med monthly august 2013

AUGUST 2013

CodeHeart Video App Could Revolutionize Prehospital Medicinepg. 48

Med MonthlyMed Monthly

the First

Responders

issue

Varied Quality of CPR Among EMS, Hospitals

Hurts Survivalpg. 44

How to Improve Efficiency and Empower

Crew Memberspg. 40

Top 9 ReasonsPeople Call First Responders

pg. 78

contents40 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

legal34 CONTINUING TO IMPLEMENT THE ACA IN A CAREFUL, THOUGHTFUL MANNER36 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 arts50 ART SEARCHING TO THE HEART

healthy living54 CHOCOLATE CHIA PUDDING

features

in every issue4 editor’s letter8 news briefs

60 resource guide78 top 9 list

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

50international26 IMPLEMENTING A COLLABORATIVE MODEL TO ACCELERATE THE DEVELOPMENT OF REGIONAL HEALTHCARE

research and technology28 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

44

ART SEARCHINGTO THE HEART

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VARIED QUALITY OF CPR AMONG EMS, HOSPITALS HURTS SURVIVAL

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4 | AUGUST 2013

editor’s letter

August’s issue ushers in new ways that First Responders can improve the way they work. From revolutionizing technol-ogy 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 emergen-cies. 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 situ-ations 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 Care-less, “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 vaca-tion 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 vacil-late 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 cor-rect. 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.

Managing Editor

Ashley Austin

Med Monthly

Publisher

Managing Editor

Creative Director

Staff Writer

Contributors

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

August 2013

P.O. Box 99488Raleigh, NC 27624

[email protected]

Online 24/7 at medmonthly.com

contributors

Philip Driver

Ashley Austin

Thomas Hibbard

Ashley Warburton

Ashley Acornley, MS, RD, LDNChuck BuckJames CarelessBrandon K. JohnsonAmanda KanaanDr. Molly Leavitt, D.C.Laura MaaskeMark J. MazurPeter S. ReichertzNisha Salim

MEDMONTHLY.COM |5

Laura Maaskeis a medical illustrator with a Mas-ter's of Science degree in Biomedi-cal Visualization from the University of Toronto. She launched Medim-agery in 1997, specializing in the creation of patient education ma-terials, 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 [email protected] or call 262.308.1300.

Amanda Kanaan is the owner/founder of WhiteCoat Designs – an online marketing agency committed to growing doctors’ practices through cost-effective and powerful online marketing solutions. Amanda regu-larly 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 [email protected] or http://www.whitecoat-designs.com.

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 [email protected] or at (502) 327-5400.

Molly Leavitt, D.C. is a chiropractor is Raleigh, NC and strongly advocates teaching patients the responsibility of self-care. One of her primary areas of concern is the obesity epidemic that affects patients physically, emotionally and financially.

Nisha Salim is a freelance writer who specializes in writing factually accurate, re-search-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.

Creative Director

Thomas Hibbard

6 | AUGUST 2013

designer's thoughts

“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, pseudony-mous 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 prac-tices, hospitals and first responders.

Agfa Healthcare has developed the newest in its Direct Radi-ography (DR) detectors, the DX-D 35C, an 11 X 14 inch wire-less 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 cap-tures and transmits the high quality images to the workstation, increasing efficiency for the technologist, particularly in por-table 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 Sci-ences states, “MultiOmyx uniquely facilitates the ability to vi-sualize 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 revo-lution of iPads and tablets that offer a depth and a tactile expe-rience 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 [email protected].

From the Drawing Board

Med Monthly Welcomes New Staff WriterAshley 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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8 | AUGUST 2013

news briefs

Evolving technologies and market forces reveal that digi-tal 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 pe-riod. 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 Se-nior Research Analyst Divyaa Ravishankar. “They are look-ing 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 motivat-ing greater demand for digital pathology systems. On their part, vendors are designing high throughput scanners that will meet these ever heavier workloads.

Large-Scale Switch to Digital Pathology Systems Anticipated

COMING SOON

IN MED MONTHLY

In the upcoming

September 2013 issue,

Med Monthly’s theme

will be the

Magic of Referrals

Digital pathology will enable academicians and profes-sionals 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 im-ages, 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 standardi-sation in digital pathology have been hard to achieve due to the image formats and complex workflows involved. Strategic partnerships will be essential to pushing mar-ket growth. Vendors who provide one or two components for the entire digital pathology portfolio will need to iden-tify 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 show-cased to end users.”

Source: http://www.newswiretoday.com/news/130001/

MEDMONTHLY.COM |9

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 particu-larly 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 detec-tor 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 or-thopaedic 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 sys-tem 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-new-small-format-wireless-flat-panel-detector-agfa-healthcare-fulfils-important-imaging-ma

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.

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ACIPHEX CAN EASEHEARTBURN PAIN FROMBECOMING AN ISSUE

New Small Format, Wireless Flat Panel Detector From Agfa HealthCare Fulfils Important

Imaging Market Need

10 | AUGUST 2013

insight

Deaths From Prescription Painkiller Overdoses Rise Sharply Among Women

CDC study shows emergency department visits also on the rise among women

MEDMONTHLY.COM |11

The 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 pain-killer 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-the-counter 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 (1-800-222-1222) 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

12| AUGUST 2013

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

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 estrogen-based 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

insight

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

NIH-funded study finds neitherbenefit 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

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 Wyeth-Ayerst 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

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.

By Nisha SalimNishaSalim.com

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. Elder-proof the home to minimize the risk of injuries that patients may suffer due to falls. Replace rugs with non-skid 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.

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.

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

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.

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.

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

18 | AUGUST 2013

practice tips

So 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%ofphysicianshavewebsitesbutonly33%ofthem

have anything more than biographical and practice information on it;

• Only4%madeatleastoneblogpostinthepast12months 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

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

MEDMONTHLY.COM |19

By Amanda KanaanPresident, 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.

20| AUGUST 2013

by Chuck BuckPublisher, ICD10monitor.com

Congress Advised Not to Delay ICD-10 Implementation

practice tips

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&view=article&id=968:congress-advised-not-to-delay-icd-10-implementation&catid=48:icd10-enews&Itemid=168

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The Gross revenue is over $1,500.000 during 2012 with consistent high revenue numbers for the past several years. The average number of patients seen daily is between 26 and 32 with room for improvement. You will find this Med Spa to be in a highly visible location with upscale amenities. The building is leased and the lease can be assigned or restructured. Highly profitable and organized, this spa POISED FOR SUCCESS.

practice tips

22 | AUGUST 2013

Easily AddRevenue

To YourPractice

By Dr. Molly Leavitt, D.C.

