Six Sigma and Medical Care

Does your hospital utilize Six Sigma in its planning and methodology?
Six Sigma Catapults Hospitals to Next Level of Quality
If not, the consequences can be very costly to you...and to the hospital.

"Lawsuit could set precedent about end-of-life decisions

Robert Cribb
Toronto Star
Staff Reporter
September 04, 2010

As her father lay struggling for breath in a Toronto hospital bed, Joy Wawrzyniak pleaded with doctors to intervene and save his life.

Medical staff instead stood back and allowed the World War II veteran to die, against his wishes and to the shock of his daughter, Wawrzyniak claims in a stunning $1 million lawsuit filed this week against Sunnybrook Health Sciences Centre and two doctors responsible for her father’s care.

While Wawrzyniak and her father, Douglas (Dude) DeGuerre, had repeatedly requested he receive life-saving treatment in case of a medical emergency, doctors unilaterally overruled those wishes without consent or consultation, the lawsuit claims...."
Lawsuit could set precedent about end-of-life decisions

Thyroid T3 Recovery from Fibromyalgia

What if... your doctor prescribed years of pain killers and antidepressants for your Fibromyalgia... when what you needed was thyroid supplementation?


"Recovery from "Fibromyalgia" with T3
Therapy after T4 and Desiccated Thyroid Failed

Fifteen years ago, I published a case study in which a hypothyroid female dramatically recovered from her diagnosis of fibromyalgia by swithching to T3 after she had failed to benefit from both T4 and desiccated thyroid.
Fibromyalgia researchers who work with their heads buried in the sand of failure will dismiss the case, as they did all those years ago, because the report isn't about a blinded study. However, as Carlton Fredericks, PhD noted, such reports are controlled. After all, the woman recovered quickly and dramatically with T3 after extensive treatment with two other approaches to thyroid hormone therapy failed. It is a failure of intellect that dismissive fibromyalgia researchers saw (and undoubtedly will still see) the study as "uncontrolled." By the very unfolding of the woman's case, the trial was indeed controlled.

This highly illustrative case of recovery from "fibromyalgia" through thoughtful administered T3 therapy has for many years been unavailable except through my office. The reason is that the journal containing the report was sold in 1996 to Haworth Medical Press, which didn't make the issue containing the report available to subscribers.

Today, however, Thyroid Science makes the case report available for perpetuity through its open-access webpages. For those who are curious about T3 therapy and its proper use, and how so-called "fibromyalgia" can be relieved with hormone treatment, we republish this case report. "

Introduction to the Case Report at THYROID SCIENCE

Do you trust your doctor?

Do you trust your doctor? Increasingly, many (Canadians) do not.
It may be wise to ask questions. Today, university medical education is often funded by Pharma (grants to chairs and departments, for research, dictating what shall be taught) and continued in the doctor's office during visits by drug company reps with high school educations and doctor prescribing info and personality profiles on their Bl*ckberries.

From an article at Maclean's

...horror stories have made Canadians wary, says Mario Canseco of Angus Reid Public Opinion, who oversaw the Maclean’s poll. “Not only do they worry that there will be mistakes, but they assume so,” he says. “Even if you’re happy with your GP, you see what’s happened to those around you. You think it may be your time next.”

For doctors, this is an unaccustomed, and not especially pleasant, spot to be in. For generations, physicians have enjoyed greater public respect and appreciation than practically any professionals—a reflection, perhaps, of their status in many communities as the most educated people in town. That’s changing, however, as post-secondary education becomes the norm and Canadians in general grow less deferential. “There used to be a very paternalistic relationship between doctors and their patients,” says Dr. Rocco Gerace, registrar of the College of Physicians and Surgeons of Ontario. “It worked both ways. Patients would essentially give doctors the decision-making ability, as opposed to considering options and then consenting. It’s changed dramatically, and I think for the better.”

That shift has been accelerated by the Internet, which puts not only diagnostic information but reviews of individual physicians at the fingertips of patients. RateMDs.com, a California-based site that went online in 2004, has doubled its traffic every year since, with Canadians as its most enthusiastic constituency. The site now has user-submitted ratings for over 85 per cent of Canadian doctors, and a surprising 45 per cent of its 1.2 million monthly visits originate in this country. The phenomenon speaks not only to patients’ doubts, but an appetite for frank criticism that Hugh MacLeod, chief executive of the Edmonton-based Canadian Patient Safety Institute, says will only grow. “For those in the system who think things are getting wild now,” he says, “put on your seat belts.”

