A few studies have shown mixed results. There is no question that primary care really needs to change, and the PCMH model is incredibly promising. It deserves to be implemented, but also needs to be studied more. Population Health Management , May Team-based versus traditional primary care models and short-term outcomes after hospital discharge. Canadian Medical Association Journal , April Annals of Internal Medicine , January 17, Medical homes and cost and utilization among high-risk patients. American Journal of Managed Care , March Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use.
Medical homes: cost effects of utilization by chronically ill patients. American Journal of Managed Care , February, Improving patient care.
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The patient centered medical home. A Systematic Review. Annals of Internal Medicine , February Medical Care , May Sounds a little too much like a capitation plan.
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So many patients rely on the multiple types of medications on the market today, including angiotensin-converting enzyme ACE inhibitors, such as Captopril Capoten and Enalapril Vasotec ; and beta blockers, such as Bisoprolol Zebeta. The majority of these work by blocking the effects of hormones that get released by the body during heart failure.
These medications work relatively well in the early to mid stages of heart failure, but once patients reach the later stages, the drugs' effectiveness drops significantly. They also come with serious side effects, including worsening kidney function and hypotension, to the point that people with acute heart failure are often weaned off medication as their other organs start failing.
Pacemakers, also known as cardiac resynchronization therapy, or CRT, have been around for more than half a century. These small devices consist of electrodes implanted into the heart that deliver electrical impulses to regulate heartbeat.
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Two other main classes of devices are implantable cardiac defibrillators, or ICDs, which work similar to pacemakers, using electricity to correct irregular heart beats; and ventricular assistance devices, or VADs, supplementary pumps that help the heart pump blood. Within the past year, breakthroughs in sensor and nanotechnology have made CRT and ICDs most patients now have a single device that does both safer and more reliable.
Previously, the devices were imprecise, occasionally causing "violent hiccups," Ellenbogen said. Now, however, doctors are able to place multiple sensors more precisely on different chambers of the heart, allowing more coordination. The newest pacemakers and defibrillators also contain sensors that can monitor other things, like oxygen levels in the blood, physical activity, body temperature, adrenaline and hormone levels, syncing that information to regulate heart rate more akin to what the heart does naturally.
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In addition to the high toll on life, heart failure exacts a huge financial cost. Even more is spent on hospital readmissions. Almost half of all patients are readmitted to the hospital within six months of diagnosis. Because the data show that if the patient comes to us and they are short of breath and having symptoms, it is already too late," Kahwash said. To that end, researchers at Sensible Medical have developed the SensiVest , a vest patients can wear over their clothes that uses radar technology originally developed by the military to scan inside the body and monitor fluid buildup in the lungs.
As the heart ceases to pump blood properly, fluid backs up into the lungs, causing shortness of breath, swelling and other symptoms. The problem starts about week or two before the patient feels it. Instead of waiting for patients to report symptoms, as doctors have previously done, patients can simply don the vest the scan takes about three minutes' total.
The information is transmitted wirelessly to their doctor, who can conduct further assessments, recommend dietary changes and intervene with medication. In a study published in August , wearing the Sensivest daily for three months decreased hospital readmission by 87 percent. Some of the most exciting and futuristic developments in heart failure devices come from the field of soft robotics.
Most current devices, including modern VADs and an artificial heart currently on the market, the Carmat , are made at least partially of hard materials, requiring lots of sensors and stopgaps so they don't hurt patients, and coming with a high risk of infection as they come into contact with human soft tissue. The artificial blood flow they create can also cause serious problems, including blood clots and stroke.
Last year scientists at Harvard University and Boston Children's Hospital announced that they had developed a customizable soft robotic sleeve that fits around the heart and twists and compresses in sync with its natural beating, helping it to pump blood. Most people with heart failure still have some limited function in the organ. The author presents an extraordinary record of various case histories through which she has personally verified this interconnection, showing how the physical side has healed by working with the spiritual aspect. As part of the overall picture, the heart is not just an effective and powerful symbol of a well-organized society, but it also represents the meeting point for both body and emotions, due to physiological reasons.
This therefore makes the heart the key towards reaching a new concept of total healing. The book is accompanied by a supporting review of the latest news and publications related to this new healing concept; a field in which the author has trained very thoroughly.follow site
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