MEDMONTHLY.COM |17

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 physi-cian 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

24 | AUGUST 2013

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C isco and the United Foun-dation for Children’s Health (UFCH) have jointly an-nounced the launch of a

“Connected Healthy Children China Program.” In addition to a cash dona-tion of RMB 1 million to the program, Cisco has also deployed its collabora-tion 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

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-launch-connected-healthy-children-china-program

MEDMONTHLY.COM |27

Implementing a Collaborative Model

to Accelerate the Development of

Regional Healthcare, While Benefitting

Underserved Children

28 | AUGUST 2013

research & technology

Altered Protein Shapes May Explain Differences in Some

Brain Diseases

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

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.,

NIH-funded study finds that various strains ofalpha-synuclein have diverse effects in neurons

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 alpha-synuclein 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 alpha-synuclein 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.htmhttp://www.ninds.nih.gov/disorders/dementiawithlewybodies/dementiawithlewybodies.htm

Source: http://www.nih.gov/news/health/jul2013/ninds-03.htm

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30 |AUGUST 2013

Clarient, A GE Healthcare Company, Introduces First

Lab Developed TestTo Assess Multiple

Proteins atSingle-Cell Level

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GE Healthcare today announced the introduction by Clarient Diagnostic Services, a GE Healthcare Company, of the first lab developed test using MultiOmyx™, a ground-breaking 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-ge-healthcare-company-introduces-first-lab-developed-test-assess-multiple-proteins-single-c


32 |AUGUST 2013

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.

“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 one-time 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 value-added 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 & SullivanFrost & 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.


SMBG Suppliers Look to Tap the Huge Underpenetrated Diabetic Population in Asia-Pacific

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Continuing to Implement the ACA in a Careful, Thoughtful Manner

By Mark J. MazurAssistant Secretary for Tax Policy,U.S. Department of the Treasury

34 | AUGUST 2013

legal

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. Real-world 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-to-Implement-the-ACA-in-a-Careful-Thoughtful-Manner-.aspx

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36 | AUGUST 2013

legal

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.

Weight For It:How Will the

American Medical Association’s (AMA) New Decision Affect

Employers?

By Brandon K. JohnsonMcBrayer, McGinnis, Leslie and Kirkland, PLLC

MEDMONTHLY.COM |37

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:• Hasaphysicalormentalcondition

that substantially limits a major life activity (such was walking, talking, learning, seeing); or,

• Hasahistoryofadisability;or,• Isperceivedtohaveaphysical

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 ADA-protected 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

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-how-will-the-amas-new-decision-affect-employers/

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

‘‘

legal

38 |AUGUST 2013

On June 24, 2012, the U.S. Supreme Court handed down its decision in Mutual Pharma-ceutical 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 in-novator drug labeling precisely in order to obtain approval of their products by the U.S. Food and Drug Administra-tion (“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-

A Short-Lived Victory for Generic Drug Manufacturers?

By Peter S. Reichertz,Partner With Sheppard,

Mullin, Richter & Hampton, LLP

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

A Short-Lived Victory for Generic Drug 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 FDA-approved 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-lived-victory-generic-drug-manufacturers

MEDMONTHLY.COM |39

40 | AUGUST 2013

features

HOW TO IMPROVE EFFICIENCY AND EMPOWERCREW MEMBERS

By EMSWorld.com

MEDMONTHLY.COM |41

This medical air transport agency, in three Northwest U.S. states, has taken its employee

scheduling and workforce management abilities to new heights


W ith multiple locations and over 200 employ-ees 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

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-to-improve-efficiency-and-empower-crew-members

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“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.”

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features

44 | AUGUST 2013

Varied Quality of CPR Among EMS, Hospitals Hurts Survival

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.

By the American Heart Association

MEDMONTHLY.COM |45

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:

• Minimizeinterruptionstochestcompressions.Compressionsgeneratebloodflowandshouldbe delivered more than 80 percent of the time the patient doesn’t have a pulse.

• Providetherightrateofcompressions—100to120perminuteareoptimalforsurvival.• Givedeepenoughcompressions—atleast2inchesforadultsandatleast1/3thedepthofthe

chest in infants and children.• Allowthechesttobouncebackcompletelysotheheartcanrefill.• Givenomorethan12rescuebreathsaminute,withthechestjustvisiblyrising,sopressure

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:

• HealthandemergencycareprovidersgatherdataonthequalityofCPRdeliveryandpatientresponse at the scene.

• Ifpossible,anexperiencedteamleadershouldoverseeandevaluatethequalityofCPRtoensure guidelines are followed, patient needs addressed and other problems limited (such as rescuer fatigue).

• Toensurequalityimprovement,providers,managers,institutionsandsystemsofcareshoulddo 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?preview=947961b64b4a75ca1a9c35caa7a0c3e1

Source: http://newsroom.heart.org/news/varied-quality-of-cpr-among-ems-hospitals-hurts-survival


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 scenario-based training. The findings also showed that high-quality 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 real-time 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

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 ArrestSCA, 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 CorporationZOLL 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.



46 |AUGUST 2013

48 | AUGUST 2013

features

By James CarelessEMSWorld.com

CODEHEART VIDEO APP COULD

REVOLUTIONIZE PREHOSPITAL

MEDICINE

MEDMONTHLY.COM |49

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.

Genesis 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-

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.

Today’s Version, and What It Means for EMS 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/product-review-codeheart-video-app-could-revolutionize-prehospital-medicine

CodeHeart app allows users to shoot high-quality video of charts, instruments, patients or indeed anything else

that is relevant to a medical diagnosis.

the arts

50 | AUGUST 2013

Art Searchingto theHeart

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.

By

MEDMONTHLY.COM |51

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.

When I tell people I am a medi-cal illustrator, I might hear a re-sponse 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 mid-dle 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 wonder-ment at how I might possibly capture both, to think like an artist and to think like a scien-tist, in one reach. Continuing in my practice, this reach be-comes broader with time, at both edges.

Science is Beautiful and Art is Process


Laura’s Website - www.medimagery.com

52 | AUGUST 2013

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 [email protected] or call 262.308.1300.

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

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.


MEDMONTHLY.COM |53

Medimagery Medical Illustration & [email protected]://www.medimagery.com/http://www.linkedin.com/in/lauramaaskehttp://twitter.com/#!/Medimageryhttp://www.facebook.com/Medimageryhttp://www.facebook.com/laura.maaskehttp://medillsb.com/ArtistPortfolioThumbs.aspx?AID=4115

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

healthy living

54 | AUGUST 2013

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)

Chocolate Chia Pudding Servings: 2 servings

Ingredients:• 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:Per Serving

123 calories52 calories from fat6.2g total fat0mg cholesterol17.9mg sodium,243.3mg potassium12.2g carbohydrates8.8g fiber2g sugar7g protein

By Ashley Acornley, MS, RD, LDN

MEDMONTHLY.COM |55

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

Arizona1400 W. Washington, Rm. 230Phoenix, AZ 85007(602)542-3095http://www.do.az.gov

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

California2005 Evergreen St., Ste. 1200Sacramento, CA 95815(916)263-2382www.medbd.ca.gov

Colorado1560 Broadway St. #1310Denver, CO 80202(303)894-7750http://www.dora.state.co.us/optometry/

Connecticut410 Capitol Ave., MS #12APPP.O. Box 340308Hartford, CT 06134(860)509-7603 ext. 4http://www.dph.state.ct.us/