All this crowd-sourcing raises an obvious question: are medical mistakes becoming more common? Or are they merely being amplified by proliferating media, both social and mainstream? Geoff Norman, a McMaster University psychologist who studies how doctors make errors, believes recent scandals played out in the media have simply caused patients to demand reviews and investigations, the coverage of which has fed impressions that things are going awry. Doctors are more willing to own up to mistakes, he argues, and he points to the publication in 2000 of “To Err Is Human,” a report by the Washington-based Institute of Medicine, as a watershed moment in encouraging practitioners to acknowledge their fallibility. “Now,” he says, “there’s almost like a legislative review process when something goes wrong.”

http://www2.macleans.ca/2010/08/16/do-you-trust-your-doctor/
Print version
http://www2.macleans.ca/2010/08/16/do-you-trust-your-doctor/print/

The link between adrenal fatigue and DNA methylation

Link

The link between adrenal fatigue and DNA methylation
Townsend Letter for Doctors and Patients, May, 2005 by Susan Solomon

Adrenal function is vital to life: without cortisol we die. This fact has been known since the 1930s when it was described by Banting and Best. Glucocorticoids are essential for maintaining carbohydrate, protein and fat metabolism. They also have a permissive effect which allows for glucagon and catecholamines to work. Important glucocorticoid effects include the normal functioning of the nervous system, water metabolism, vascular reactivity, regulation of circulating lymphocytes and the immune system and "resistance to stress." Complete lack of adrenal function is a disease state known as Addison's Disease. Conventional medicine only recognizes two states: you either make cortisol or you don't. Allopathic physicians are unaware of the decline in adrenal function as illness becomes chronic.

The etiology of adrenal fatigue begins with a "stressor," or in functional medicine terms, a "trigger." Triggers fall into several categories: psychosocial stress, environmental toxins (radon, mercury, mold), infectious organisms (fungal, bacterial, parasitic), food allergies (wheat, corn, sugar, milk), and other toxins (alcohol, drugs, prescription medications) to name a few. In addition, stressful events such as surgery or car accidents place a huge (usually unrecognized) load on the adrenal glands. The initial response to each of the above events is to elevate cortisol levels to help cope with the stress. However, over time, the adrenals become weakened and lose their circadian rhythm. This is due in large part to poor nutrition. All stressful events require increased amounts of several nutrients: vitamin C, pantothenic acid, B6 (pyridoxine), B12 (methylcobalamin), and folate. Interestingly, if the adrenal glands are catheterized and a "stressor" is introduced, the first chemical to leave the adrenals is not cortisol as one would suspect, but large amounts of vitamin C. These nutrients are severely lacking in the typical American diet or are not found in high enough amounts. More often than not "orthomolecular" dosing is necessary to correct the deficits.

The initial response to any stress is the hypersecretion of cortisol, but over time (approximately one year) there develops a negative feedback and a genuine "fatigue" causing reduced levels of DHEA-S and cortisol. The end result is an organism with reduced immunity, increased likelihood of autoimmune disease, heart attacks, elevated cholesterol and triglycerides, skin disorders, carbohydrate cravings, protein wasting, fatigue and depression (to name but a few). Physicians normally view these as separate events in a given organ and do not see that the symptoms represent a disease process (inflammation) that may occur in one or more organs simultaneously. Therefore everyone with any chronic disease, not just cardiovascular disease, should be screened using DHEA-S and a homocysteine level. As DHEA-S decreases, the level of homocysteine rises, with a concomitant decrease in most B-vitamins, but especially folate and B12. The currently accepted norms for these parameters are too permissive, reminiscent of glucose control in years past. All of our organs are linked and nothing that happens is random. We are all the result of our genetic interaction with our environment.

With the establishment of "disease" another pivotal biochemical event happens: abnormal methyl metabolism. Multiple reports in the recent literature link abnormal DNA methylation with the onset of cancer in laboratory animals. Undoubtedly this occurs in humans as well.

It is my clinical experience that as soon as a patient's DHEA-S falls to below 160 the ability to make methyl groups nosedives as well. These patients may then present with symptoms of depression (inability to synthesize S-adenosylmethionine), joint pain (inability to make methylsulfonylmethionine), and gastric acid reflux disease (inability to make betaine or trimethylglycine), to name a few. Not only does the ability to make methyl groups decrease, but the ability to convert to a methylated product is also compromised. For example, in chronically ill individuals the use of B12--as either the cyanocobalamin or the hydroxocobalamin form seems to do little to improve fatigue or mental functioning. The ideal compound to replenish B12 is methylcobalamin--the only active form. In each case, oral supplementation with the missing methyl-containing substrate ameliorates the symptoms. In each of the scenarios listed, the severity of the illness correlates with the level of the reduced or deficient DHEA-S and the concomitant elevated homocysteine level. The elevated homocysteine level is not only a marker for inflammation, but it is a marker for deficient B vitamins as well. The stage is now set for abnormal DNA methylation and the induction of cancer.

