9 Health Tips

1. Move More
Make it a daily challenge to find ways to move your body. Climb stairs if given a choice between that and escalators or elevators. Walk your dog; chase your kids; toss balls with friends, mow the lawn. Anything that moves your limbs is not only a fitness tool, it's a stress buster. Think 'move' in small increments of time. It doesn't have to be an hour in the gym or a 45-minute aerobic dance class or tai chi or kickboxing. But that's great when you're up to it. Meanwhile, move more. Thought for the day: Cha, Cha, Cha…. Then do it!

2. Cut Fat
Avoid the obvious such as fried foods, burgers and other fatty meats (i.e. pork, bacon, ham, salami, ribs and sausage). Dairy products such as cheese, cottage cheese, milk and cream should be eaten in low fat versions. Nuts and sandwich meats, mayonnaise, margarine, butter and sauces should be eaten in limited amounts. Most are available in lower fat versions such as substitute butter, fat free cheeses and mayonnaise. Thought for the day: Lean, mean, fat-burning machine…. Then be one!

3. Quit Smoking
The jury is definitely in on this verdict. Ever since 1960 when the Surgeon General announced that smoking was harmful to your health, Americans have been reducing their use of tobacco products that kill. Just recently, we've seen a surge in smoking in adolescents and teens. Could it be the Hollywood influence? It seems the stars in every movie of late smoke cigarettes. Beware. Warn your children of the false romance or 'tough guy' stance of Hollywood smokers. Thought for the day: Give up just one cigarette…. the next one.

4. Reduce Stress
Easier said than done, stress busters come in many forms. Some techniques recommended by experts are to think positive thoughts. Spend 30 minutes a day doing something you like. (i.e.,Soak in a hot tub; walk on the beach or in a park; read a good book; visit a friend; play with your dog; listen to soothing music; watch a funny movie. Get a massage, a facial or a haircut. Meditate. Count to ten before losing your temper or getting aggravated. Avoid difficult people when possible. Thought for the day: When seeing red, think pink clouds….then float on them.

5. Protect Yourself from Pollution
If you can't live in a smog-free environment, at least avoid smoke-filled rooms, high traffic areas, breathing in highway fumes and exercising near busy thoroughfares. Exercise outside when the smog rating is low. Exercise indoors in air conditioning when air quality is good. Plant lots of shrubbery in your yard. It's a good pollution and dirt from the street deterrent. Thought for the day: 'Smoke gets in your eyes'…and your mouth, and your nose and your lungs as do pollutants….hum the tune daily.

6. Wear Your Seat Belt
Statistics show that seat belts add to longevity and help alleviate potential injuries in car crashes. Thought for the day: Buckle down and buckle up.

7. Floss Your Teeth
Recent studies make a direct connection between longevity and teeth flossing. Nobody knows exactly why. Perhaps it's because people who floss tend to be more health conscious than people who don't? Thought for the day: Floss and be your body's boss.

8. Avoid Excessive Drinking
While recent studies show a glass of wine or one drink a day (two for men) can help protect against heart disease, more than that can cause other health problems such as liver and kidney disease and cancer. Thought for the day: A jug of wine should last a long time.

9. Keep a Positive Mental Outlook
There's a definitive connection between living well and healthfully and having a cheerful outlook on life. Thought for the day: You can't be unhappy when you're smiling or singing.

Stealth Health: Get Healthy Without Really Trying

Living healthier doesn't have to be complicated or time-consuming, experts say

By Colette Bouchez
WebMD Weight Loss Clinic - Feature

Reviewed By Brunilda Nazario, MD

How much do you know about what makes up a healthy lifestyle? Here's a pop quiz.

1. How do you define working out?

a. Going to the gym.
b. Turning the jump-rope for the neighbor's kid.
c. Playing Frisbee with your dog.

2. How do you define good nutrition?

a. Eating a vegetable at every meal.
b. Eating two vegetables at every meal.
c. Drinking a fruit smoothie for breakfast.

3. Which of these is a healthy activity?

a. Push-ups, sit-ups, or running the track.
b. Walking the dog after dinner.
c. Spending Saturday afternoon snoozing on the sofa.

Believe it or not, the correct answer to every question is A, B, and C -- even that Saturday afternoon snooze! According to the growing "Stealth Health" movement, sneaking healthy habits into our daily living is easier than we think.

"You can infuse your life with the power of prevention incrementally and fairly painlessly, and yes, doing something, no matter how small, is infinitely better for you than doing nothing," says David Katz, MD, MPH, director of Yale University's Prevention Research Center and of the Yale Preventive Medicine Center. Katz is also co-author of the book Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits into Your Life without Really Trying.

