgentcareamerica.com

Urgent Care & Occupational Medicine Consultant

Triangle Nutrition Therapy 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 (919)876-9779 http://trianglediet.com/

ELECTRONIC MED. RECORDS ABELSoft 1207 Delaware Ave. #433 Buffalo, NY 14209 (800)267-2235 www.abelmedicalsoftware.com

Acentec, Inc 17815 Sky Park Circle , Suite J Irvine, CA 92614 (949)474-7774 www.acentec.com

Lawrence Earl, MD COO/CMO ASAP Urgentcare Medical Director, NADME.org 908-635-4775 (m) 866-405-4770 (f ) ASAP-Urgentcare.com UrgentCareMentor.com

AdvancedMD

Utilization Solutions

201 E. Pine St. #1310 Orlando, FL 32801 (888)348-8457 www.collaboratemd.com

service@pushpa.biz (919) 289-9126

www.pushpa.biz

10011 S. Centennial Pkwy Sandy, UT 84070 (800) 825-0224 www.advancedmd.com

CollaborateMD

DocuTAP

DENTAL Biomet 3i

Integritas, Inc.

4555 Riverside Dr. Palm Beach Gardens, FL 33410 (800)342-5454 www.biomet3i.com

4701 W. Research Dr. #102 Sioux Falls, SD 57107-1312 (877)697-4696 www.docutap.com

EQUIPMENT APPRAISER Brumbaugh Appraisals 8601 Six Forks Road, Suite 400, Raleigh, NC 27615 (919) 870-8258 www.brumbaughappraisals.com

FINANCIAL CONSULTANTS Sigmon Daknis Wealth Management 701 Town Center Dr. , Ste. #104 Newport News, VA 23606 (757)223-5902 www.sigmondaknis.com

Sigmon & Daknis Williamsburg, VA Office 325 McLaws Circle, Suite 2 Williamsburg, VA 23185 (757)258-1063 http://www.sigmondaknis.com/

INSURANCE, MED. LIABILITY Aquesta Insurance Services, Inc.

Michael W. Robertson 3807 Peachtree Avenue, #103 Wilmington, NC 28403 Work: (910) 794-6103 Cell: (910) 777-8918 www.aquestainsurance.com

Medical Protective

5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776 http://www.medpro.com/ medical-protective

MGIS, Inc.

1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447 www.mgis.com

MEDMONTHLY.COM | 61

medical resource guide INSURANCE, MED. LIABILITY

Nicholas Down http://bit.ly/yHwxb0

Martin Fried

www.martindfried.com

Professional Medical Insurance Services

16800 Greenspoint Park Drive Houston, TX 77060 (877)583-5510 www.promedins.com

Wood Insurance Group

4835 East Cactus Rd., #440 Scottsdale, AZ 85254-3544 (602)230-8200 www.woodinsurancegroup.com

LOCUM TENENS Physician Solutions

PO Box 98313 Raleigh, NC 27624 (919)845-0054 www.physiciansolutions.com

Bank of America

Barry Hanshaw 18 Bay Path Drive Boylston MA 01505 508 - 869 - 6038 JHans76271@aol.com www.barryhanshaw.com

MMA Medical Architects

520 Sutter Street San Francisco, CA 94115 (415) 346-9990 http://www.mmamedarc.com

Laura Maask 262-308-1300 Laura@medimagery.com

medimagery.com

Marianne Mitchell (215)704-3188 http://www.mariannemitchell.com http://www.colordrop.blogspot.com

MEDICAL EQUIPMENT

1295 Walt Whitman Road Melville, NY 11747 (888)862-4050 www.allproimaging.com

Biosite, Inc

9975 Summers Ridge Road San Diego, CA 92121 (858)805-8378

www.artisanprinter.com

Deborah Brenner

877 Island Ave #315 San Diego, CA 92101 (619)818-4714 www.deborahbrenner.com

800 Shoreline, #900 Corpus Christi, TX 78401 (888)246-3928

www.cryopen.com

Pia De Girolamo

62 | AUGUST 2013

www.piadegirolamo.com

391 Technology Way Winston Salem, NC 27101 (336)722-8910 www.carolinachemistries.com

Robert Sayre Marketing Adviser/Business Coach http://www.linkedin.com/pub/robsayre/2/977/355/

