Tag Archives: Healthcare

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The return of whooping cough

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Pertussis, or whooping cough, is a highly contagious acute infectious disease caused by the bacterium Bordetella pertussis. Outbreaks were first described in the 16th century; the organism was first isolated in 1906.

Pertussis was one of the most common childhood diseases and a major cause of childhood mortality in the United States in the 20th century. The disease is more common during spring and spreads when an infected person coughs or sneezes and other people breathe in the bacteria. During the 1940s, before a vaccine was introduced, more than 200,000 cases of pertussis were reported annually.

As a result of the pertussis vaccine, used since 2000, incidence has decreased more than 80%. The vaccine targets three antigens in the bacteria.

However, despite vaccination, pertussis bacteria are becoming smarter at colonizing and feeding off unsuspecting hosts. Australia’s whooping cough epidemic from 2008 to 2012 resulted in more than 140,000 cases in 2011, revealing an alarming rise of evolving strains able to evade vaccine-generated immunity.

New studies showed that the evolving strains made additional changes to better survive in their host, regardless of that person’s vaccination status. The researchers also identified new antigens as potential vaccine targets.

Now, whooping cough is emerging as a superbug. According to microbiologist Dr. Laurence Luu, who led a team of researchers with Professor Ruiting Lan, the whooping cough strains are evolving to improve their survival, regardless of vaccination, by producing more nutrient-binding and transport proteins and fewer immunogenic proteins that are not targeted by the vaccine.

As a result, whooping cough bacteria are better at hiding and feeding — able to efficiently scavenge nutrients from the host during infection and also evade the body’s natural immune system because the bacteria are making fewer proteins that the body recognizes.

Another issue is that immunity wanes quickly after vaccination, indicating the need for a new vaccine that can better protect against the evolving strains, stop the transmission of the disease, and provide longer lasting immunity. The good news is that while the number of whooping cough cases has increased during the past decade, the incidence is nowhere near as high as what it was before whooping cough vaccines.

Vaccination is especially important for children, people who are in contact with children, and pregnant women who need the vaccine to produce antibodies to protect their newborns from developing whooping cough in the first few weeks of life.

Babies under six months have a high risk of catching the disease if they are not protected by maternal immunization or have not yet completed the three-dose primary vaccine course. Older adults who live with someone who has whooping cough and those who have not had a booster in the past 10 years are also at risk.

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Is your job affecting your sleep?

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Experts recommend seven to nine hours of sleep nightly. In fact, according to the National Sleep Foundation, not getting enough sleep could negatively impact your immune system. That’s in addition to other sleep-deprivation issues, such as a lack of focus and productivity. And let’s not forget that kids aren’t the only ones who get cranky when they’re sleepy.

But even if you sleep the recommended number of hours each night, you may not be getting “good” sleep, especially if you’re dreaming about work. A study by Health Sleep reveals that 79% of people have work-related dreams.

“Considering the significant amount of time we spend ‘on the clock,’” it makes sense for familiar places and everyday situations to creep into our dreams,” says Jennifer Martinez of Healthy Sleep. These types of dreams were more prevalent in intermediate, first-level, and mid- to senior-level management than in entry level employees who were 15% to 17% less likely to dream about work.

Types of work-related dreams

So, what type of work-related dreams are most frequent?

Making a huge mistake (34.9%) and being late to work (32.3%) topped the list. However, employees also dreamed about being unprepared, missing a deadline, facing a pile of work, and being humiliated.

Less frequent work-related dream scenarios include getting yelled at by the boss, being laid off or fired, and yelling at co-workers. Some people even dream about yelling at the boss or the company going out of business.

So, why are negative dreams so prevalent? “Nightmares and dreams can sometimes be strongly linked to our real-life experiences,” Martinez explains. “We can assume the prevalence of negative dreams may indicate how disappointing or embarrassing scenarios related to work can affect us, even while we are sleeping.”

However, not all work-related dreams are bad. A small percent of dreamers probably didn’t want to wake up. For example, 10.5% dreamed of receiving a promotion/raise, and 9.6% dreamed of getting hired for their dream job.

Also, 29.5% dreamed of having a normal day at work — although that could be negative or positive depending on the dreamer. And among the 15.75% that dreamed of being back at their first job, that could also be interpreted either way.

