With therapeutic milk to the seven methods

Chinese medicine believes that sweet milk-Wei Han has Shengjinzhike, intestinal moisture, heat movement, such as the spleen Buxu effectiveness. To carry out proper processing of milk or other food and deploy together, can be made from a variety of "therapeutic milk." Milk porridge Method: 250 ml of fresh milk, rice, 60 grams, the amount of sugar. First semi-boiled rice to rice, adding milk, Zhu Chengyu slow fire, stirring adding sugar, put the full solution. Sooner or later take warm, fresh attention, not to degenerate. : Xu Sun can make up, the spleen and stomach health, run five internal organs. Apply to the weak strain, the lack of blood, after the virtual win disease, the frail elderly, malnutrition Dengzheng. Big milk Zaotang Method: 500 ml of milk, 25 grams date, 100 grams of rice. First date with the rice and Zhu Chengyu, and then adding milk to boil. : Make up blood, spleen and stomach health, the applies to Tixu fatigue, lack of blood Dengzheng. Yu Ye fresh milk Method: 60 grams of japonica rice, fried peach kernel Hu 80 grams, 45 grams peach kernel Hu Sheng, 12 grams of sugar, 200 ml of milk. Japonica rice to clean, soak 1 hour remove, Lvgan water, and peach kernel Hu, milk plus a small amount of ground water mixing, filtering funnel Qu Zhi, juice into the pot to boiling water, adding sugar stirring, until the whole solution Lvqu after slag, taking filtrate into the boiling pot mold. : Ben Pinke fill spleen and kidney, Yi Fei Runzao for cough, asthma, and low back pain constipation, dry intestinal Jin loss, and so on, and as the disease after Tixu, neurasthenia, chronic bronchitis, sexual dysfunction, constipation in elderly Patients with food. Sooner or later or drinking on an empty stomach can eat and file. Thick milk Method: adding milk boil 3% -7% of the starch or dry cakes, lotus root starch, and so on, so that the milk Bianchou, can be a little sugar. Role: This applies to goods used to vomiting, nausea and increased energy needs of patients. Custard Method: first the old cook eggs, remove the shell, protein, egg spoon will be subject to pulverisation, adding milk can be fully mixed. In addition to the egg yolk contains protein, fat, vitamin A also contains iron, phosphorus, and other material. : This product is applicable to iron-deficiency anemia, and the need to add calcium four of the five-month baby. Self-skimmed milk Method: boiled milk, standing a few hours, remove the top layer of Naipi (that is, fat, this method can be removed from the general 80% fat) fait accompli. : This product is suitable for feeding suffering from diarrhea, dysentery, enteritis, and other gastro-intestinal infections in infants. Since the removal of milk fat with low heat, lack of vitamin A, D, and so on, can be used to add other foods, after they have recovered shall continue to feed whole milk. Tea Method: using water soaked tea leaves, and then took it into the boiling milk. As for the salt or sugar, may be based on individual tastes. Canada milk tea, so that the two unique flavor into one, the nutritional supplement each other and suppress the smell of milk and tea taste bitter, drinking up even more rich flavor, long. : Greasy tea can help digestion, Siti benefits of God, detoxification diuretic, to eliminate fatigue, but also suitable for acute and chronic enteritis, gastritis and duodenal ulcer patients, such as drinking. ** And alcohol poisoning, it can also play a role in detoxification.

The accumulation of fat part of the decision risk

American Medical Association study found that workers in a few days ago, the people of the degree of obesity is not important, it is important that the site of the accumulation of fat, fat accumulation may be a place to hide important diseases. According to the Science Daily website reported that the United States, the United States in response to the growing obese population trends,韦克福雷斯特University Medical Center researchers in assessing the risk of cardiovascular disease and metabolic disease risk, with the heart and CT scan to determine the age of 398 In the 47-year-old to 86-year-old subjects between the various parts of the accumulation of fat. It was found in the surrounding organs and muscle between the deposition of fat (that is, non-subcutaneous fat) and the volume of patients with calcified plaque is directly related to the number. It is generally believed that calcified plaque itself is not dangerous, but it appeared in blood vessels and can lead to heart disease and stroke, or atherosclerosis is not related to the stability of the Deposition of fat. Responsible for the study of Ding Jing, MD (sound), said: "Our assumption is that this fat and subcutaneous fat completely different. Subcutaneous fat may not be in danger of organ and muscle between the deposition of fat so much." In his view, Even with a Thin Man may also be too much of the non-subcutaneous fat, so it is necessary to seek non-specific subcutaneous fat deposition treatment

Boys into the gym early to do

UK survey shows that 87% of young boys want to be a "Jirou Nan." To many in the gym training for a while, the boys were always protein drink mixed drinks, eat some vitamins to improve their shape and muscle stiffness. However, experts believe that long to do so may lead to health problems, because the beverage is not necessary for the body of vitamins and minerals, in which fresh fruits, vegetables and starchy foods can eat. Experts said that children should not be prematurely lost innocence of nature, and should be partners in the outdoor play football, enjoy some of the more natural things, not carrying how long, how the pressure of body-building.