MedMedia9

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com

WhiteCoat Designs

Web, Print & Marketing Solutions for Doctors (919)714-9885 www.whitecoat-designs.com

www.dicomsolutions.com

Tarheel Physicians Supply 1934 Colwell Ave. Wilmington, NC 28403 (800)672-0441

Medical Practice Listings

8317 Six Forks Rd. Ste #205 Raleigh, NC 27624 (919)848-4202 www.medicalpracticelistings.com

MEDICAL PRACTICE VALUATIONS

Dicom Solutions 548 Wald Irvine, CA 92618 (800)377-2617

High Performance Network

MEDICAL PRACTICE SALES

Carolina Liquid Chemistries, Inc. Brian Allen

MEDICAL MARKETING

www.biosite.com

Cryopen

MEDICAL ART

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193 mark.mackinnon@bankofamerica.com www.bankofamerica.com/practicesolutions

MedImagery

ALLPRO Imaging

MEDICAL ARCHITECTS

MEDICAL EQUIPMENT FINANCING

www.thetps.com

BizScore

PO Box 99488 Raleigh, NC 27624 (919)846-4747 www.bizscorevaluation.com

medical resource guide

MEDICAL PUBLISHING

PRACTICE FINANCING Bank of America

Greenbranch Publishing

info@greenbranch.com 800-933-3711 www.greenbranch.com

MEDICAL RESEARCH

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193 mark.mackinnon@bankofamerica.com www.bankofamerica.com/practicesolutions

CNF Medical 1100 Patterson Avenue Winston Salem, NC 27101 (877)631-3077 www.cnfmedical.com

Dermabond

Ethicon, Route 22 West Somerville, NJ 08876 (877)984-4266 www.dermabond.com

DJO

1430 Decision St. Vista, CA 92081 (760)727-1280

REAL ESTATE

www.djoglobal.com

Arup Laboratories

500 Chipeta Way Salt Lake City, UT 84108 (800)242-2787

www.aruplab.com

Chimerix, Inc. 2505 Meridian Parkway, Suite 340 Durham, NC 27713 (919) 806-1074 www.chimerix.com Clinical Reference Laboratory 8433 Quivira Rd. Lenexa, KS 66215 (800)445-6917

www.crlcorp.com

Sanofi US

55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491

Scynexis, Inc.

ExpertMed

York Properties, Inc.

www.sanofi.us

Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350 Commercial Sales & Leasing (919) 821-7177 www.yorkproperties.com

STAFFING COMPANIES Additional Staffing Group, Inc. 8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601 Astaffinggroup.com

31778 Enterprise Dr. Livonia, MI 48150 (800)447-5050

www.expertmed.com

Gebauer Company

4444 East 153rd St. Cleveland, OH 44128-2955 (216)581-3030 www.gebauerspainease.com

Scarguard

15 Barstow Rd. Great Neck, NY 11021 (877)566-5935 www.scarguard.com

WEBSITE DESIGN

SUPPLIES, GENERAL

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28209 (800)552-1157 www.bsnmedical.us

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com

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classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina GP Needed Immediately On-Going 3 Days Per Week at Occupational Clinic . General Practictioner needed on-going 3 days per week at occupational clinic in Greensboro, NC. Numerous available shifts for October.

Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com 3-5 days per week in Durham, NC . Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina. General Practitioner with a knowledge or interest in addictive disease.

Needed in October on-going 1-3 times per week. This clinic requires training so respond to post before October 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Primary Care Physician in Northwest NC (multiple locations). Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm.

Outpatient only. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

64| AUGUST 2013

Immediate need for full time GP/FP for urgent cares in eastern NC. Urgent care centers from Raleigh to the eastern coast of NC seek immediate primary care physician. Full time opportunity with possibility for permanent placement. Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com General Practitioner Needed in Greensboro. Occupational health care clinic seeks general practitioner for disability physicals ongoing 1-3 days a week. Adults only. 8 am-5 pm. No call required. Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail. com Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC. Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/on-going/full-time.