The salary link

“Our study found an interesting correlation between annual income and type of dream,” Martinez says.

While 41% of those earning $75,000 or more and 40.9% of those earning between $25,000 and $49,000 had negative dreams, those earning between $50,000 and $74,000 actually had fewer negative dreams (38.2%). In addition, those earning less than $25,000 had the fewest negative dreams (33.8%).

Another interesting tidbit: Those on commission were less likely to have bad dreams than those earning a salary.

In addition, remote workers had the highest percentage of positive dreams, perhaps because they have more control of their work environment and ability to maintain work-life balance.

Stress and nightmares

The study also reveals that 57% of employees reported having work-related nightmares. And as you might imagine, there’s a correlation between stress level at work and work-related nightmares. Only 46.5% of employees who were somewhat or not at all stressed had work-related nightmares, compared to 61.7% of those who were moderately stressed. However, 79.1% of employees who were extremely or very stressed reported having work-related nightmares.

The vast majority of those who had work-related nightmares (70% to 75%) listed the following sources of stress: insufficient job skills, poor relationship with co-worker(s), lack of autonomy, poor relationship with boss, inadequate work environment, and micromanagement.

Relatively high on the list (60% to 68%) were nightmares by people who were stressed about lack of job security, overwhelming workload, work-life balance, lack of proper resources, long work hours, and unfulfilling work. However, over half of respondents having nightmares were stressed over low pay or insufficient business, few promotional opportunities, and boring work.

Tips for better sleep

If you’re suffering from these negative work-related dream experiences, Martinez recommends the following tips:

  • Unplug devices (laptops, tablets, smartphones) early in the evening.
  • Go to bed at an earlier time than usual.
  • Create a distinct workspace that is separate from your sleeping space (don’t work in bed).
  • Regularly relax away your work stresses and consider real-life options on how to resolve some of those issues.

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Groupthink and healthcare: An unhealthy alliance

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The term “groupthink” has been in popular usage since the 1970s, and its applicability to the multibillion-dollar 21st-century healthcare industry could not be more salient than it is today when we need more creative solutions to vexing problems than ever before.

Initially coined in 1974 by Irving Janis, a professor of psychology at Yale University, in reaction to terminology used by George Orwell in his seminal novel “Nineteen Eighty-Four,” it is defined by Yale Alumni Magazine as when “a group of intelligent people working together to solve a problem can sometimes arrive at the worst possible answer.”

Those firmly ensconced in the healthcare ecosystem can likely agree that groupthink plays a larger role than we would like to believe.

When Groupthink Rears Its (Misguided) Head

In the healthcare milieu, problem-solving frequently occurs from the top down, often without the valuable input of those with boots on the ground. When such changes are in the planning stages, staff members (who are often seen as nothing more than mere cannon fodder) are not consulted and typically told to suck it up and not ask questions because “this is the way we’re doing it now.”

Within nursing, when a staff nurse questions a particular accepted practice, the most dangerous words to be spoken in response are, “Well, that’s the way we’ve always done it.” In nursing, groupthink can keep nurses utilizing practices that are not evidence-based simply because change is too bothersome. Thus, in many instances, woe to the innovative nurse who has a new solution to offer.

Another form of nursing groupthink is the hazing and bullying of new nurses. In this form of groupthink, a more seasoned nurse might say, “Well, I was hazed, bullied, and sabotaged as a new nurse and now it’s my turn to get some payback; why should these new nurses get off easy?” This spurious practice is a significant driver of nurse attrition from the profession within the first few years following graduation and licensure; in terms of nursing shortages, this is a very unfortunate calculus indeed.

In medical education, groupthink occurs in the long sleepless hours worked by medical residents. Often awake for more than 24 hours at a time, the evidence is clear that such extreme lack of rest leads to mental fatigue, physical exhaustion, burnout, depression, poor judgment, and medical errors.

While some headway has been made in legislating residents’ hours, the reality is still mostly the same, with severely compromised residents populating teaching hospitals throughout the country like an army of highly educated zombies. Whoever still blindly supports such cruel and ineffective indoctrination is an obvious adherent to groupthink that absolutely endangers patients.