Florida4052 Bald Cypress Way, Bin C08Tallahassee, FL 32399(850)245-4474doh.state.fl.us

Georgia237 Coliseum Dr.Macon, GA 31217(478)207-1671www.sos.state.ga.us

HawaiiP.O. Box 3469Honolulu, HI 96801(808)[email protected]

Idaho450 W. State St., 10th FloorBoise , ID 83720(208)334-5500 www2.state.id.us/dhw

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

Massachusetts239 Causeway St.Boston, MA 02114(617)727-5339http://1.usa.gov/zbJVt7

NevadaP.O. Box 70503Reno, NV 89570(775)853-1421http://nvbdo.state.nv.us/

New Hampshire129 Pleasant St.Concord, NH 03301(603)271-5590www.state.nh.us

New JerseyP.O. Box 45011Newark, NJ 07101(973)504-6435http://www.njconsumeraffairs.gov/ophth/

New York89 Washington Ave., 2nd Floor W.Albany, NY 12234(518)402-5944http://www.op.nysed.gov/prof/od/

North CarolinaP.O. Box 25336Raleigh, NC 27611(919)733-9321http://www.ncoptometry.org/

Ohio77 S. High St.Columbus, OH 43266(614)466-9707http://optical.ohio.gov/

Oregon3218 Pringle Rd. SE Ste. 270Salem, OR 97302(503)373-7721 www.obo.state.or.us

Rhode Island3 Capitol Hill, Rm 104Providence, RI 02908(401)222-7883http://sos.ri.gov/govdirectory/index.php? page=DetailDeptAgency&eid=260

South CarolinaP.O. Box 11329Columbia, SC 29211(803)896-4665www.llr.state.sc.us

TennesseeHeritage Place Metro Center227 French Landing, Ste. 300Nashville, TN 37243(615)253-6061http://health.state.tn.us/boards/do/

TexasP.O. Box 149347Austin, TX 78714(512)834-6661www.roatx.org

Vermont National Life Bldg N FL. 2 Montpelier, VT 05620(802)828-2191http://vtprofessionals.org/opr1/opticians/

Virginia3600 W. Broad St.Richmond, VA 23230(804)367-8500www.state.va.us/licenses

Washington300 SE Quince P.O. Box 47870Olympia, WA 98504(360)236-4947http://www.doh.wa.gov/LicensesPermit-sand Certificates/ProfessionsNewRene-worUpdate/DispensingOptician.aspx

U.S. DENTAL BOARDSAlabamaAlabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244(205) 985-7267http://www.dentalboard.org/

AlaskaP.O. Box 110806Juneau, AK 99811-0806(907)465-2542http://bit.ly/uaqEO8

Arizona4205 N. 7th Ave. Suite 300Phoenix, AZ 85103(602)242-1492http://azdentalboard.us/ Arkansas101 E. Capitol Ave., Suite 111Little Rock, AR 72201(501)682-2085http://www.asbde.org/

California2005 Evergreen Street, Suite 1550 Sacramento, CA 95815877-729-7789http://www.dbc.ca.gov/

Colorado1560 Broadway, Suite 1350Denver, CO 80202(303)894-7800http://www.dora.state.co.us/dental/

Connecticut410 Capitol Ave. Hartford, CT 06134(860)509-8000http://www.ct.gov/dph/site/default.asp

DelawareCannon Building, Suite 203861 Solver Lake Blvd.Dover, DE 19904(302)744-4500http://1.usa.gov/t0mbWZ

Florida4052 Bald Cypress WayBin C-08Tallahassee, FL 32399 (850)245-4474http://bit.ly/w1m4MI

Georgia237 Coliseum DriveMacon, GA 31217(478)207-2440http://sos.georgia.gov/plb/dentistry/

HawaiiDCCA-PVLAtt: DentalP.O. Box 3469Honolulu, HI 96801(808)586-3000http://1.usa.gov/s5Ry9i

IdahoP.O. Box 83720Boise, ID 83720(208)334-2369http://isbd.idaho.gov/

Illinois320 W. Washington St.Springfield, IL 62786(217)785-0820http://bit.ly/svi6Od

Indiana402 W. Washington St., Room W072Indianapolis, IN 46204(317)232-2980http://www.in.gov/pla/dental.htm

Iowa400 SW 8th St. Suite DDes Moines, IA 50309(515)281-5157http://www.state.ia.us/dentalboard/

Kansas900 SW Jackson Room 564-STopeka, KS 66612(785)296-6400http://www.accesskansas.org/kdb/

Kentucky312 Whittington Parkway, Suite 101Louisville, KY 40222(502)429-7280http://dentistry.ky.gov/

Louisiana365 Canal St., Suite 2680New Orleans, LA 70130(504)568-8574http://www.lsbd.org/

Maine143 State House Station161 Capitol St.Augusta, ME 04333(207)287-3333http://www.mainedental.org/

Maryland55 Wade Ave.Catonsville, Maryland 21228(410)402-8500http://dhmh.state.md.us/dental/

Massachusetts1000 Washington St., Suite 710Boston, MA 02118(617)727-1944http://www.mass.gov/eohhs/gov/de-partments/dph/programs/hcq/dhpl/dentist/

MichiganP.O. Box 30664Lansing, MI 48909(517)241-2650http://www.michigan.gov/lara/0,4601,7-154-35299_28150_27529_27533---,00.html

Minnesota2829 University Ave., SE. Suite 450Minneapolis, MN 55414(612)617-2250http://www.dentalboard.state.mn.us/

Mississippi600 E. Amite St., Suite 100Jackson, MS 39201(601)944-9622http://bit.ly/uuXKxl

Missouri3605 Missouri Blvd.P.O. Box 1367Jefferson City, MO 65102(573)751-0040http://pr.mo.gov/dental.asp

MontanaP.O. Box 200113Helena, MT 59620(406)444-2511http://bsd.dli.mt.gov/license/bsd_boards/den_board/board_page.asp

56 | AUGUST 2013

OhioRiffe Center77 S. High St.,17th FloorColumbus, OH 43215(614)466-2580http://www.dental.ohio.gov/

Oklahoma201 N.E. 38th Terr., #2Oklahoma City, OK 73105(405)524-9037http://www.dentist.state.ok.us/

Oregon1600 SW 4th Ave. Suite 770Portland, OR 97201(971)673-3200http://www.oregon.gov/Dentistry/

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

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

South CarolinaP.O. Box 11329Columbia, SC 29211(803)896-4599http://www.llr.state.sc.us/POL/Dentistry/ South DakotaP.O. Box 1079105. S. Euclid Ave. Suite CPierre, SC 57501(605)224-1282https://www.sdboardofdentistry.com/

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

Texas333 Guadeloupe St. Suite 3-800Austin, TX 78701(512)463-6400http://www.tsbde.state.tx.us/

Utah160 E. 300 SouthSalt Lake City, UT 84111(801)530-6628http://1.usa.gov/xMVXWm

VermontNational Life BuildingNorth FL2Montpelier, VT 05620(802)828-1505http://bit.ly/zSHgpa