The chosen physician will need to be credentialed through the hospital, please email your CV, medical license and DEA so we can fill this position immediately. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com County Health Department in Fayetteville, NC seeks GP/IM/FP Full-Time, On-Going Shifts. GP/IM/FP Needed Immediately at County Health Department in Fayetteville, NC. Approximately 20 patients per day with hours from 8 am -5 pm. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com Occupational Clinic in Greensboro, NC seeks FP/GP for On-Going Shifts. Locum tenens position (4-5 days a week) available for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8 am-5 pm. Approximately 20 patients/ day. Excellent staff. Outpatient only. physiciansolutions@gmail.com Diabetic Clinic 1 hour from Charlotte seeks FP/GP/ IM for On-Going Shifts.Primary care physician needed immediately for outpatient diabetic clinic one hour outside Charlotte, NC On-going. Hours are 8 am -5 pm with no call. Approximately 15-20 patients a day. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing. A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. email: physiciansolutions@gmail.com

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Addictive Disease Clinic in Charlotte, NC and surrounding cities seeks GP/FP/IM for on-going shifts An addictive disease clinic with locations with locations in Charlotte, NC and surrounding cities seeks a GP with an interest in addictive medicine for on-going shifts. This clinic has 15-25 open shifts every month and we are looking to bring on a new doctor for consistent coverage. The average daily patient load is between 20 and 25 with shifts from 8 am - 5 pm and 6 am - 2 pm. If you are interested in this position please send us your CV and feel free to contact us via email or phone with questions or to learn about other positions.

Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com Child Health Clinic in Statesville, NC seeks pediatrician or Family Physician comfortable with peds for on-going, full-time shifts. Physician will work M-F 8 am - 5 pm, ongoing. Qualified physician will know EMR or Allscripts software. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk. Health Department pediatrics clinic 45 min from Raleigh needs coverage 4 days a week from January through June. Provider will see about 20 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-8450054 or emailphysiciansolutions@gmail.com.

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in January. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com FT Mid-Level Provider needed for Wilmington practice immediately. Small private practice 45 minutes outside Wilmington seeks mid-level provider starting January.

M-F 8:00-5:00, PT or FT. This practice also is looking for a PA permanently in April. Accommodations, PLI, and mileage provided. Please contact Physician Solutions at 919-845-0054 or emailphysiciansolutions@gmail.com.

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in March.

Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Call or email for more information, 919-845-0054 or physiciansolutions@ gmail.com FT/PT Mid-Level Provider needed for Wilmington practice immediately. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8:00-5:00.

Possible permanent placement. Call or email for more information. 919-845-0054 physiciansolutions@gmail. com Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or emailphysiciansolutions@gmail.com.

Asheboro Family Practice and Urgent Care seeks GP for intermittent coverage. Family Practice and Urgent Care seeks general practitioner for intermittent days beginning in March from 8a-8p. Provider will see about 35 patients with no call. Please contact Physician Solutions at 919-845-0054 or emailphysiciansolutions@gmail.com.

Greensboro occupational health care clinic seeksgeneral practitioner for intermittent shifts. Primary care physicians needed for occupational medicine. Adults only. Hours are 8am-5pm. Large corporation, no call required. Please contact Physician Solutions at 919-8450054 or emailphysiciansolutions@gmail.com.

IM/FP needed in Fayetteville health department immediately. Fayetteville health department needs coverage March through June full or part time. Clinics are adult health and women’s health. Adults only. No call 8a-5p. Please contact Physician Solutions at 919845-0054 or emailphysiciansolutions@gmail.com.

continued on page 67 MEDMONTHLY.COM |65

Woman’s Practice in Raleigh, North Carolina.

NC OPPORTUNITIES LOCUMS OR PERMANENT

We have a established woman’s practice in the Raleigh North Carolina area that is available for purchase. Grossing a consistent $800,000.00 per year, the retained earnings are impressive to say the least. This is a two provider practice that see patients Monday through Friday from 8 till 6. This free standing practice is very visible and located in the heart of medical community. There are 7 well appointed exam rooms, recently upgraded computer (EMR), the carpet and paint have always been maintained. The all brick building can be leased or purchased.

Physician Solutions has immediate opportunities for psychiatrists throughout NC. Top wages, professional liability insurance and accommodations provided.

Call us today if you are available for a few days a month, on-going or for permanent placement.