How to prevent rebound weight

8 hard this summer harder to lose weight, do not want to fall for half a month rebound went so far as the weight 5 jin, Miss Zhang is not understand is: Why is a summer of weight loss just fall on the "wasted"? Autumn weight easily rebound Miss Zhang last arms to the big hospital and South Africa to see weight loss clinic, the amount of weight after the end of the discovery and re-jin 1. She told reporters that her success throughout the summer to lose weight 8 jin, 98 jin weight. Fall just half a month, her weight rebound to 103 jin. Endocrinology hospital weight loss, said Professor Xu Yancheng, in fact, very appropriate for weight loss in the fall. Pan Shou the human body during the year was volatile, high summer temperatures affect the appetite, and women in summer clothes with less, in order to highlight the tall destinations will be reduced food. From summer into the fall, people generally relatively thin, this has been the basis of the fall is relatively easy to lose weight. But people are easy to get fat in the fall. When autumn gradually cool climate, the human body to enhance comfort, the relative summer, to reduce the sweat, water and salt metabolism in the body to restore balance to restore normal digestive function, energy metabolism is relatively stable, at this time, the gradual accumulation of fat, the beginning of the human body fat. Increased appetite, sleep is more obvious. In the fall, would like to consolidate the results of the summer to lose weight, you need to reduce the proper sleep, diet and increase exercise. Otherwise, the summer weight loss results will come to naught, rebounded in the fall. There may, when necessary, under the guidance of a doctor in the amount of material服用减肥药. Everyone's eating habits, patterns of life, such as weight loss will affect the history of any product. Editing tips: Although many people preferred to go on a diet to lose weight, but often have little effect. Why do we eat are "slimming food" in the end not only failed to lose weight, but it is also a fertility? The reason is that supermarkets can be some of the apparent weight loss diet food is our greatest nemesis. 1 eat "oil" too much The fat diet is bad, and in order to prevent fat, it is necessary to less involved in high-fat foods. To eliminate fatty foods, said the white is less oil, oil use medical terminology as "fat" and vegetable oil and animal fat are, vegetable oil is pure fat and fat of the major components of fat, fat also found in lean meat, internal organs, Eggs, milk, soy products and even food, certain vegetables, (such as: candida) have a certain amount of fat. Question 2 eat more carbohydrates 1 gram of carbohydrate or 1 g protein produced only 4 kilo-calories, 1 gram of fat and 9 kilocalories productive, so eat more fat is equal to eat a lot of carbohydrates or protein. Vegetable oil than the equivalent weight of fat contained more fat, because fat in addition to fat, but also contain water, protein, fibrous tissue. Some people say: "I do not Chi Feirou, eat vegetable oil, fat can be avoided." Essentially a misunderstanding, melon seeds, peanuts, walnuts, pine nuts, hazelnut and summer fruits such as nuts, food ingredients almost half of the fat . Some people love to eat these foods is equivalent to eating a lot of fat. -Some restaurants, cooking oil increases, Chu Guo cooking time but also to look out onto oil-all kinds of "boiled fish", "Shui Zhurou", "Xiang Laxie" in essence " Cooking oil, "eating into the oil can not be over. Carbohydrate digestion by the gut into a single sugar (glucose, fructose and galactose) was Xishouruxue, was part of the organization have direct access to energy for human needs, stored in a part of the cell, if there is one extra sugar, Will be stored in the fat in the body. The carbohydrate-containing food grain, beans, milk, fruits, dried fruits and vegetables. The previous low standard of living of poor non-staple food, most people eat every meal staple half a catty on April 2 it is not unusual now to improve the standard of living, good non-staple food, and also a staple food for over half a catty 42 a. Some people eat too much fruit, especially food with high sugar content of fruit (bananas, persimmons, grapes, litchi), an increase of carbohydrate intake. 3 issue of excess protein Protein is also an material and energy production, if eating more food into the energy demand exceeds the human body, or stored fat. Protein-containing food for more meat, eggs, milk, soy category, food, vegetables and fruits have a small amount of protein. Protein-rich food (meat, eggs, milk, soy beans) are high-fat, the food will eat more fat to eat as much. The protein product of the metabolism excretion from the kidney, eat more protein will increase the burden on the kidneys, more than a product of the metabolism of the kidney caused by discharge capacity will be "azotemia" hazardous to health. 4 + dessert snacks Some people like to eat snacks, drink sweet drinks, in particular, are boring life when watching television or eating snacks and more. Snacks in carbohydrates, protein, fat, almost all of the ingredients. Equal to the energy to eat snacks, some snacks also very high energy, such as nuts, oily foods, bananas, pistachios, cashew nuts, potato chips, extruded starch-containing foods, candies, dried fruit, fruit, sweet sugary drinks, Dried beef, fish protein, energy consumption can not be generated, in the form of fat to be stored.