VirginiaPerimeter Center9960 Maryland Dr., Suite 300Henrico, VA 23233(804)367-4538http://www.dhp.virginia.gov/dentistry

Washington310 Israel Rd. SEP.O. Box 47865Olympia, WA 98504(360)236-4700http://www.doh.wa.gov/LicensesPermit-sandCertificates/ProfessionsNewRene-worUpdate/Dentist.aspx West Virginia1319 Robert C. Byrd Dr.P.O. Box 1447Crab Orchard, WV 258271-877-914-8266http://www.wvdentalboard.org/

WisconsinP.O. Box 8935Madison, WI 537081(877)617-1565http://dsps.wi.gov/Default.aspx?Page=90c5523f-bab0-4a45-ab94-3d9f699d4eb5 Wyoming1800 Carey Ave., 4th FloorCheyenne, WY 82002(307)777-6529http://plboards.state.wy.us/dental/index.asp

MEDMONTHLY.COM |57

Nebraska301 Centennial Mall SouthLincoln, NE 68509(402)471-3121http://dhhs.ne.gov/publichealth/Pages/crl_medical_dent_hygiene_board.aspx

Nevada6010 S. Rainbow Blvd. Suite A-1Las Vegas, NV 89118(702)486-7044http://www.nvdentalboard.nv.gov/

New Hampshire2 Industrial Park Dr. Concord, NH 03301(603)271-4561http://www.nh.gov/dental/

New JerseyP.O Box 45005Newark, NJ 07101(973)504-6405http://bit.ly/uO2tLg New MexicoToney Anaya Building2550 Cerrillos Rd.Santa Fe, NM 87505(505)476-4680http://www.rld.state.nm.us/boards/Den-tal_Health_Care.aspx

New York89 Washington Ave.Albany, NY 12234(518)474-3817http://www.op.nysed.gov/prof/dent/

North Carolina507 Airport Blvd., Suite 105Morrisville, NC 27560(919)678-8223http://www.ncdentalboard.org/

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

AlabamaP.O. Box 946 Montgomery, AL 36101 (334)242-4116http://www.albme.org/

Alaska550 West 7th Ave., Suite 1500Anchorage, AK 99501(907)269-8163http://bit.ly/zZ455T

Arizona9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258(480)551-2700http://www.azmd.gov

Arkansas1401 West Capitol Ave., Suite 340Little Rock, AR 72201(501)296-1802http://www.armedicalboard.org/

California2005 Evergreen St., Suite 1200Sacramento, CA 95815(916)263-2382 http://www.mbc.ca.gov/

Colorado1560 Broadway, Suite 1350Denver, CO 80202(303)894-7690http://www.dora.state.co.us/medical/

Connecticut401 Capitol Ave. Hartford, CT 06134(860)509-8000http://www.ct.gov/dph/site/default.asp

DelawareDivision of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904(302)744-4500http://dpr.delaware.gov/

District of Columbia899 North Capitol St., NE Washington, DC 20002 (202)442-5955http://www.dchealth.dc.gov/doh

Florida2585 Merchants Row Blvd.Tallahassee, FL 32399(850)245-4444http://www.stateofflorida.com/Portal/DesktopDefault.aspx?tabid=115

Georgia2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913http://bit.ly/vPJQyG

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

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

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

Indiana402 W. Washington St. #W072Indianapolis, IN 46204(317)233-0800http://www.in.gov/pla/

Iowa400 SW 8th St., Suite C Des Moines, IA 50309(515)281-6641http://medicalboard.iowa.gov/

Kansas800 SW Jackson, Lower Level, Suite ATopeka, KS 66612(785)296-7413http://www.ksbha.org/

Kentucky310 Whittington Pkwy., Suite 1B Louisville, KY 40222(502)429-7150http://kbml.ky.gov/default.htm

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

Maine161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601http://bit.ly/hnrzp

Maryland4201 Patterson Ave.Baltimore, MD 21215(410)764-4777http://www.mbp.state.md.us/

Massachusetts200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200http://www.mass.gov/eohhs/gov/de-partments/borim/

MichiganBureau of Health Professions P.O. Box 30670 Lansing, MI 48909(517)335-0918http://www.michigan.gov/lara/0,4601,7-154-35299_28150_27529_27541-58914--,00.html

MinnesotaUniversity Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq

Mississippi1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216(601)987-3079http://www.msbml.state.ms.us/

MissouriMissouri Division of Professional Registration 3605 Missouri Blvd. P.O. Box 1335 Jefferson City, MO 65102 (573)751-0293 http://pr.mo.gov/healingarts.asp

U.S. MEDICAL BOARDS

58 | AUGUST 2013

Montana301 S. Park Ave. #430Helena, MT 59601(406)841-2300http://bit.ly/obJm7J p

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

NevadaBoard of Medical ExaminersP.O. Box 7238Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/

New HampshireNew Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203http://www.nh.gov/medicine/

New JerseyP. O. Box 360Trenton, NJ 08625 (609)292-7837http://bit.ly/w5rc8J

New Mexico2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220http://www.nmmb.state.nm.us/

New YorkOffice of the ProfessionsState Education Building, 2nd FloorAlbany, NY 12234(518)474-3817http://www.op.nysed.gov/

North CarolinaP.O. Box 20007Raleigh, NC 27619(919)326-1100http://www.ncmedboard.org/

North Dakota418 E. Broadway Ave., Suite 12Bismarck, ND 58501(701)328-6500http://www.ndbomex.com/

Ohio30 E. Broad St., 3rd FloorColumbus, OH 43215(614)466-3934http://med.ohio.gov/

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

Oregon1500 SW 1st Ave., Suite 620Portland, OR 97201(971)673-2700http://www.oregon.gov/OMB/

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://www.dos.state.pa.us/portal/server.pt/community/state_board_of_medi-cine/12512

Rhode Island3 Capitol HillProvidence, RI 02908(401)222-5960http://1.usa.gov/xgocXV

South CarolinaP.O. Box 11289Columbia, SC 29211(803)896-4500http://www.llr.state.sc.us/pol/medical/

South Dakota101 N. Main Ave. Suite 301Sioux Falls, SD 57104(605)367-7781http://www.sdbmoe.gov/

Tennessee425 5th Ave. NorthCordell Hull Bldg. 3rd FloorNashville, TN 37243(615)741-3111http://health.state.tn.us/boards/me/

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

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

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

VirginiaVirginia Dept. of Health ProfessionsPerimeter Center9960 Maryland Dr., Suite 300Henrico, VA 23233(804)367-4400http://1.usa.gov/xjfJXK

WashingtonPublic Health Systems DevelopmentWashington State Department of Health101 Israel Rd. SE, MS 47890Tumwater, WA 98501(360)236-4085http://www.medlicense.com/washington-medicallicense.html

West Virginia101 Dee Dr., Suite 103Charleston, WV 25311(304)558-2921http://www.wvbom.wv.gov/

WisconsinP.O. Box 8935Madison, WI 53708(877)617-1565http://drl.wi.gov/board_detail.asp?boardid=35&locid=0