Ignorance Isn’t Bliss

Innovative thinking is the natural enemy of groupthink. While some may readily embrace groupthink as the modus operandi of American healthcare, others push back against such ignorance with the power of the creative mind.

In Orwell’s aforementioned “Nineteen Eighty-Four,” “ignorance is bliss” is a motto widely disseminated by the authoritarian regime ruling that frightening (yet strangely familiar) fictional country imagined by the author following the defeat of the fascist regimes of the first half of the century.

Healthcare is not an industry where groupthink, blissful ignorance, or pandering to the powerful produce any appreciably positive results. To the contrary, groupthink and its accompanying lack of knowledge or forethought are what has lent an air of inevitable dysfunction to healthcare delivery, especially in the United States, where we spend more per capita for far worse outcomes than any other industrialized country.

Historical rejection by the medical establishment of alternative/complementary therapies has kept many potential solutions out of the hands of consumers, and the death grip of insurance companies on politicians’ reelection campaigns also drives groupthink in the White House and the halls of Congress. Outright rejection of single-payer and related solutions also stymies creative approaches to our current situation, not to mention the denial of climate change, a true public health crisis of unprecedented proportions.

The Rise of Innovation

In what remains of the 21st century, we need more leaders, influencers, researchers, innovators, and rank and file clinicians to rise to the occasion and provide us with new fixes to longstanding problems.

The outright rejection of groupthink and ignorance is paramount if we are to move forward. Weak-willed and ineffective politicians, mercenary insurers, greedy pharmaceutical companies, cadres of lobbyists, and others standing in the way of innovation and positive change must be thwarted by most any means necessary.

As the millennial generation enters into full leadership of most industries worldwide over the coming decade, we must hold out hope that the younger generation can succeed where its predecessors failed. Healthcare costs are out of control, Americans continue to get sicker, and we spend more for less with each passing year.

We need creative, courageous minds to gather together, reject groupthink, swear off the status quo, and move us into a brighter future. Without such leadership, groupthink and its stalwart companion ignorance will continue to hobble our best efforts.

Who will lead the charge, dear Reader? Look no further than the face in the mirror.

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Considering giving up alcohol? You’re in good company

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For years now, people have been abstaining from alcohol during the month of January. This trend follows the typical pattern of people wanting to focus on health after holiday indulgences and failed resolutions from the previous year. Once the month is over, many return to their previous habits.

This year is different. Now, there is a major trend toward eliminating alcohol altogether. In the past few months, four people I know personally have happily announced that they’ve given up alcohol. All acknowledged that they feel better than they have in years.

So, why now?

The title of a Dec. 30, 2019, article in The Economist boldly proclaimed that “Drinking is going out of style.” Zion Market Research reported in 2018 that the global nonalcoholic beverage market will reach a record value of $1.65 trillion by 2024.

Part of the new alcohol-free language includes “sober curious” based on the best-selling book by the same name that encourages socializing without alcohol and “zero-proof” drinks, which include completely alcohol-free wine, beer and “mocktails.”

There are some deeper meanings behind these terms.

  • Sober curious doesn’t imply full abstinence, but rather supports a willingness to give sober social activities a try.
  • Zero-proof drinks allow people to still appear to be drinking because their drinks look exactly like the alcoholic versions.
  • Mocktails maintain the social enjoyment of being in a public bar or bar-like space enjoying drinks, but without the associated issues of intense inebriation, drunk driving and hangovers, among other things.

All of these reflect a strong desire to transition away from the socially accepted perception of needing alcohol to have a good time.

Even social media is reflecting this trend. According to Social Standards’ consumer analytics, there has been an 85% increase in online discussions about low‑ and no‑alcohol drinking in the past couple of years.

It’s clear that the sober lifestyle is more than just the latest fad. It appears to be here to stay. What that means is that we’re not only going to see more non-alcoholic drinks available in traditional bars, but we’ll also see more “sober bars” opening that cater exclusively to those seeking a place to socialize in which no alcohol is served.

Living a “booze-free” life used to be seen as missing out on one of life’s social customs. Now, however, as wellness has become a strong priority, sobriety is now considered a health-conscious choice.