From your morning shower to the evening news, from your work commute to your household chores, Katz says, there are at least 2,400 ways to sneak healthy activities into daily living.

"If you let yourself make small changes, they will add up to meaningful changes in the quality of your diet, your physical activity pattern, your capacity to deal with stress, and in your sleep quality -- and those four things comprise an enormously powerful health promotion that can change your life," says Katz.

And yes, he says, a nap on the couch can be a health-giving opportunity -- particularly if you aren't getting enough sleep at night.

Nutritionist and diabetes educator Fran Grossman, RD, CDE, agrees. "You don't have to belong to a gym or live on wheat grass just to be healthy," says Grossman, a nutrition counselor at the Mt. Sinai School of Medicine in New York. "There are dozens of small things you can do every day that make a difference, and you don't always have to do a lot to gain a lot."

Do a Little, Get a Lot

The notion that good health can come in small tidbits is not really new. Research showing that making small changes can add up to a big difference has been quietly accumulating for a while.

For example, a study published in the Archives of Internal Medicine in 2004 found that adding just 30 minutes of walking per day was enough to prevent weight gain and encourage moderate weight loss.

And if 30 minutes is still too big a bite? Another study, published in Medicine & Science in Sports & Exercise, found that three brisk 10-minute walks per day were as effective as a daily 30-minute walk in decreasing risk factors for heart disease.

"Just the act of going from sedentary to moderately active gives you the greatest reduction in your risks," says Helene Glassberg, MD, director of the Preventive Cardiology and Lipid Center at the Temple University School of Medicine in Philadelphia.

But it's not only in fitness where small changes can make a difference. The same principles apply at the kitchen table (and the office snack bar).

"Reducing fat intake, cutting down on sugar, eating a piece of fruit instead of a candy bar -- over time, these things can make a difference," says Grossman.

As long as the changes are moving you toward your goal -- be it weight loss, a reduction in cholesterol or blood pressure, or better blood sugar control -- you can get there by taking baby steps, she says.

Moreover, Grossman tells WebMD, making small changes can help give us the motivation to make bigger ones.

"A lot of bad eating habits are about not taking charge of your life, and that attitude is often reflected in other areas," says Grossman. On the other hand, she says, when you make small changes at the kitchen table, the rewards may show up in other areas of your life.

"It's the act of taking control that makes the difference in motivating you," says Grossman. "An inner confidence and power begins to develop that can be seen in other areas of life."

Tripping Over Baby Steps

Of course, not everyone is certain that baby steps can walk you all the way to good health. Marc Siegel, MD, a clinical associate professor at the NYU School of Medicine, says that while doing something is certainly better than doing nothing, making such small changes is like using a Band-aid to stop a hemorrhage.

"It's a small, gimmicky idea to target people with very unhealthy lifestyles, and for some it may be useful," says Siegel, author of False Alarm: the Truth about the Epidemic of Fear. But he fears that for most people, it's sending the wrong message.

"In some ways it's a resignation, an admission that things can't be changed -- and that's certainly not the long-term answer," Siegel tells WebMD.

Katz concedes that the Stealth Health approach may not be right for everybody.

"There is a trade-off because if you try to make the pursuit of health easier for people, you run the risk of leading them to believe they don't need to do very much -- and that would be the wrong message," he says.

At the same time, Katz believes that for those who find making health changes a daunting task, Stealth Health techniques can make a difference.

"If you want the really big gains, there has to be some pain," says Katz. "But there is a lot to be said for the idea that you can make some gains with little or no pain, and that's infinitely better than no gains."

Try the Stealth Health Approach

Tempted to give "Stealth Health" a try? Katz recommends picking any three of the following 12 changes and incorporating them into your life for four days. When you feel comfortable with those changes, pick three others. Once you've incorporate all dozen changes, you should start to feel a difference within a couple of weeks, he says.

To Improve Nutrition:

1. Buy whole foods -- whether canned, frozen, or fresh from the farm -- and use them in place of processed foods whenever possible.
2. Reject foods and drinks made with corn syrup, a calorie-dense, nutritionally empty sweetener that many believe is worse for the body than sugar, says Katz.
3. Start each dinner with a mixed green salad. Not only will it help reduce your appetite for more caloric foods, but it also will automatically add veggies to your meal.

To Improve Physical Fitness:

1. Do a squat every time you pick something up. Instead of bending over in the usual way, which stresses the lower back, bend your knees and squat. This forces you to use your leg muscles and will build strength.
2. Every time you stop at a traffic light (or the bus does), tighten your thighs and butt muscles and release as many times as you can. (Don't worry, no one will see it!) This will firm leg and buttock muscles, improve blood flow -- and keep you mildly amused!
3. Whenever you're standing on a line, lift one foot a half-inch off the ground. The extra stress on your opposite foot, ankle, calf and thigh, plus your buttocks, will help firm and tone muscles. Switch feet every few minutes.