Wyoming320 W. 25th St., Suite 200Cheyenne, WY 82002(307)778-7053http://wyomedboard.state.wy.us/

MEDMONTHLY.COM | 59

medical resource guide

Find Urgent CarePO Box 15130Scottsdale, AZ 85267(602)370-0303

www.findurgentcare.com

MedMedia9PO Box 98313Raleigh, NC 27624(919)747-9031

www.medmedia9.com

Ring Ring LLC6881 Maple Creek Blvd, Suite 100West Bloomfield, MI 48322-4559(248)819-6838

www.ringringllc.com

ADVERTISING

BILLING & COLLECTION

Advanced Physician Billing, LLCPO Box 730Fishers, IN 46038(866)459-4579

www.advancedphysicianbillingllc.com

60 | AUGUST 2013

ANSWERING SERVICES

Corridor Medical Answering Service3088 Route 27, Suite 7Kendall Park, NJ 08824(866)447-5154

www.corridoranswering.net

Docs on Hold14849 West 95th St. Lenexa, KS 66285(913)559-3666

www.soundproductsinc.com

CODING SPECIALISTS

The Coding Institute LLC2222 Sedwick DriveDurham, NC 27713(800)508-2582

http://www.codinginstitute.com/

CAREER CONSULTING

Doctor’s Crossing4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545

http://doctorscrossing.com/

COMPUTER, SOFTWARE

American Medical Software1180 Illinois 157Edwardsville, IL 62025(618) 692-1300

www.americanmedical.com

CDWG300 N. Milwaukee AveVernon Hills, IL 60061(866)782-4239

www.cdwg.com/

Instant Medical History4840 Forest Drive #349Columbia, SC 29206(803)796-7980

www.medicalhistory.com

ACCOUNTING

Boyle CPA, PLLC3716 National Drive, Suite 206Raleigh, NC 27612(919) 720-4970

www.boyle-cpa.com

Ajishra Technology Support3562 Habersham at Northlake, Bldg JTucker, GA 30084(866)473-0011

www.ajishra.com

Applied Medical Services4220 NC Hwy 55, Suite 130BDurham, NC 27713(919)477-5152

www.ams-nc.com

Axiom Business Solutions4704 E. Trindle Rd.Mechanicsburg, PA 17050(866)517-0466

www.axiom-biz.com

Frost Arnett480 James Robertson ParkwayNashville, TN 37219(800)264-7156

www.frostarnett.com

Gold Key Credit, Inc.PO Box 15670Brooksville, FL 34604888-717-9615

www.goldkeycreditinc.com

Horizon Billing Specialists4635 44th St., Suite C150Kentwood, MI 49512(800)378-9991

www.horizonbilling.com

Management Services On-Call200 Timber Hill Place, Suite 221Chapel Hill, NC 27514(866)347-0001

www.msocgroup.com

Marina Medical Billing Service18000 Studebaker Road4th FloorCerritos, CA 90703(800)287-8166

www.marinabilling.com

Mediserv6451 Brentwood Stair Rd.Ft. Worth, TX 76112(800)378-4134

www.mediservltd.com

Practice Velocity1673 Belvidere RoadBelvidere, IL 61008(888)357-4209

www.practicevelocity.com

Sweans Technologies501 Silverside Rd.Wilmington, DE 19809(302)351-3690

www.medisweans.com

VIP BillingPO Box 1350Forney, TX 75126(214)499-3440

www.vipbilling.com

ELECTRONIC MED. RECORDS

INSURANCE, MED. LIABILITY


FINANCIAL CONSULTANTS

Sigmon Daknis Wealth Management701 Town Center Dr. , Ste. #104Newport News, VA 23606(757)223-5902

www.sigmondaknis.com

Sigmon & DaknisWilliamsburg, VA Office325 McLaws Circle, Suite 2Williamsburg, VA 23185 (757)258-1063

http://www.sigmondaknis.com/

MEDMONTHLY.COM | 61

Biomet 3i4555 Riverside Dr.Palm Beach Gardens, FL 33410(800)342-5454

www.biomet3i.com

ABELSoft1207 Delaware Ave. #433Buffalo, NY 14209(800)267-2235

www.abelmedicalsoftware.com

Acentec, Inc17815 Sky Park Circle , Suite JIrvine, CA 92614(949)474-7774

www.acentec.com

AdvancedMD 10011 S. Centennial PkwySandy, UT 84070(800) 825-0224

www.advancedmd.com

CollaborateMD201 E. Pine St. #1310Orlando, FL 32801(888)348-8457

www.collaboratemd.com

DocuTAP4701 W. Research Dr. #102Sioux Falls, SD 57107-1312(877)697-4696

www.docutap.com

Aquesta Insurance Services, Inc.Michael W. Robertson3807 Peachtree Avenue, #103Wilmington, NC 28403Work: (910) 794-6103Cell: (910) 777-8918

www.aquestainsurance.com

Medical Protective5814 Reed Rd.Fort Wayne, In 46835(800)463-3776

http://www.medpro.com/medical-protective

MGIS, Inc.1849 W. North TempleSalt Lake City, UT 84116(800)969-6447www.mgis.com

Medical Credentialing(800) 4-THRIVE

www.medicalcredentialing.org

Medical Practice Listings8317 Six Forks Rd. Suite #205Raleigh, NC 27624(919)848-4202

www.medicalpracticelistings.com

myEMRchoice.com24 Cherry LaneDoylestown, PA 18901(888)348-1170

www.myemrchoice.com

Physician Wellness Services5000 West 36th Street, Suite 240Minneapolis, MN 55416888.892.3861

www.physicianwellnessservices.com

Synapse Medical Management18436 Hawthorne Blvd. #201Torrance, CA 90504(310)895-7143

www.synapsemgmt.com

Urgent Care America17595 S. Tamiami TrailFort Meyers, FL 33908(239)415-3222

www.urgentcareamerica.com

Urgent Care & Occupational Medicine ConsultantLawrence Earl, MDCOO/CMO ASAP UrgentcareMedical Director, NADME.org908-635-4775 (m)866-405-4770 (f )