Please contact Physican Solutions at 919-845-0054 or physiciansolutions@gmail.com For more information about Physician Solutions or to see all of our locums and permanent listings, please visit physiciansolutions.com

Contact Cara or Philip for details regarding this very successful practice.

Medical Practice Listings; 919-848-4202

PRIMARY CARE PRACTICE East of Raleigh, North Carolina We are offering a well established primary care practice only minutes east of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day.

Currently operating on paper charts, there is no EMR in place. The Gross revenue is about $235,000 yearly.

We are offering this practice for $130,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased.

Contact Cara or Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician.

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202

classified listings

Classified

continued from page 65

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Geriatric physician needed immediately 2 to 5 days per week, on-going eastern NC. Nursing homes in Durham, Fayetteville and Rocky Mount seek GP/IM/ FP with geriatric experience to work full or part time.

Nursing home focuses on therapy and nursing after patients are released from the hospital. 8a-5p, no call.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Nursing home in Durham seeks PT/FT NP/PA for immediate ongoing scheduling. Durham nursing home seeks part time or full time mid-level for ongoing locums.

Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

COLUMBUS IM FT/PT Mid-Level Provider needed for practice near Wilmington. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8-5p. Possible permanent placement. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Fayetteville occupational health care clinic seeks GP for May 5-9. Primary care physicians needed for occupational medicine. Adults only. 8-5p. Large corporation, no call required. Intermittent dates in the future and second office in Greensboro with ongoing scheduling. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Health Dept 45 min NE of Raleigh seeks MD coverage Tues/Thurs ongoing May 14. GP/FP/IM/Peds doctor needed for the following clinics in Louisburg: Adult, Family Planning, Peds, STD for ongoing scheduling or intermittent shifts. 8-5p.Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail. com.

Community Health Dept in Washington, NC (1 h 45 min E of Raleigh) seeks FP for coverage June 15 FT/PT ongoing. Family practitioner sought for eastern Carolina community health center in Washington, NC. Must see all ages, 8-5p. Start June 15 ongoing. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Nursing home in Durham seeks PT/FT Geriatrics doctor for immediate ongoing scheduling. Durham nursing home seeks part time or full time MD for ongoing locums. Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practice 1 h SE of Raleigh seeks July 6-7 coverage. Goldsboro FP seeks MD for July 6-7 and intermittent shifts. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Pediatric clinic near Greensboro needs 10 weeks of 3 day a week coverage beginning June 1. Burlington pediatric clinic seeks coverage June 1 3 days a week for 10 weeks. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Greenville Clinic seeks GP May 20-22. GP/IM needed for May 20-22 and intermittent shifts. Must have experience or be willing to do pain management and trigger point injections. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@ gmail.com.

Raleigh practice seeks BC FP for permanent placement in new facility summer 2013. Board Certified Family Practitioner sought for FT permanent placement in new clinic in Raleigh to start summer of 2013.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing . A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

continued on page 68 MEDMONTHLY.COM | 67

classified listings

Classified

continued from page 67

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

IM/FP/Peds needed in Fayetteville health department immediately. Fayetteville health department needs immediate coverage for the following clinics: adult health, women’s health and STD. No call 8a-5p.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Pediatrician Needed MD June-Aug, Burlington NC 3x week for 10 wks starting June 1st, 8-5 Mon-Fri Burlington, NC: located 1 hour west of Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Pediatrician, IM & FP needed, Fayetteville NC Urgent Need for immediate MDs - Pediatrics, Family Practice or Internal Medicine - PT/FT, 8-5 Mon-Fri. Ongoing. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Locum & Permanent MD Needed , Kinston NC Urgent Need for immediate MD placement, 8-5 MonFri. Must be able to do family planning & light maternity, Kinston, NC: 1.5 hours outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

PT MD needed for Occupational practice, Greensboro NC. Urgent need for PT MD to do disability physicals 2-3 days weekly, 8-5, on-going scheduling.