To Improve Stress Control:

1. Give your partner a hug every day before work. Studies show this simple act can help you remain calm when chaos ensues during your day, Katz says.
2. Have a good cry. It can boost your immune system, reduce levels of stress hormones, eliminate depression, and help you think more clearly.
3. Twice a day, breathe deeply for three to five minutes

To Improve Sleep:

1. Sprinkle just-washed sheets and pillowcases with lavender water. The scent has been shown in studies to promote relaxation, which can lead to better sleep.
2. Buy a new pillow. Katz says that studies show that pillows with an indent in the center can enhance sleep quality and reduce neck pain. Also, try a "cool" pillow -- one containing either all-natural fibers or a combination of sodium sulfate and ceramic fibers that help keep your head cool.
3. Eat a handful of walnuts before bed. You'll be giving yourself a boost of fiber and essential fatty acids along with the amino acid tryptophan -- a natural sleep-inducer.

SOURCES: Archives of Internal Medicine. 2004; vol 164: pp 31-39. Medicine & Science in Sports & Exercise, September 2002. David Katz, MD, MPH, director, Prevention Research Center, Yale University; co-author, Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits into Your Life without Really Trying. Fran Grossman, MS, RD, CDE, nutrition counselor, Mt. Sinai School of Medicine, New York. Helene Glassberg, MD, director, Preventive Cardiology and Lipid Center, Temple University School of Medicine, Philadelphia. Marc Siegel, MD, clinical associate professor, New York University School of Medicine; author, False Alarm, The Truth about the Epidemic of Fear.

INSTILLING QUALITY AND PATIENT SAFETY IN THE SURGICAL RESIDENCY TRAINING PROGRAM

by Alejandro C. Dizon, MD, FPCS, FACS

The publication in 1999 of the Institute of Medicine report: To Err is Human: Building a Safer Health System has brought a realization that more people die directly or indirectly due to medical errors in hospitals compared deaths from motor vehicle and airline accidents. As much as 100,000 die in US hospitals because of medical errors and 15,000,000 experience harm or adverse events in healthcare facilities. The World Health Organization deduces that in developing countries, these figures may proportionally be bigger. Contrary to the promise of the medical profession “To do no harm”, unfortunately the hospital can be one of the most dangerous place in the world.

For these reasons, the thrust in many developed countries and organizations is to enforce many safety processes, procedures and initiatives that address quality and patient safety. We are currently monitoring surgical success on the basis of morbidities and mortalities and sometimes, surgical site infection but we lack the instruments and mechanism to accurately validate this and miss the “contribution” of errors or events chance in lessening if not preventing future adverse events or outcomes to patients. This understanding and awareness should be brought to the consciousness of everyone in the healthcare industry, which includes the training of residents in the various training programs.

The old and current model for training still is based upon the “Read one–See one- Do one” model (a “See one – Do one- Read during, again or later” may sadly occasionally happen). This would be ideal if there is full and complete oversight and supervision by the attending consultant. But in reality, how often does this actually happen and we allow trainees to be “independently” doing surgical procedures in the context of “training”. How often will a trainee be doing a surgical procedure on an actual patient for the first time “independently”?

With the present lack of a more objective measure for compliance to the requirements of a training program, we still currently utilize primarily the number or volume of cases performed by a trainee. More credit is given to independently done procedures versus supervised ones. But are there measures of quality that will show that the surgical procedures performed had favorable outcomes? Were the patients properly and adequately assessed and prepared pre-operatively, intra-operatively and post-operatively? More importantly, were the patients informed and educated properly with regards to the diagnosis, planned procedure(s) and the expected outcome of the intervention? What is the degree of supervision in a surgical procedure that will be performed by a trainee who will be doing the procedure for the first time? What is the expertise or competence level of the surgeon supervising? We have all been guilty of somehow losing the “PATIENT” in a system that promulgates “good” training that fails to consistently provide even minimum safeguards against patient harm.

The other issue that has a big impact on surgical training programs is the current system and culture in our heath care systems and institutions. What dominates is the hierarchal system of practice and training that discourages lower ranked individuals to correct or question the superiors. Many of the “scut” or daily work is delegated to the newest member of the team. This may limit direct supervision of “senior” over “junior” house staff members and overwhelms the most junior member of the residency staff with the floor calls and work. These include assessment and management of most of the surgical patients in the wards or out patient clinics. This system and tradition likewise promotes a “Train and blame” culture that focuses on and even highlights the errors and faults of the individual but fails to approach and analyze the problem from a systems perspective. Even problems occurring with private patients during a resident’s duty can be easily blamed on the “incompetence” of the resident. In the Philippine setting, the work of a floor resident is even made more difficult by the high nursing turnover that transfers to the resident many of the tasks or decision making that could have been done by a more experienced nurse.