Alcohol may be going the way of smoking. With so much awareness of the downsides of alcohol, especially in the area of addiction, viewing it through the lens of its impact on health means that we don’t have to go the way our predecessors did a hundred years ago when they tried banning alcohol altogether. We all know how that turned out.

Instead, we can each make a choice based on our own values and preferences, which makes it more likely to become integrated into an overall collective movement to improve health and well-being. Optimum health requires utilizing the best options available to maximize potential. Ultimately, this means reducing or eliminating those things which interfere with that potential. Right now, it appears that alcohol is on the outs.

Given that most of us have probably been negatively affected by the use and abuse of alcohol directly or in association with a family member, I see this as a very optimistic sign for future generations.

In the meantime, I suggest doing a Google search for sober bars or alcohol-free bars in your area and find out for yourself what this new trend is all about.

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Spotting ‘hidden’ but dangerous terms in a commercial lease

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Signing a commercial lease agreement is a huge milestone in the life of your business. It can greatly contribute to the success or failure of your business. When signing a commercial lease agreement, it is important to pay close attention to the business as well as the legal terms of the agreement, as it is usually not easy to change or get out of a commercial lease agreement once it has been signed.

On the upside, commercial leases are not based on standard forms and can be customized to the needs of your business. Generally, a standard lease will usually lean towards suiting the landlord’s needs. However, all the terms can be negotiated and you, as the tenant, can and should negotiate these terms to suit and protect your business needs as well.

You should, therefore, speak to an experienced real estate lawyer before you sign any lease agreement. A good real estate lawyer should explain all the terms of the agreement to you in layman’s terms.

He or she can assist with negotiating and making sure that the terms of the agreement are friendly to the needs of your business. A good understanding of the terms will help you to avoid unfair clauses that could be costly to you and your business a few months or years down the line.

Below are some important terms or clauses that are often overlooked, but that can be very dangerous for your business.

Permitted use clause

A restricted use clause limits how you may use the space. Ideally, you would want to avoid severe restrictions on how you may use the commercial space. To this end, a broad use clause will be much more favorable to you than a restrictive one.

Among other things, a restrictive use clause can have an impact on the future expansion and development of your business. You need to make sure that there is no clause in the lease agreement that will limit your scope or ability to expand your business activities.

For example, if you want to sublet a portion of the property to a sub-tenant who may be important to the development of your business, will the agreement allow you to do this? Or perhaps you want to start a food canteen for your staff in the future; will you be permitted to prepare and serve food on the premises?

Ask the landlord for a copy of the building’s certificate of occupation and check that your needs will not violate the use terms of the certificate.

Another example might concern parking. Depending on your type of business, client parking might be very important to you.

Will you be able to use the property’s parking lot for your clients? Can you use the parking bays in front of your area exclusively for your clients? Will your staff have allocated parking bays? A first-come, first-serve parking scenario might not suit your needs but the lease you signed might stipulate that this is how it will be.

Relocation clause

A relocation clause allows your landlord to relocate your business to a different area within the rental complex. Landlords often want the option of relocation in case another tenant wants to expand or they are willing to pay a higher rental fee.

A relocation clause puts you at a disadvantage because your customers might have become accustomed to meeting you at a specific address, and now, all of a sudden, you are no longer at that address. Not to mention the cost and time it will take to update all your marketing and sales materials to reflect the new address.

The best way to avoid this is to negotiate the relocation clause out of the lease agreement before signing. Alternatively, you need to negotiate terms that will protect you in this scenario.

For example, the new premises must be comparable to the original one, the landlord must cover the cost of relocation (this may include new business cards and new equipment fittings) and so on. You might want to add that you will have the right to terminate the lease if the new premises are not suitable.

Renewal clause

This is probably one of the most overlooked clauses in commercial leases.

An option to renew at the end of the lease term can be of great value to the tenant. It gives you the choice to move or stay on the premises and avoid the cost and inconvenience of moving. However, be very careful before accepting such a clause. It can come with significant risks. A clause that merely says that the parties “agree to agree” on renewal terms at a later stage could be dangerous.