Greensboro, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Permanent Family Practice doctor needed for Summer 2013, Raleigh, NC Need FP/BC MD for June-Sept MonFri , 8-5, New Facility in downtown Raleigh, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Permanent PA or MD needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5, Goldsboro, NC: 1 hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practice MD needed 2-3x/w in July, Goldsboro July 6 & 7 and intermittent dates, 8-5p,Goldsboro, NC 1h SE of Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

68| AUGUST 2013

FULL TIME MD needed for Family Practice in Washington, N.C. Family Practitioner needed for FT MD June 15-Sept 1 on-going Mon- Fri 8-5, Washington, NC, 1 hour 45 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Geriatric Experienced Mid Level or MD, Durham NC Must have geriatric experience, PT/FT, Locations in Durham, Rocky Mount & Fayetteville, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

MD needed for June 6 & intermittent dates, Charlotte N.C. June 6 & Intermittent weekdays, 8-5 in Charlotte, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Physicians needed South Carolina A family and urgent care in Little River, SC seeks an FP/EM physician for 1 to 2 days per week, on-going shifts. The practice is a one-physician facility and is looking for a physician to come in regularly. The practice is small and does not have a large patient load.

The qualified physician will have experience in Family or Emergency medicine. If you have any availability and a SC medical license contact us today and we will do our best to work around your schedule. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Physicians needed Virginia Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com continued on page 70

Hospice Practice Wanted Practice for Sale in South Denver Neurofeedback and Psychological Practice Located in South Denver, Colorado, this practice features high patient volume and high visibility on the internet. Established referral sources, owner (psychologist) has excellent reputation based on 30 years experience in Denver. Private pay and insurances, high-density traffic, beautifully decorated and furnished offices, 378 active and inactive clients, corporate clients, $14,000 physical assets, good parking, near bus and rapid transit housed in a well-maintained medical building.

Live and work in one of the most healthy cities in the U.S.

Hospice Practice wanted in Raleigh/ Durham area of North Carolina.

Medical Practice Listings has a qualified physician buyer that is ready to purchase. If you are considering your hospice practice options, contact us for a confidential discussion regarding your practice.

List Price: $150,000 | Established: 2007 | Location: Colorado For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com

To find out more information call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

FAMILY PRACTICE FOR SALE A beautiful practice located in Seattle, Washington This upscale primary care practice has a boutique look and feel while realizing consistent revenues and patient flow. You will be impressed with the well appointed layout, functionality as well as the organization of this true gem of a practice. Currently accepting over 20 insurance carriers including Aetna, Blue Cross and Blue Shield, Cigna, City of Seattle, Great West and United Healthcare. The astute physician considering this practice will be impressed with the comprehensive collection of computers, office furniture and medical equipment such as Welch Allyn Otoscope, Ritter Autoclave, Spirometer and Moore Medical Exam table.

Physician compensation is consistently in the $200,000 range with upside as you wish. Do not procrastinate; this practice will not be available for long.

List price: $255,000 | Year Established: 2007 | Gross Yearly Income: $380,000

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

classified listings

Classified

continued from page 68

To place a classified ad, call 919.747.9031

Physicians needed

Practice wanted

Virginia

North Carolina

Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from pediatrics to geriatrics, we welcome your inquires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com

Pediatric Practice Wanted in Raleigh, NC Medical Practice Listings has a qualified buyer for a pediatric practice in Raleigh, Cary or surrounding area. If you are retiring, relocating or considering your options as a pediatric practice owner, contact us and review your options. Medical Practice Listings is the leading seller of practices in the US. When you list with us, your practice receives exceptional national, regional and local exposure.

Contact us today at (919) 848-4202.

Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immediately FT/PT for Virginia clinic near Washington DC. 8-5p Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Practice for sale

Nurse Practitioners needed

North Carolina

North Carolina

Primary Care Practice Only Minutes East of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. The Gross revenue is about $235,000 yearly. Contact Cara or Philip at 919 848 4202 or email: medlistings@gmail.com to receive details.

Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte.

8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte.

8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

70 | AUGUST 2013

Family Practice located in Hickory, NC. Well-established and a solid 40 to 55 patients split between an MD and physician assistant. Experienced staff and outstanding medical equipment. Gross revenues average $1,500,000 with strong profits. Monthly practice rent is only $3,000 and the utilities are very reasonable. The practice with all equipment, charts and good will are priced at $625,000.

Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

Classified To place a classified ad, call 919.747.9031

Practice for sale North Carolina (cont.)