These issues should be addressed in the residency training programs in the interest of quality health care delivery and patient safety. We should review the design of the surgical curriculum and implementation of training programs in the context of safety for the patient. The first is the appropriate and competent teaching and supervision of trainees. The “Read one - See one- Do one” or Apprenticeship Model in teaching is still very effective if done properly. The teaching and supervision is the responsibility of the consultant training staff should be the most competent (if not the expert) in the field and cannot be delegated to anyone else. How often does it happen that supervision is delegated to fellow residents or even more concerning, no supervision at all? Even the manner of promotion is based on the number of years and the minimum (!) number of procedures performed. We should look more not into the minimum numbers but the success and quality of surgeries performed, not determined by numbers. The basis for promotion may differ from person to person as every learner is different. (e.g one resident may require 2 cases while another resident –slow learner or less skillful- may require 10 cases before promoting). This may be a logistical nightmare in terms of maintaining the structure of a program but shouldn’t our patients deserve no less before we certify a surgeon from a training program as competent and qualified?

The trend now in developed countries is to utilize Simulators or Virtual Reality (VR) Training systems. This is a model currently used in the airline industry that require pilots to successfully complete hours in a flight simulator and training planes before they are certified to fly commercial flights. Programs who have adapted this require a minimum number of hours of exposure and successful outcomes in these medical simulator systems before the trainees are allowed to perform surgery on “real” patients. These training platforms may not come cheap but one can actually innovate to achieve similar outcomes of teaching procedures and developing surgical judgment.

Next is breaking down the traditional hierarchy in the surgical training programs. The teamwork concept should be put in place to include not only the resident staff but also all members of the healthcare team (interns, nurses, technicians and even consultants). We should likewise veer away from the traditional “train and blame” or culture of blame to what quality advocates term as a “culture of safety”. The culture of blame tends to pinpoint mistakes and errors to an individual and in turn leads individuals to hide or “bury” mistakes in the process, for fear of reprimands. A culture of safety likewise investigates mistakes and errors from a systems perspective by looking more as to defects in the process or systems that “allowed” a person to commit the mistake. Systems solutions provide a wider and broader scope in preventing the same errors from recurring.

Lastly we should incorporate the basic principles of quality and safety in the training programs. We currently look closely at outcomes and complications and often retrospectively, providing more of technical solutions. We have to teach the importance of proper and complete, documented assessments, care coordination with the other specialties, respecting patient and family rights, providing patient education and proper post-operative care monitoring and follow-up. We should also implement and emphasize importance of the “time-out” or universal protocol to ensure that a complete pre-operative assessment, pre-procedure briefing with the surgical team, determination of correct procedure/patient/operative site and post-operative debriefing is performed in all surgeries. Clinical quality and safety monitors should be done to measure compliance and guide improvement processes.

We have gone a long ways in teaching the science and skills necessary for good surgery. Now we have to revisit the basics of patient safety, specifically surgical safety, to ensure the delivery of quality healthcare, healthcare that is not only safe and effective, but also timely and patient-centered. This is our responsibility not only to our patients but also to our profession. We should remember that we have to teach our young surgeons well because the students and trainees of today will be those that will take care of US in the future.

Recognizing a Stroke

(Just a forwarded message. This needs verification.)

----- A neurologist says that if he can get to a stroke victim within 3

hours he can totally reverse the effects of a stroke...totally. He said the

trick was getting a stroke recognized, diagnosed and getting to the patient

within 3 hours which is tough.

RECOGNIZING A STROKE

Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer brain damage when people nearby fail to recognize the symptoms of a stroke.

Now doctors say a bystander can recognize a stroke by asking three simple questions:

1. *Ask the individual to SMILE.

2. *Ask him or her to RAISE BOTH ARMS.

3. *Ask the person to SPEAK A SIMPLE SENTENCE (Coherently) (i.e. . . It is sunny out today) If he or she has trouble with any of these tasks, call 9-1-1 immediately and describe the symptoms to the dispatcher.

After discovering that a group of non-medical volunteers could identify facial weakness, arm weakness and speech problems, researchers urged the general public to learn the three questions. They presented their conclusions at the American Stroke Association's annual meeting last February. Widespread use of this test could result in prompt diagnosis and treatment of the stroke and prevent brain damage.