Prevention is of utmost importance in the treatment of high blood pressure

Prevention and treatment which is more important Not for the health of the population suffering from high blood pressure, prevention is more important. If you already suffer from high blood pressure, should be equal emphasis on treatment and prevention. For the management of high blood pressure, the two sides have a responsibility to doctors and patients. From the perspective of the medical staff, medical personnel have the responsibility to put in place to ensure that treatment and supervision should be patient medication, the patient should be told the way of life on blood pressure. From the patient's point of view, it should be reasonable to adjust the way of life. I tell you that this formula 4: The elimination of tobacco and alcohol, basic vegetarian, and adhere to the medication, moderate exercise. Movement can walk the main general to walk 5 to 10 km can be. "140/90 standards," the hospital can do what I attended the hospital where a doctor from China Association of Physicians of cardiovascular branch of China Gerontological Society, as well as cardio-cerebral vascular diseases sponsored by the Professional Committee of the "standard 140/90", we first of all on health care for the mobilization of education, stressed the importance of the project ; Followed by the Office of the patient through the training of nurses; for the last patient follow-up to register and to provide interest-free patients registered facilities. We chose the mild to moderate essential hypertension and blood pressure in patients with the standards have not yet participated in the "standard 140/90", follow-up once a month. The project was started in March this year, after nearly six months, the patient's compliance and to improve the standard rate. We plan to expand the "standard 140/90" project team at the same time to further simplify the process of the project, such as text messages to remind mainly to strengthen the on-line publicity. Slow disease management focus on community hospitals There are also slow disease management and input-output ratio. Should have special staff to work in the long term slow the long-term disease management responsibility should be placed in community hospitals. At present, major hospitals and community hospitals should be further straightened out perfect, should give full play to the role of the community, to slow disease management in their practices on the community. In addition, the guarantee of funding is very important. Do not worry suffering from high blood pressure medicine Patients with high blood pressure should have knowledge of the following: ● To learn more about the dangers of hypertension, especially high systolic blood pressure hazards. ● step-down standards for different groups of people is not the same, such as diabetes and / or kidney patients, blood pressure control standards would also like to re-strict standards should be 130/80mmHg. ● Do not be afraid to take medicine, drugs for high blood pressure and side effects were minimal compared to the harm. ● Do not worry about the emergence of drug-dependent. To control blood pressure, it is necessary to adhere to the medication. ● Do not frequent dressing change. Drugs may have to play a role in 4 to 6 weeks, the dressing was changed frequently difficult to get the desired effect. ● Do not be afraid combination. At present, the combination treatment that can effectively improve the efficacy and reduce side effects, a good effect on patients. ● to encourage patients to self-test of blood pressure at home and do records. To get up early every day, before the medicine is the best time to blood pressure measurement, the conditions in the first test in the evening. What are the factors that influence blood pressure control Mood, diet, exercise, climate, such as sleep can affect the person's blood pressure. If these factors caused fluctuations in blood pressure, leading to poor blood pressure control, as patients should be dealt with: ● removal of the above-mentioned factors. ● In the combination treatment on the basis of adjustment, not to large-scale dressing change. ● adhere to the drug 4 to 6 weeks to observe the situation of blood pressure. If blood pressure remains high (above the 160/100mmHg), and then to consider changing treatment.