For example, you’ve been renting the premises for $18,000 per month (escalating at a fixed % per year for the initial rental term) for 5 years. Your renewal clause states that you have the right to renew and that the new rental period and rental shall be agreed on in writing between the landlord and the tenant at the time of renewal.

When you give the landlord notice that you would like to renew, he agrees to renewal but at $120,000 per month. Where does that leave you? You could argue that it is unfair and that you could fight him in court, but will it be worth the legal cost? After all, the court might say that you expressly agreed to that clause!

Avoid an “agreement to agree” clause at all costs. Your renewal clause must be drafted with great care. At the very least, the agreement should give you a basic sense of what you can potentially expect to pay in rental fees should you decide to renew.

Compliance clause

The lease will generally require you to comply with state and federal laws. For example, the Americans With Disability Act requires all businesses that are open to the public or that employs more than 15 people to have premises that are accessible to disabled people. If this applies to your business and you signed the compliance clause, you will be responsible to make the premises compliant with the Act, and pay for any modifications such as ramps or wider doorways, if it didn’t comply before.

Make sure that the premises are indeed in compliance with all relevant laws and regulations at the commencement of the lease period, before you sign to agree to keep it in compliance with the law. Ask the landlord for a warranty that the premises are in compliance and include the warranty in your lease agreement.


The above-mentioned pitfalls are only a few of the issues that tenants must look out for when signing a commercial lease agreement. It is very important to understand all the legal implications of every clause in your agreement.

While you may not be able to understand many of the terms in such an agreement, this is exactly why it is always a good idea to speak with a lawyer to help you understand what you are getting into, before signing any lease agreement. The future and success of your business might depend on it.

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Dump your stuff now, before you die

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Who amongst us wouldn’t like to feel lighter, freer, less encumbered? I would!

Maybe due to my time dealing with death as a healthcare professional, being an older U.S. Peace Corps volunteer in Africa, or because of the “gypsy year” I’m in right now, I am convinced we don’t need most of what we think we do.

How many of us default to storage units when our home becomes too crowded? How old are the condiments we’re not using in our refrigerator? What’s the inside of our car look like?

When will we rid ourselves of all this extra? Or will we? Dump your stuff now, before you die.

So many folks don’t and then it’s their survivors who are stuck dealing with it. Think about it (and, this is usually the toughest part, thinking about it); for many of us, it’s hard enough initially to simply exist after a loved one’s death.

Even when people die well, there’s a lot to do — in addition to grappling with the grief and loss.

I am not necessarily saying you need to sign up with Marie Kondo, join The Minimalists or have your home feng shui’d. All these, though, are great strategies.

Marie Kondo touts there is merit in only keeping what brings us joy. “Living meaningful lives with less” as The Minimalists,Joshua Fields Millburn and Ryan Nicodemus, purport is right on. And, feng shui, with its harmonizing principles of energy and flow, really does change an environment; thereby, its dwellers, too.

However, I do encourage you to consider the following:

Talk to your loved ones about what’s important to you and why you want to leave particular items to them. This might open a wider conversation about what’s of value to them also.

As much as you would like someone to have something, that person may not want it. Remember the adage, “One man’s treasure is another man’s trash?” Once known, you may feel freer to let things go. Take photos, if you must, before releasing. Be sure to document the details regarding what’s left.

Come up with a “clear the clutter” plan of action. If you have storage units, get some help and schedule a blitz. I had one client with five, large, non-climate-controlled units bursting at the brim with expensive antiques rotting away in the Texas heat. We did manage to get the antiques moved and reduce the units by half before her sudden, untimely death.

Maybe start smaller to get the momentum going. Clear out your pantry, your junk drawer or the trunk of your car. Take the drill off the top of the refrigerator and put it back in the garage (true story!).

Then, keep at it. Like the 1906 Story of the Engine That Thought It Could by Charles S. Wing, repeat to yourself, “I think I can, I think I can , I think I can…”

Envision the endgame and what it will be like when you’ve accomplished this endeavor. Tap into it with all your senses: see it, feel it, hear it, smell it, taste it.

Imagine living your life unburdened, traveling so much lighter. For me, it’s to only have what’s exquisite and essential around me. I’m keeping this image front and center as I sort through paper piles and discard old baggies.