Impressive Internal Medicine Practice in Durham, NC: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four wellequipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com Primary Care Practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider.

Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several wellappointed exam rooms throughout. New computers and medical management software add to this modern front desk environment. This practice is being offered for $435,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or send an email to medlistings@gmail.com Internal Medicine Practice located just outside Fayetteville, NC is now being offered. The owning physician is retiring and is willing to continue working for the new owner for a month or two assisting with a smooth transaction. The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accommodates 35 patients per day. You will be hard pressed to find a more beautiful practice that is modern, tastefully decorated and well appointed with vibrant art work. The practice, patient charts, equipment and good will is being offered for $415,000 while the free standing building is being offered for $635,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

Modern Vein Care Practice located in the mountains of NC. Booking seven to 10 procedures per day, you will find this impressive vein practice attractive in many ways.

Housed in the same practice building with an internal medicine, you will enjoy the referrals from this as well as other primary care and specialties in the community. We have this practice listed for $295,000 which includes charts, equipment and good will. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at www.medicalpracticelistings.com

South Carolina Lucrative ENT Practice with room for growth, located three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/thyroid surgery. Room for establishing allergy, cosmetics, laryngology and trans-nasal esophagoscopy. All the organization is done; walk into a ready-made practice as your own boss and make the changes you want, when you want. Physician will to stay on for a smooth transition. Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equipment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@ gmail.com

Washington Family Practice located in Bainbridge Island, WA has recently been listed. Solid patient following and cash flow makes this 17-year-old practice very attractive. Contact Medical Practice Listings for more details. email: medlistings@gmail.com or (919) 848-4202. 

MEDMONTHLY.COM | 71

Primary Care Practice for Sale Hickory, North Carolina

NC MedSpa For Sale MedSpa Located in North Carolina

Established primary care practice in the beautiful foothills of North Carolina The owning physician is retiring, creating an excellent opportunity for a progressive buyer.

There are two full-time physician assistants that see the majority of the patients which averages between 45 to 65 per day.

There is lots of room to grow this already solid practice that has a yearly gross of $1,500,00.

You will be impressed with this modern and highly visible practice.

Call for pricing and details.

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings vist www.medicalpracticelistings.com

We have recently listed a MedSpa in NC This established practice has staff MDs, PAs and nurses to assist patients. Some of the procedures performed include: Botox, Dysport, Restylane, Perian, Juvederm, Radiesse, IPL Photoreju Venation, fractional laser resurfacing as well as customized facials. There are too many procedures to mention in this very upscale practice. The qualified buyer will be impressed with the $900,000 gross revenue. This is a new listing, and we are in the valuation process.

Contact Medical Practice Listings today to discuss the practice details.

For more information call Medical Practice Listings at 919-848-4202 or e-mail medlistings@gmail.com

www.medicalpracticelistings.com

Woman's Practice A vailable for Sale Available for purchase is a beautiful boutique women’s Internal Medicine and Primary Care practice located in the Raleigh area of North Carolina.

The physician owner has truly found a niche specializing in women’s care. Enhanced with female-related outpatient procedures, the average patient per day is 40+. The owner of the practice is an Internal Medicine MD with a Nurse Practitioner working in the practice full time. Modern exam tables, instruments and medical furniture.

Gross Yearly Income: $585,000 | List Price: $365,000

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com

PRACTICE FOR SALE

Comprehensive Ophthalmic and Neuro-Ophthalmic Neuro-Ophthalmic Practice

OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina Well-established practice serving the Greensboro and High Point areas for over 15 years. Five exam rooms that are fully equipped, plus digital X-Ray. Extensive corporate accounts as well as walk-in traffic. Lab equipment includes CBC. The owning MD is retiring, creating an excellent opportunity for a MD to take over an existing patient base and treat 25 plus patients per day from day one. The practice space is 2,375 sq. feet. This is an exceptionally opportunity. Leased equipment includes: X-Ray $835 per month, copier $127 per month, and CBC $200 per month. Call Medical Practice Listings at (919) 848-4202 for more information.

Raleigh North Carolina This is a great opportunity to purchase an established ophthalmic practice in the heart of Raleigh. Locate on a major road with established clients and plenty of room for growth; you will appreciate the upside this practice offers.