Ten of the new mental health patients Standard

1, the full sense of security: a sense of security is one of the basic human needs if state of anxiety, people will soon be aging. Depression, anxiety and other psychological, give rise to the functions of the digestive system disorders, and may even lead to disease. 2, fully aware of their own, their ability to make a point to determine if the contrary. If you barely beyond their ability to do the work, will it and, in a significant adverse physical and psychological. Due to the overload of work, or even give health problems. 3, the goal of life is a realistic one. Due to the development of social production level of material living conditions there is a limit to life if the target set too high would have a sense of frustration is not conducive to the physical and mental health. 4, to maintain contact with the outside environment. Because the people need is the spirit of multi-level, contact with the outside world, on the one hand can be a rich spiritual life, on the other hand, in a timely manner can adjust their behavior in order to better adapt to the environment. 5, to maintain the integrity and individuality in harmony. In the ability of personality, interests, personality and temperament and other psychological characteristics must be in harmony and unity in order to maximize the display. 6, has a certain ability to learn. Will soon update the knowledge of modern society, in order to adapt to the new situation, we must constantly learn new things so that the life and work easier and less detours for more success. 7, to maintain good personal relationships. Interpersonal relationships, being a positive relationship, but also to the negative relationship between negative, and the coordination of relations or not, people's mental health a lot. 8, appropriate to express and control their emotions. There were different emotions emotional experience. The unpleasant feeling to be released in order to achieve a psychological balance. But we can not vent too much, otherwise, not only affect their own lives, but also exacerbated the interpersonal conflicts, in good physical and mental health. 9, a limited play to their talents and interests. People skills and interests should be fully brought into play, but it can not hinder the interests of others and can not harm the interests of groups, otherwise, give rise to interpersonal disputes, inviting worry, not conducive to the physical and mental health. 10, is not in breach of social ethics, the basic needs of the individual should be a certain degree of satisfaction. Of course, to be legitimate, or face condemnation of conscience, the pressure of public opinion and even the law, there is no natural to speak of Mental Health.

Depression to children attracted a high degree of vigilance

"If there is the next life, I can become one, I must be the best children!" 13-year-old boy and a half to go to school before suddenly ZHANG Xiao Yi from the 24-storey residential high-rise jump, as he's flying a vertical, Words remark has become a peerless. Six months ago, took place in Tianjin's Tanggu district this scene, do not want to become a touch of black memories. At that time, both the media or family members ZHANG Xiao Yi, will lead children to commit suicide for reasons attributed to over-indulge in online games. And in recent days, Beijing director of the pediatric hospital and stability, child psychiatrist Professor Zheng Yi guest education CCTV program "exchange", the consultation re-analysis of the case, to arrive at a conclusion worthy of attention: ZHANG Xiao Yi led to the suicide death, he was Typical of children suffering from depression. Professor Zheng Yi said that in this case, the face of it, is online games claimed the lives of children. ZHANG Xiao Yi's stay in the 4 suicide note, referred to their own online games Suibai characters, but also to their own fantasy "to fly." "But a careful analysis of the characteristics of the child's behavior, we can see that it is incompatible with the addiction of the game." Professor Zheng believes that addiction is from a particular pleasure to be in the act, or else it will anxiety, irritability. For example, drug abuse, drug addiction up, so what will do, but can not think of death, the Internet Addiction to do, and do not necessarily lead to suicide. This view of health and Beijing University law professor Sun Dongdong coincides with the view. He said: "ZHANG Xiao Yi had written a suicide note 4, he has been considered dead, have a world-weary pessimism, self-blame mentality, and this time his activities have taken place in the spirit of the pathological changes. As the play for a day and a night game, it is the network-induced depression symptoms become more severe, leading to his suicide in order to seek relief. " As a result, experts believe that networks can not be a simple case of youth suicide and inevitably linked. This will allow young people simplification of the psychological analysis of the phenomenon and ignored the psychological problems of adolescents in the early prevention, detection and treatment. Professor Zheng Yi said that, in fact, similar to the way ZHANG Xiao Yi teenage boy, growing up in a special time in the process, they showed the reality can not meet. May feel that they are not learning, personal relationships may be handled properly, some of the reality of the phenomenon can not explain it, he experienced pain, but no one told him how to deal with; he felt frustrated, but no one told him How to deal with. In the past, people among the adults there is the issue of depression in order to vote in Children and depression of the event, alert parents, schools, community attached great importance. According to experts, children like fever, there will be a cold physiological responses, psychological barriers have also issued a variety of psychological signal for help. A 13-year-old girl committed suicide before the signal for help several times. She usually one to sleep, but all of a sudden go to bed together with her mother, said that was not practical, fear, even a week to go to the shells do not go to the piano. However, due to family seriously not only the children feel tired before the tragedy happened. "When the children had abnormal psychological reaction, to see psychologists is the best option." Zheng Yi said that there are psychological barriers to a large extent have had a biological change is not a simple education can be resolved. Doctors can be a comprehensive diagnosis, education, early intervention, raising a minor child's psychological defense capabilities to reduce mental illness.