ASAP-Urgentcare.comUrgentCareMentor.com

Utilization [email protected](919) 289-9126

www.pushpa.biz

DENTAL

CONSULTING SERVICES,PRACTICE MANAGEMENT

Triangle Nutrition Therapy6200 Falls of Neuse Road, Suite 200Raleigh, NC 27609(919)876-9779

http://trianglediet.com/

DIETICIAN

Integritas, Inc.2600 Garden Rd. #112Monterey, CA 93940(800)458-2486

www.integritas.com

Dental Management Club4924 Balboa Blvd #460Encino, CA 91316

www.dentalmanagementclub.com

The Dental Box Company, Inc.PO Box 101430Pittsburgh, PA 15237(412)364-8712

www.thedentalbox.com EQUIPMENT APPRAISER

Brumbaugh Appraisals8601 Six Forks Road, Suite 400, Raleigh, NC 27615(919) 870-8258

www.brumbaughappraisals.com

62 | AUGUST 2013


MEDICAL ART

Brian Allenwww.artisanprinter.com

Deborah Brenner877 Island Ave #315San Diego, CA 92101(619)818-4714

www.deborahbrenner.com

Pia De Girolamowww.piadegirolamo.com

MEDICAL EQUIPMENT

ALLPRO Imaging1295 Walt Whitman RoadMelville, NY 11747(888)862-4050

www.allproimaging.com

Biosite, Inc9975 Summers Ridge RoadSan Diego, CA 92121(858)805-8378

www.biosite.com

Cryopen800 Shoreline, #900Corpus Christi, TX 78401(888)246-3928

www.cryopen.com

Carolina Liquid Chemistries, Inc.391 Technology WayWinston Salem, NC 27101(336)722-8910

www.carolinachemistries.com

Dicom Solutions548 WaldIrvine, CA 92618(800)377-2617

www.dicomsolutions.com

Tarheel Physicians Supply1934 Colwell Ave. Wilmington, NC 28403 (800)672-0441

www.thetps.com

MEDICAL PRACTICE SALES

Medical Practice Listings8317 Six Forks Rd. Ste #205Raleigh, NC 27624(919)848-4202


BizScorePO Box 99488Raleigh, NC 27624(919)846-4747

www.bizscorevaluation.com

MEDICAL PRACTICE VALUATIONS

MEDICAL MARKETING

High Performance NetworkRobert SayreMarketing Adviser/Business Coach

http://www.linkedin.com/pub/rob-sayre/2/977/355/


www.medmedia9.com

WhiteCoat DesignsWeb, Print & Marketing Solutions for Doc-tors(919)714-9885

www.whitecoat-designs.com

MMA Medical Architects520 Sutter StreetSan Francisco, CA 94115(415) 346-9990

http://www.mmamedarc.com

MEDICAL ARCHITECTS

LOCUM TENENS

Physician SolutionsPO Box 98313Raleigh, NC 27624(919)845-0054

www.physiciansolutions.com

Nicholas Downhttp://bit.ly/yHwxb0

Martin Friedwww.martindfried.com

Barry Hanshaw 18 Bay Path DriveBoylston MA 01505508 - 869 - [email protected]

www.barryhanshaw.com

MedImageryLaura Maask 262-308-1300 [email protected]

medimagery.com

Marianne Mitchell(215)704-3188

http://www.mariannemitchell.comhttp://www.colordrop.blogspot.com

Professional Medical Insurance Services16800 Greenspoint Park DriveHouston, TX 77060(877)583-5510

www.promedins.com

Wood Insurance Group4835 East Cactus Rd., #440Scottsdale, AZ 85254-3544(602)230-8200

www.woodinsurancegroup.com

INSURANCE, MED. LIABILITY MEDICAL EQUIPMENTFINANCING

Bank of AmericaMark MacKinnon, Regional Sales Manager3801 Columbine CircleCharlotte, NC 28211(704)[email protected]

www.bankofamerica.com/practicesolutions


MEDMONTHLY.COM | 63

MEDICAL RESEARCH

Arup Laboratories500 Chipeta WaySalt Lake City, UT 84108(800)242-2787

www.aruplab.com

Chimerix, Inc.2505 Meridian Parkway, Suite 340Durham, NC 27713(919) 806-1074

www.chimerix.com

Clinical Reference Laboratory8433 Quivira Rd.Lenexa, KS 66215(800)445-6917

www.crlcorp.comSanofi US55 Corporate DriveBridgewater, NJ 08807(800) 981-2491

www.sanofi.usScynexis, Inc.3501 C Tricenter Blvd.Durham, NC 27713(919) 933-4990

www.scynexis.com

MEDICAL PUBLISHING

Greenbranch Publishing [email protected]

www.greenbranch.com

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

Astaffinggroup.com

SUPPLIES, GENERAL

BSN Medical5825 Carnegie BoulevardCharlotte, NC 28209(800)552-1157

www.bsnmedical.us

STAFFING COMPANIES

CNF Medical1100 Patterson AvenueWinston Salem, NC 27101(877)631-3077

www.cnfmedical.comDermabondEthicon, Route 22 WestSomerville, NJ 08876(877)984-4266

www.dermabond.com DJO1430 Decision St.Vista, CA 92081(760)727-1280

www.djoglobal.com ExpertMed31778 Enterprise Dr.Livonia, MI 48150(800)447-5050

www.expertmed.com

Gebauer Company4444 East 153rd St. Cleveland, OH 44128-2955(216)581-3030

www.gebauerspainease.com

Scarguard15 Barstow Rd.Great Neck, NY 11021(877)566-5935

www.scarguard.com


www.medmedia9.com

REAL ESTATE

York Properties, Inc.Headquarters & Property Management 1900 Cameron StreetRaleigh, NC 27605(919) 821-1350



WEBSITE DESIGN

PRACTICE FINANCING

Bank of AmericaMark MacKinnon, Regional Sales Manager3801 Columbine CircleCharlotte, NC 28211(704)[email protected]

www.bankofamerica.com/practicesolutions

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Visit us online anytime at medmonthly.com

64| AUGUST 2013

To place a classified ad, call 919.747.9031

classified listings

Classified

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: [email protected]

3-5 days per week in Durham, NC . Geriatric physi-cian 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: [email protected] GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease Clinics located in Charlotte, Hick-ory, Concord & Marion North Carolina. General Practi-tioner 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 Octo-ber 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected]

Primary Care Physician in Northwest NC (multiple locations). Primary care physician needed immediately for ongoing coverage at one of the larg-est 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: [email protected]

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: [email protected]

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: [email protected]

General Practitioner Needed in Greensboro. Occupa-tional 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: [email protected]

Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC. Pediatric clinic in Ro-anoke Rapids, NC seeks Peds physician or FP comfort-able 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 immedi-ately. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected]

County Health Department in Fayetteville, NC seeks GP/IM/FP Full-Time, On-Going Shifts. GP/IM/FP Need-ed Immediately at County Health Department in Fay-etteville, NC. Approximately 20 patients per day with hours from 8 am -5 pm. Call or email for more informa-tion. 919-845-0054 [email protected]

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. [email protected]

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 [email protected]

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: [email protected]

MEDMONTHLY.COM |65



Classified

Physicians needed

North Carolina (cont.)

Addictive Disease Clinic in Charlotte, NC and sur-rounding cities seeks GP/FP/IM for on-going shiftsAn addictive disease clinic with locations with loca-tions 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: [email protected]

Child Health Clinic in Statesville, NC seeks pediatri-cian 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: [email protected]

Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk. Health Department pediat-rics 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 919-845-0054 or [email protected].

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 informa-tion. 919-845-0054 [email protected]

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 [email protected].

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Depart-ment 45 minutes from Charlotte seeks on-going cover-age 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 [email protected]

FT/PT Mid-Level Provider needed for Wilmington practice immediately. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-lev-el provider starting immediately. FT/PT. M-F 8:00-5:00. Possible permanent placement. Call or email for more information. 919-845-0054 [email protected]

Western North Carolina Health Department needs con-tinuing physician coverage. County Health Depart-ment 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 protected].