Efforts to repair adrenal fatigue include nutrients (in their most active form), glandular preparations, DHEA (and in severe cases cortisol itself), and lifestyle modifications with removal of triggers. Even with these measures, expect adrenal recovery to take 3 to 5 years.

Does your physician know that DHEA is an endocrine hormone, essential for life - or does he think it is a health food supplement?

Bibliography at link

A framework for assessing the performance of health systems

Theme Papers
A framework for assessing the performance of health systems
Christopher J.L. Murray1 & Julio Frenk2
Health systems vary widely in performance, and countries with similar levels of income, education and health
expenditure differ in their ability to attain key health goals. This paper proposes a framework to advance the
understanding of health system performance. A first step is to define the boundaries of the health system, based on the concept of health action. Health action is defined as any set of activities whose primary intent is to improve or maintain health. Within these boundaries, the concept of performance is centred around three fundamental goals: improving health, enhancing responsiveness to the expectations of the population, and assuring fairness of financial contribution. Improving health means both increasing the average health status and reducing health inequalities.
Responsiveness includes two major components: (a) respect for persons (including dignity, confidentiality and
autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt
attention, access to social support networks during care, quality of basic amenities and choice of provider). Fairness of financial contribution means that every household pays a fair share of the total health bill for a country (which may mean that very poor households pay nothing at all). This implies that everyone is protected from financial risks due to health care. The measurement of performance relates goal attainment to the resources available. Variation in performance is a function of the way in which the health system organizes four key functions: stewardship (a broader concept than regulation); financing (including revenue collection, fund pooling and purchasing); service provision (for personal and non-personal health services); and resource generation (including personnel, facilities and knowledge).
By investigating these four functions and how they combine, it is possible not only to understand the proximate
determinants of health system performance, but also to contemplate major policy challenges.
Keywords: outcome and process assessment, health care; health care rationing; health services accessibility; social
justice; health systems plans; financing, health

PDF

Beyond Mediocrity: What Canadians Should Expect From Their Healthcare System

... And Why They're Not Getting It
Thought provoking and honest.

Public Presentation by Steven Lewis, U of Calgary/SFU
Dalhousie University School of Health Administration
Halifax, N.S.
Audio/slide presentation
Link

'What Would You Think If...
Your dry cleaner made you wait 3 weeks for your clothes
7% of the meals you ate in restaurants gave you food poisoning"

Part of a series - http://schoolofhealthadministration.dal.ca/Excellence%20in%20Health%20Series/

"Excellence in Health Series
Tomorrow’s Thinking ~ Today’s Care

In 2008 the School of Health Administration established a public-education program entitled, Excellence in Health Series. The Excellence in Health Series is designed to provide an open forum, equally accessible to the public and professional community. The lectures provide a ‘large-canvas’, upon which cutting-edge topics are discussed, from healthcare planning and management, healthcare funding and delivery, healthcare law and legislation, to healthcare policy. All members of the public are welcomed, as are healthcare professionals, from healthcare practitioner, policy analyst, lawyer, to healthcare administrator. To maximally engage the public, the series is held in the evenings, off campus, at a local Hotel, and no admission fee is charged.

The Excellence in Health Series will feature national and internationally lecturers, each respected for their leadership on the topic of discussion. To ensure maximum learning opportunity to the public and professional communities throughout the region, nationally and internationally, the Excellence in Health Series is digitally recorded and made available through the School of Health Administration website.

Beyond Mediocrity: What Canadians Should Expect from their Healthcare System and Why they're not Getting it.
By: Steven Lewis

Medicare and the Law: Playing with a Full(er) Deck
By: William Lahey

How to Reduce Your Risk of Experiencing a Medication Error
By: Dr. Neil MacKinnon

A Weight On Our Minds: Obesity in Nova Scotia
By: Dr. Sara Kirk

Population Aging and Health Care
By: Dr. Kenneth Rockwood

Coronation Street star speaks out on her thyroid condition

We are grateful when awareness of thyroid health can be raised. Britain's CORONATION STREET and LOOSE WOMEN star Sherrie Hewson has done us all a great service by speaking out about living with an underactive thyroid gland. Link