Don’t wait any longer to reduce your footprint. Relieve your survivors before you can’t. I repeat, “Dump your stuff now, before you die.” Everybody benefits.

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How the coronavirus outbreak and political unrest are impacting global tourism

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The Associated Press has reported that the new coronavirus outbreak originating in Wuhan, China, has severely affected global tourism, leading to billions of dollars in losses.

The virus has infected nearly 3,000 people, killed 81, and has left the Chinese government with no choice but to expand drastic travel restrictions. Beijing has ordered millions of Chinese citizens to stay put and avoid travel. Outbound and inbound tourism are hugely impacted.

According to the China Outbound Tourism Research Institute, 7 million Chinese people were to be traveling from China to various global destinations during the Lunar New Year. It seems that the tourism industry will now see the vast majority of those stay put to contain the epidemic. Hong Kong announced that it would restrict visitors from mainland China to prevent the spread of the coronavirus.

The Lunar New Year is the reason for one of the biggest travel seasons in Asia, but this year tourism in the region is not looking as rosy. It has also been affected by the ongoing anti-government protests in Hong Kong and other parts of the world. Hong Kong International Airport has seen a 16% drop in footfalls from the year before, losing close to 1 million passengers. International tourism to the former British colony has plummeted by 40%.

Another popular destination, the self-governed island of Taiwan, has also witnessed a drop in tourists from mainland China. Elsewhere in Asia, popular tropical destination Thailand has witnessed a fall in Asian tourists after several boating accidents raised questions about the safety standards of tour operators. Now, with the spread of the coronavirus, the Thais are looking at a revenue loss of $1.6 billion.

Europe is a popular international destination for Chinese tourists, especially Italy and the U.K. The trade war between the U.S. and China has already affected travel from China to the U.S., and now the virus will add to the woeful figures.

Tourism in other areas of the world is taking a massive hit due to political and economic unrest in some countries. Lebanon’s economic crisis has the country heading toward financial bankruptcy. As the crisis intensified, businesses have been paralyzed. The hospitality sector, which is one of the main pillars of the Lebanese economy, is facing maximum heat.

Hotel occupancy is plummeting, restaurants are closing, and tour operators, like their fellow businessmen, are running at a massive loss. Political unrest has resulted from decades-long corruption and mismanagement, coming to a head with new proposed taxes. Increased road closures and strikes are keeping tourists away.

In Chile, the tourism sector is bracing for a hard year of losses amid social and political unrest. December to March is the South American country’s annual peak tourist season, but this year the industry expects to see a whopping 38.2% plunge in the number of visitors. Nearby Argentina is Chile’s primary source of tourists, but its crippling economic crisis has affected outbound travel, too.

India’s tourism industry has taken a hit due to the ongoing protests against the Citizenship Amendment Act, an economic slowdown, and the Thomas Cook collapse. Multiple countries, including the U.K., U.S., Canada, Singapore, Russia, and Taiwan, among others, have issued travel advisories.

The Taj Mahal, one of the world’s most popular tourist attractions, witnessed a decline of close to 200,000 tourist footfalls, or a 60% decline, last December, per a Reuters report. Global governments have cautioned their citizens to refrain from visiting or be careful while visiting the country. Tourist groups that have already booked are cutting their trips short, leading to more lost revenue.

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What emergency departments need to know about coronavirus

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First reported in late December 2019 in the major central China city of Wuhan, the newly discovered coronavirus (2019-nCoV) is now rapidly spreading. As of Jan. 28, thousands have been sickened and the death toll exceeds 100. Eighteen countries, including the United States have confirmed 2019-nCoV cases. Four U.S. states — Illinois, Washington, California, and Arizona — report cases of the virus.

There is a possible zoonotic origin to the outbreak. Most patients in the Wuhan outbreak have an epidemiological link to the Huanan Seafood Wholesale Market, a large seafood and animal market, according to early reports by Chinese health authorities. However, a description of the first clinical cases published in The Lancet on Jan. 24 challenges that link.

2019-nCoV is in the same family of viruses as Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV).

Diagnosis and Treatment of 2019-nCoV

The CDC recommends that clinicians treat patients with fever and symptoms of lower respiratory illness who have a history of travel in Wuhan, or who were in close contact with a person suspected of having 2019-nCoV, as being patients under investigation (PUI).