Asheboro Family Practice and Urgent Care seeks GP for intermittent coverage. Family Practice and Ur-gent Care seeks general practitioner for intermittent days beginning in March from 8a-8p. Provider will see about 35 patients with no call. Please contact Physi-cian Solutions at 919-845-0054 or [email protected].

Greensboro occupational health care clinic seeks-general 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 919-845-0054 or [email protected].

IM/FP needed in Fayetteville health department im-mediately. 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 919-845-0054 or [email protected].

We have a established woman’s practice in the Raleigh North Carolina area that is available for purchase. Grossing a consis-tent $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 prac-tice is very visible and located in the heart of medical commu-nity. There are 7 well appointed exam rooms, recently upgraded computer (EMR), the carpet and paint have always been main-tained. The all brick building can be leased or purchased.

Contact Cara or Philip for detailsregarding this very successful practice.

Medical Practice Listings; 919-848-4202

Woman’s Practice in Raleigh, North Carolina.

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 [email protected]

NC OPPORTUNITIES LOCUMS OR PERMANENT

For more information about Physician Solutions or to see all of our locums and permanent listings,

please visit physiciansolutions.com

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.

PRIMARY CARE PRACTICE -East of Raleigh, North Carolina

MedicalPracticeListings.com | [email protected] | 919-848-4202

Medical Practice ListingsSelling and buying made easy

MEDMONTHLY.COM | 67

classified listings

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 [email protected].

Nursing home in Durham seeks PT/FT NP/PA for imme-diate 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 Physi-cian Solutions at 919-845-0054 or email [email protected].

COLUMBUS IMFT/PT Mid-Level Provider needed for practice near Wilmington. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provid-er starting immediately. FT/PT. M-F 8-5p. Possible per-manent placement. Please contact Physician Solutions at 919-845-0054 or email [email protected].

Fayetteville occupational health care clinic seeks GP for May 5-9. Primary care physicians needed for oc-cupational medicine. Adults only. 8-5p. Large corpo-ration, no call required. Intermittent dates in the future and second office in Greensboro with ongoing sched-uling. Please contact Physician Solutions at 919-845-0054 or email [email protected].

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 Solu-tions at 919-845-0054 or email [email protected].

Community Health Dept in Washington, NC (1 h 45 min E of Raleigh) seeks FP for coverage June 15 FT/PT on-going. 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 [email protected].

Nursing home in Durham seeks PT/FT Geriatrics doc-tor for immediate ongoing scheduling. Durham nurs-ing 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 con-tact Physician Solutions at 919-845-0054 or email [email protected].

Family Practice 1 h SE of Raleigh seeks July 6-7 cover-age. Goldsboro FP seeks MD for July 6-7 and intermit-tent shifts. 8-5p. Please contact Physician Solutions at 919-845-0054 or email [email protected].

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 [email protected].

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

Raleigh practice seeks BC FP for permanent place-ment in new facility summer 2013. Board Certified Family Practitioner sought for FT permanent place-ment in new clinic in Raleigh to start summer of 2013. Please contact Physician Solutions at 919-845-0054 or email [email protected]. Clinic between Fayetteville and Wilmington seeks FP/GP/IM Mar 22 FT ongoing . A small hospital’s outpa-tient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing begin-ning March 22. Shifts can be either 8 or 12 hours. No call. Please contact Physician Solutions at 919-845-0054 or email [email protected].

Western North Carolina Health Department needs con-tinuing physician coverage. County Health Depart-ment 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 [email protected].


Classified

Physicians needed






Classified

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 prac-tice 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. Physi-cian Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: [email protected]

Physicians needed

Physicians needed


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 [email protected].

Pediatrician Needed MD June-Aug, Burlington NC3x week for 10 wks starting June 1st, 8-5 Mon-FriBurlington, NC: located 1 hour west of Raleigh. Please contact Physician Solutions at 919-845-0054 or email [email protected]. Pediatrician, IM & FP needed, Fayetteville NCUrgent Need for immediate MDs - Pediatrics, Family Practice or Internal Medicine - PT/FT, 8-5 Mon-Fri. On-going. Please contact Physician Solutions at 919-845-0054 or email [email protected]. Locum & Permanent MD Needed , Kinston NCUrgent Need for immediate MD placement, 8-5 Mon-Fri. Must be able to do family planning & light ma-ternity, Kinston, NC: 1.5 hours outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email [email protected]. PT MD needed for Occupational practice, Greensboro NC. Urgent need for PT MD to do disability physicals2-3 days weekly, 8-5, on-going scheduling.Greensboro, NC. Please contact Physician Solutions at 919-845-0054 or email [email protected]. Permanent Family Practice doctor needed for Summer 2013, Raleigh, NC Need FP/BC MD for June-Sept Mon- Fri , 8-5, New Facility in downtown Raleigh, NC. Please contact Physician Solutions at 919-845-0054 or email [email protected]. Permanent PA or MD needed in Goldsboro, NCOn-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 [email protected].

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

FULL TIME MD needed for Family Practice in Washing-ton, 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 [email protected]. Geriatric Experienced Mid Level or MD, Durham NCMust have geriatric experience, PT/FT, Locations in Durham, Rocky Mount & Fayetteville, NC. Please con-tact Physician Solutions at 919-845-0054 or email [email protected]. 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 [email protected].

Physicians needed

Virginia

Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions re-quire 30 to 40 hours per week, on-going. If you are seek-ing 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: [email protected]

68| AUGUST 2013


classified listings

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.

Hospice Practice Wanted

To find out more information call 919-848-4202 or e-mail [email protected]


Located in South Denver, Colorado, this practice features high patient volume and high visibility on the internet. Established referral sources, owner (psychologist) has excellent reputa-tion 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.

List Price: $150,000 | Established: 2007 | Location: Colorado

Practice for Sale in South Denver

For more information contact Dr. Jack McInroy at 303-929-2598 or [email protected]

Neurofeedback and Psychological Practice

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

FAMILY PRACTICE FOR SALEA beautiful practice located in Seattle, Washington

MedicalPracticeListings.com | [email protected] | 919.848.4202



Classified

Practice wanted

Pediatric Practice Wanted in Raleigh, NCMedical 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 re-ceives exceptional national, regional and local exposure. Contact us today at (919) 848-4202.

North Carolina

Practice for sale

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 wait-ing 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: [email protected] to receive details.

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 informa-tion. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: [email protected]

classified listings

70 | AUGUST 2013


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

Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immedi-ately FT/PT for Virginia clinic near Washington DC. 8-5pPlease contact Physician Solutions at 919-845-0054 or email [email protected].

Physicians needed

Virginia

Nurse Practitioners needed

North Carolina

Permanent NP needed in Goldsboro, NCOn-going permanent position Mon- Fri 8-5Goldsboro, NC: 1hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email [email protected]. Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in em-ployee 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 [email protected].