This practice performs comprehensive ophthalmic and neuro-ophthalmic exams with diagnosis and treatment of eye disease of all ages.

Surgical procedures include no stitch cataract surgery, laser treatment for glaucoma and diabetic eye disease. This practice offers state-of-the-art equipment and offer you the finest quality optical products with contact lens fitting and follow-up care & frames for all ages.

List Price: $75,000 | Gross Yearly Income: $310,000

Asking price: $385,000

Contact Cara or Philip 919-848-4202 for more information or visit MedicalPracticeListings.com To view more listings visit us online at medicalpracticelistings.com

MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA The perfect opportunity for anyone who wants to purchase an established business. of the oldest Locums companies l Large client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner

Wanted: Urgent Care Practice

l One

Urgent care practice wanted in North Carolina.

Qualified physician is seeking to purchase an established urgent care within 100 miles of Raleigh, North Carolina.

If you are considering retiring, relocations or closing your practice for personal reasons, contact us for a confidential discussion regarding your urgent care. You will receive cash at closing and not be required to carry a note.

Medical Practice Listings Buying and selling made easy

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients.

FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,

Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff.

Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:

evaluation of patient on admission and development of a comprehensive treatment plan, serve on medical staff committees, complete court papers, documentation of patient progress in medical record, education of patients/families, provision of educational groups for patients.

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com

Internal Medicine Practice for Sale Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments.

The average patients per day is 20-25+, and the gross yearly income is $555,000.

Listing Price: $430,000

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com 74 | AUGUST 2013

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

ROANOKE RAPIDS, NC In mid December, a pediatrician or family medicine doctor comfortable with seeing children is needed full time in Roanoke Rapids (1 hour north of Raleigh, NC) until a permanent doctor can be found.

Credentialing at the hospital is necessary.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com

CALLING ALL WRITERS

Pediatrics Practice Wanted Pediatrics practice wanted in NC Considering your options regarding your pediatric practice? We can help.

Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina.

Are you educated in the medical and health care field and looking to showcase your exceptional writing skills?

To become a contributing writer in Med Monthly magazine, contact MedMedia9 at medmedia9@gmail.com

Contact us today to discuss your options confidentially.

Med Monthly

Contact us:

919.747.9031 medmedia9@gmail.com medmonthly.com

Medical Practice Listings Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

Editorial Calendar: Sept. 2013 - The Magic of Referrals l Oct. 2013 - Medical Research

Unfortunately, its motor is inside playing video games.

Kids spend several hours a day playing video games and less than 15 minutes in P.E. Most can’t do two push-ups.

Many are obese, and nearly half exhibit risk factors of heart disease. The American Council on Exercise and major medical organizations consider this situation a national health risk. Continuing budget cutbacks have forced many schools to drop P.E.—in fact, 49 states no longer even require it daily.

You can help. Dust off that bike. Get out the skates.

Swim with your kids. Play catch. Show them exercise is fun and promotes a long, healthy life. And call ACE. Find out more on how you can get these young engines fired up. Then maybe the video games will get dusty.

A Public Service Message brought to you by the American Council on Exercise, a not-for-profit organization committed to the promotion of safe and effective exercise

American Council on Exercise

®

ACE Certified: The Mark of Quality Look for the ACE symbol of excellence in fitness training and education.

For more information, visit our website: www.ACEfitness.org

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ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY

Practice for Sale in Raleigh, NC Primary care practice specializing in women’s care

By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients.

Raleigh, North Carolina The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider. Exceptional cash flow and profit will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several well-appointed exam rooms and beautifully decorated throughout. New computers and medical management software add to this modern front desk environment.

Contact one of our advertising agents and find out how inexpensive yet powerful your ad in Med Monthly can be.

List price: $435,000

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings visit www.medicalpracticelistings.com

medmonthly.com | 919.747.9031

PRIMARY CARE PRACTICE - Hickory, North Carolina This is an outstanding opportunity to acquire one of the most organized and profitable primary care practices in the area. Grossing a million and a half yearly, the principal physician enjoys ordinary practice income of over $300,000 annually.