While routes of transmission are still undetermined, healthcare providers should request that patients under investigation for 2019-nCoV wear surgical masks. Practitioners should conduct investigations in a private exam room with the door closed — ideally in an airborne infection isolation room.

All personnel entering the room should exercise standard precautions, contact precautions, and airborne precautions. Eye protection in the form of goggles or a face shield is recommended.

Healthcare providers should gather a detailed travel history for febrile patients with respiratory symptoms. For symptomatic patients who had been in China since Dec. 1, 2019, and had onset of symptoms within two weeks of leaving, healthcare providers should consider 2019-nCoV and notify infection control and local or state health department.

Upon notification, the health department should contact CDC’s Emergency Operations Center (EOC) at 770-488-7100. Health department officials should also complete a 2019-nCoV PUI case investigation form in either a .pdf or a Microsoft word format.

The EOC will guide health departments in the collection, storage, and shipment of specimens to the CDC, even during afterhours or on weekends and holidays. Only the CDC provides diagnostic testing for 2019-nCoV at this time.

Specifically, the CDC warns “For biosafety reasons, it is not recommended to perform virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI for 2019-nCoV.”

The CDC provides recommendations of the collection and testing to increase the likelihood of detecting 2019-nCoV infection. Practitioners should collect and test multiple specimens of all three specimen types — lower respiratory, upper respiratory, and serum specimens — from different sites. Stool, urine, and other specimen types may be stored. Clinicians should collect specimens as soon as possible after identifying a PUI, regardless of symptom onset time.

There is limited information characterizing the spectrum of illnesses associated with this virus. No vaccine or specific treatment is currently available. The CDC recommends that travelers avoid unnecessary trips to China, and suggests those who have traveled to China and are symptomatic seek medical care, and avoid contact with others. Care for 2019-nCoV is supportive.

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New resources in precision medicine that every doctor should know about

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Precision medicine, or personalized medicine as it is sometimes referred to, is a most significant and promising healthcare trend. The National Institutes of Health (NIH) defines precision medicine as an individualized plan that uses a patient’s genetic makeup and their environment and lifestyle to deliver the right preventative advice or targeted disease treatment.

For example, precision medicine as it applies to cancer treatment might encompass:

  • testing a patient’s cancer to analyze its specific features;
  • studying a patient’s genetics to choose specific and appropriate meds that might work alone, or in tandem with other medications; and
  • doing individualized genetic testing to look for tumor markers.

The NIH has also started an ambitious research program designed to advance the study and applications involved in precision medicine, which can have positive ramifications for the future of medicine as a whole. The Precision Medicine Initiative is geared toward learning how genetics, environment, and lifestyle can help determine the best approach to prevent or treat disease.

Through the initiative, for example, scientists at the National Cancer Institute hope that further study of the disease’s genetics and biology will lead to better life-extending treatments. The initiative’s All of Us Research Program is also using the health data of approximately 1 million volunteers to study many other diseases, and improve prevention, diagnosis, and treatment stats.

Precision medicine has such a huge range of potential applications that the sky is literally the limit in terms of how it may help doctors treat virtually any disease in the future.

But right now, there are several exciting developments that you, as a physician or hospital administrator, should know about and investigate further to see if they may be appropriate for your patients’ needs. These developments include:

New drug therapy that zooms in on underlying causes.

The Centers for Disease Control has highlighted the fact that that a new small molecule drug, ivacaftor, is improving the outcomes of cystic fibrosis (CF) patients by closely targeting the specifics of why an individual patient has CF, as opposed to treating its symptoms.

Early administration of this therapy has greatly reduced the need for inpatient hospital stays and allowed patients to improve.

Cascade screening.

The CDC has also highlighted cascade screening, which means a healthcare team contacts the family members of patients with a range of conditions to interview them about and inform them about the hereditary implications of the illness they may all eventually deal with.

Then, patients who wish to be screened for genetic markers or a disease itself can do so. The information that doctors learn from a patient’s relative can then be applied to treating the original patient. It’s extremely important to take issues of consent and privacy into account in terms of this approach, but if done right, the benefits to patients and their families can be invaluable.