Permanent NP needed in Goldsboro, NCOn-going permanent position Mon- Fri 8-5Goldsboro, NC: 1hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email [email protected]. Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in em-ployee 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 [email protected].

Practice for sale


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 well-equipped 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 list-ings 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 own-ership 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 well-appointed 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 [email protected]

Internal Medicine Practice located just outside Fayette-ville, 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 transac-tion. The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accom-modates 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 be-ing 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: [email protected]

MEDMONTHLY.COM | 71

Lucrative ENT Practice with room for growth, located three miles from the beach. Physician’s assistant, audiolo-gist, 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, laryngol-ogy and trans-nasal esophagoscopy. All the organiza-tion 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. Hos-pital 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, Ra-leigh, NC 27624. PH: (919) 848-4202 or email: [email protected]

South Carolina

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. Con-tact Medical Practice Listings for more details. email: [email protected] or (919) 848-4202.

Washington


Classified

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 List-ings at (919) 848-4202 for more information. View addition-al listings at www.medicalpracticelistings.com

MedSpa Located in North Carolina

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.

NC MedSpa For Sale

For more information call Medical Practice Listings at919-848-4202 or e-mail [email protected]


Primary Care Practice for SaleHickory, 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

Established primary care practice in the beautiful foothills of North Carolina

Call 919-848-4202 or email [email protected]

Woman's Practice Available for SaleAvailable for purchase is a beautiful boutique women’s Internal Medicine and Primary Care prac-tice located in the Raleigh area of North Carolina.

The physician owner has truly found a niche special-izing 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 Medi-cine 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

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.

Wanted:Urgent Care Practice

Call 919-848-4202 or e-mail [email protected]

Medical Practice ListingsBuying and selling made easy

Ophthalmic and Neuro-Ophthalmic PracticeRaleigh 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, la-ser 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

Contact Cara or Philip 919-848-4202 for more information or visit MedicalPracticeListings.com

Comprehensive Neuro-Ophthalmic Practice

OCCUPATIONAL HEALTH CARE PRACTICE FOR SALEGreensboro, 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 equip-ment includes CBC. The owning MD is retiring, creat-ing 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 in-cludes: 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.

PRACTICE FOR SALE

Asking price: $385,000

To view more listings visit us online at medicalpracticelistings.com

Please direct all correspondence to [email protected] serious, qualified inquirers.

lOne of the oldest Locums companieslLarge client listlDozens of MDs under contractlExecutive office settinglModern computers and equipmentlRevenue over a million per yearlRetiring owner

MD STAFFING AGENCY FOR SALEIN NORTH CAROLINA

The perfect opportunity for anyone who wants to purchase an established business.

PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks:

PA/FT ongoing, start immediatelyPhysician 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 immediatelyThe Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physi-cian 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,

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: [email protected]

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 immediatelyAn 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, documenta-tion of patient progress in medical record, education of patients/families, provision of educational groups for patients.

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: [email protected]

PEDIATRICIANOR FAMILY MEDICINEDOCTOR NEEDED IN

ROANOKE RAPIDS, NC

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

74 | AUGUST 2013

American Council on Exercise®

4 8 5 1 P A R A M O U N T D R I V E , S A N D I E G O , C A 9 2 1 2 3 U S A

( 8 0 0 ) 8 2 5 - 3 6 3 6 X 6 5 3 | W W W . A C E F I T N E S S . O R G

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

A M E R I C A ’ S A U T H O R I T Y O N F I T N E S STM

ACE Certified: The Mark of QualityLook for the ACE symbol of excellence

in fitness training and education.For more information, visit our website:

www.ACEfitness.org

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.

Unfortunately, its motor is inside playing video games.

Pediatrics practice wanted in NCConsidering your options regarding your pediatric prac-tice? We can help. Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina.

Contact us today to discuss your options confidentially.

Pediatrics Practice Wanted

Medical Practice ListingsCall 919-848-4202 or e-mail [email protected]


CALLING ALL WRITERS

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

To become a contributing writerin Med Monthly magazine,contact MedMedia9 [email protected]

Med MonthlyContact us:

[email protected]

medmonthly.com

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

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

PRIMARY CARE PRACTICE - Hickory, North Carolina

MedicalPracticeListings.com | [email protected] | 919-848-4202


By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients. Contact one of our advertising agents and find out how inexpensive yet powerful your ad in Med Monthly can be.

medmonthly.com | 919.747.9031

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY

Primary care practice specializing in women’s careRaleigh, North Carolina

The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership trans-fer. 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 prac-tice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several well-appointed exam rooms and beautifully decorat-ed throughout. New computers and medical management software add to this modern front desk environment.

List price: $435,000

Practice for Sale in Raleigh, NC

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


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.

Contact Medical Practice Listings for more information.

Primary Care Practice For Sale

Medical Practice Listings919.848.4202 | [email protected]


Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email: [email protected]

PEDIATRICIAN

FAYETTEVILLE, NCor family medicine doctor needed in

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:

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

• 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


Reasons People Call First Responderstop

78 | AUGUST 2013

CARDIAC-RELATED CONCERNSNot surprisingly, cardiac-related calls top the EMS charts. According to the Centers for Disease Control, heart disease caused al-most 1 in every 4 deaths in the United States.

1

the top

First responders are the primary line of de-fense when it comes to emergency care. Let’s take a look at the Top 9 reasons first re-sponders are called.

5

2STROKESSomeone 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 frag-ile and when poor diet or poor health habits

become the norm, those blood vessels can either become blocked, or burst.

3MOTOR VEHICLE ACCIDENTSThough they’re often lumped into the larger category of trau-matic injuries—which includes all bumps, bruises, sprains and breaks, plus anything from falls to

collisions and sports injuries—motor vehicle ac-cidents are the number-one cause of death in people under the age of 35.

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.

RESPIRATORY PROBLEMSBreathing problems are a ma-jor cause of EMTs providing ad-vanced 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 asth-ma attacks.

4 COLD/FLU/PNEUMONIA/SEASONAL ILLNESSESAnother frequent problem paramed-

ics encounter is cold, cough, and flu-like symptoms, particu-larly when symptoms worsen into problems like bronchitis and pneumonia. These illnesses and associated breathing problems made up the largest percent-age of patients that paramed-ics see.

EMERGENCY CHILDBIRTHEmergency childbirth is not an everyday occurrence. Therefore emergency responders, police, fire and EMS have a basic under-standing of proper childbirth.

MEDMONTHLY.COM | 79

7

6POISONINGPoisoning is the second lead-ing cause of unintentional in-

jury after motor vehicle traffic (MVT) deaths.

OVERDOSESFor many decades, the overwhelm-ing 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.

89

Reasons People Call First Responders

P.O. Box 98313, Raleigh, NC 27624

phone: 919.845.0054 fax: 919.845.1947e-mail: [email protected]

www.physiciansolutions.com

Short-term or long-term, Physician Solutions has you covered

Scan this QR code with your smartphone to learn more.

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.

Physician Solutionsis now hiring primary care

MD’s, PA’s and FNP’s inNorth Carolina, Virginia

and South Carolina

med monthly august 2013

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