Hickory is located in the foot-hills of North Carolina and is surrounded by picturesque mountains, lakes, upscale shopping malls and the school systems are excellent. If you are looking for an established practice that runs like a well oiled machine, request more information.

The free standing building that houses this practice is available to purchase or rent with an option. There are 4 exam rooms with a well appointed procedure room. The owning physician works 4 to 5 days per week and there is a full time physician assistant staffed as well.

For the well qualified purchasing physician, the owner may consider some owner-financing. Call us today.

List price: $425,000 | Year Established: 2007 | Gross Yearly Income: $1,500,000

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

Primary Care Practice For Sale Wilmington, NC Established primary care on the coast of North Carolina’s beautiful beaches.

Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients.

Excellent exam room layout, equipment and visibility.

Comfortable seeing children. Needed immediately.

Contact Medical Practice Listings for more information.

Medical Practice Listings

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com

919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com

Adult & pediAtric integrAtive medicine prActice for sAle This Adult and Pediatric Integrative Medicine practice, located in Cary, NC, incorporates the latest conventional and natural therapies for the treatment and prevention of health problems not requiring surgical intervention. It currently provides the following therapeutic modalities: • • • • •

Conventional Medicine Natural and Holistic Medicine Natural Hormone Replacement Therapy Functional Medicine Nutritional Therapy

• • • • • •

Mind-Body Medicine Detoxification Supplements Optimal Weigh Program Preventive Care Wellness Program Diagnostic Testing

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20 Gross Yearly Income: $335,000+ | List Price: $125,000

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com

the top First responders are the primary line of defense when it comes to emergency care.

Let’s take a look at the Top 9 reasons first responders are called.

Reasons

1

CARDIAC-RELATED CONCERNS

Not surprisingly, cardiacrelated calls top the EMS charts. According to the Centers for Disease Control, heart disease caused almost 1 in every 4 deaths in the United States.

78

| AUGUST 2013

People Call First Responders

2

MOTOR VEHICLE ACCIDENTS

Though they’re often lumped into the larger category of traumatic injuries—which includes all bumps, bruises, sprains and breaks, plus anything from falls to collisions and sports injuries—motor vehicle accidents are the number-one cause of death in people under the age of 35.

4 5

3

Breathing problems are a major cause of EMTs providing advanced life support care in the urban environment. Poor air quality, seasonal allergies, mold, dust, and adverse weather such as extreme cold, heat, or humidity can all trigger asthma attacks.

STROKES

Someone in the U.S. dies from a stroke every 3.3 minutes. The same risk factors that affect heart disease come into play. Much like the heart, the blood vessels of the brain are fragile and when poor diet or poor health habits become the norm, those blood vessels can either become blocked, or burst.

BURNS

It is estimated that 1.2 million Americans are burned each year, and that more than 50,000 require hospitalization. Nearly a million a year seek emergency department treatment for burns. Burns also account for roughly 5,000 deaths per year.

7

POISONING

Poisoning is the second leading cause of unintentional injury after motor vehicle traffic (MVT) deaths.

9

RESPIRATORY PROBLEMS

8

6

COLD/FLU/ PNEUMONIA/ SEASONAL ILLNESSES

Another frequent problem paramedics encounter is cold, cough, and flu-like symptoms, particularly when symptoms worsen into problems like bronchitis and pneumonia. These illnesses and associated breathing problems made up the largest percentage of patients that paramedics see.

OVERDOSES

For many decades, the overwhelming majority of U.S. overdose deaths were men killed by heroin or cocaine.

But by 2010, 40 percent were women — most of them middle-aged women who took prescription painkillers.

EMERGENCY CHILDBIRTH

Emergency childbirth is not an everyday occurrence. Therefore emergency responders, police, fire and EMS have a basic understanding of proper childbirth.  MEDMONTHLY.COM | 79

Physician Solutions is now hiring primary care MD’s, PA’s and FNP’s in North Carolina, Virginia and South Carolina

If you are a well informed physician or mid-level, we could use your services from 2 to 5 days per week. Find out why dozens of doctors choose Physician Solutions.

Short-term or long-term, Physician Solutions has you covered P.O. Box 98313, Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

phone: 919.845.0054 fax: 919.845.1947 e-mail: physiciansolutions@gmail.com www.physiciansolutions.com