Easily accessible research information.

MD Anderson has set up a personalized care therapy resource website, through which any doctor can look up information on a diagnosed genetic marker and find cutting-edge info on clinical trials, disease mutations, and tumor profiling. Patients working with their doctors to better understand their conditions can use the website, too.

It’s vitally important to keep up with precision medicine developments in your specialty fields and apply what is available for you as a physician or administrator right now. With precision medicine, you lengthen a patient’s odds for a better outcome in so many potential ways. Just as important is that precision medicine can change the way your patients view their disease(s).

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The cost of changing jobs

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What is the cost of changing jobs? Make no mistake, there is always a cost involved that has nothing to do with salary.

Gone are the days when the norm was to work one job at one company until retirement. We have a much more mobile workforce with more opportunities, and people change jobs often to avail themselves of perceived advantages, better pay, and better work-life balance.

But sometimes when you change jobs, the benefits don’t materialize as you’d expected, and regrets ensue.

So, the challenge is to accurately evaluate whether the perceived payoffs will become reality and if they’re worth the cost of changing jobs.

Early in my career, I accepted a position in management with a great salary. I thought this was an ideal job. Wrong.

I didn’t fully assess the cost of this employment. I hadn’t studied their mission statement, which would have flashed a neon warning that our values were not aligned and would become a daily, stress-filled battle. The job was a full hour’s drive away in gridlock traffic, which consumed two hours of my “leisure” life. To get to work on time, I had to drop my infant daughter at the babysitter’s by 5a.m., and it was dark when I picked her up at night; she thought I was the babysitter and the babysitter her mother. Then there was the cost of childcare.

When all these negatives finally converged, I realized this “great” job cost too much in terms of quality of life and the quality of relationship with my child.

So when you consider accepting a new job, think of how it will affect your home life. Take off the rose-colored glasses and think brutally. Does it require too much time away from family? Money is no substitute for rewarding family relationships, so don’t assume that your family wants things more than it wants you.

What about your quality of life? Are you going to be spending much of your off hours sitting in a car in traffic? What about the cost of commuting—for example, fuel and time? Even if you’re keen on audiobooks, that still limits any time you can spend with friends going to the theatre, to a concert, to a pub, to the bowling alley. Is this job worth the cost of impairing your social network?

Don’t diminish the cost of leaving familiar co-workers—even the annoying ones because there are always more annoying co-workers in a future job. One co-worker has the latest jokes; another has the latest grapevine news, and there’s the one who always makes you smile with his music trivia. There’s also the familiarity of a routine—mundane things like where and when you take your breaks or eat your lunch and with whom.

There’s a loss in leaving familiar co-workers and routines behind. This is why “comfort food” is comforting—because it’s familiar and filled with memories. When you leave a job, you’ll be out of your comfort zone, learning new things, acclimating to new people, establishing new routines. Until the new becomes old, there will be a cost to pay for the loss of familiarity.

And, of course, leaving your comfort zone can make you anxious. How well do you cope with anxiety and the stress of the unknown? Don’t underestimate the mental resources needed to cope successfully with your new challenges. And again, the stress you face will likely impact your family as well.

If a higher salary is the reason for your change, then how much more will you reasonably earn? Not just the salary on paper, but the real cost? That supposedly great job early in my career? After I’d calculated the costs of fuel, time, babysitter, special clothes, I figured I was sacrificing all that was important to me for only a few hundred dollars per month! Not worth it.

How many more hours per week will you be working to earn this higher salary? On a per hour basis, is it as much as you’d expected?

I remember one co-worker changing jobs because he’d been offered two dollars more per hour, which sounded like a hefty pay increase to him. What he did not factor in was his total pay and benefits he was exchanging. He didn’t consider that he was contracting to work fewer hours per month, and in the process, lost his medical benefits.

The upshot was that his two dollar an hour pay increase actually caused him to lose pay to the tune of $500 per month! Not a smart financial move. So if pay is a major consideration in your next career move, make sure you compute actual take-home pay, not a theoretical pay raise.

It’s not that you should never take another job. The upshot is that you need to fully consider all the costs of changing employment and analytically decide whether the cost is worth the rewards.

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