Middle-aged friends pay attention to depression, somatization

Lent over Miss Wang, agile imaginative power, sophisticated work, but not long ago, a young female college student to replace her work, Ms. Wang is a very sad and worried. Since then, she was depressed, hard to sleep at night, but wake up very early, obviously decreased appetite, headache, chest tightness, fatigue can not, does not apply in deep pain. Hospital were diagnosed as "neurasthenia" and "autonomic dysfunction" and "syndrome", but a variety of treatment was not obvious until recently, insomnia increased use of sleeping pills is invalid, the event to a psychiatrist diagnosed with depression. Depression is a very common, but less susceptible to the understanding of mental disorders. Such as mild depression is consciously low mood, sadness distress, reduced interest, reduced speech, slow thinking, do not want to, and other activities, and as a result of trauma can be induced. Most of the others from the outside can not see anything abnormal. In addition, patients often do not apply a variety of physical symptoms, the physical symptoms of the patient can feel very prominent, resulting in a cover up depression, we called this phenomenon "of the body." Although depression can occur in all age, but the "body" is in many middle-aged, middle-aged women in particular, often from the point of view of psychoanalysis. Although middle-aged may be due to the more vulnerable to psychological frustration arising from depression, worry, but on the outside, in order to maintain self-esteem is often strong for every person smile. So that the bad feelings out difficult to resolve, through the subconscious into the role of the inward projection, resulting in a variety of physical symptoms. Patients can be physical symptoms as a result of long-term and comprehensive treatment in hospitals, and between. However, if double-check or dig out that they can be symptoms of depression. If the above-mentioned Ms. Wang, a doctor from the body is found behind the symptoms of her cause and give antidepressant treatment, adverse physical and emotional ease the symptoms have been given the correct diagnosis. If a person continuously for a long time the existence of depression, there are a variety of physical discomfort, severe insomnia, but a variety of hospital and could not check the corresponding anomaly, or ineffective treatment of a variety of symptoms, suspected to have depression May be, shall call a psychiatrist for further examination, treatment in a timely manner. Depression is a good prognosis of mental illness, the current treatment of depression and effective means of antidepressants such as fluoxetine, both domestic and imported, have good curative effect, the treatment, many patients can be recovered.

Eat more potatoes to prevent recurrence of hemorrhoids

Piles of autumn and winter is the high season, many suffering from hemorrhoids to a friend, this time it will Abnormal think hard In fact, as long as the attention of the conditioning diet, give up some of the bad habits of day-to-day, it is entirely possible to prevent recurrence of hemorrhoids. In the fall season, significantly transform the stage, the temperature gradually dry, relatively large temperature difference between morning and evening, the body vulnerable to water evaporation. What is more, many people in uncontrolled tonic in the fall, leading to the digestive system disorders, which cause diarrhea or constipation, diarrhea and constipation and hemorrhoids are a major cause of relapse. In fact, a reasonable regulation of diet to prevent constipation is the most scientific method. Should pay attention to the following: First of all, drink boiled water, weak tea to drink, eat carrots, tomatoes, pears, Lily, Tremella, and so on, to add to the body of water, but also appropriate to add coarse grains, beans, and other fiber-rich foods, increased bowel movements and prevent constipation, And can not be blindly over-tonic. Secondly, some people believe that eating celery to reduce constipation, this is not the case, in the celery contains crude fiber, and defecation is really conducive to the dietary fiber in some of the roots of plants, more fruits, such as potatoes, yam, lotus root, wheat bran And so on. Also, eat less spicy and stimulating food, drink less. Because alcohol and pepper in the stomach and intestinal absorption of small, will be discharged directly from the rectum, thus increasing the anus and rectum to stimulate the easily led to the fall symptoms.

Mild preferred to use what internal medicine

Many people suffering from hemorrhoids to find around in search of drug treatment, in fact, hemorrhoid symptoms do not need treatment, that is, do not need hemorrhoidal "radical." In general, drug treatment applied to a variety of internal and external hemorrhoids, mixed hemorrhoid, is the first choice for mild internal hemorrhoid treatment. The common symptoms of hemorrhoids, the drug in the treatment of pain relief and side effects of bleeding significantly, hemorrhoids caused by the fall anus, itching and constipation have a good effect, or a combination of internal hemorrhoids prolapse, can reduce the swelling to alleviate the symptoms, and For serious off basic null and void. Hemorrhoid treatment branch of the Department of the drug treatment and oral medication. Local drug treatment is for external use drugs, including the main components of hydrocortisone, lubricants, detergents and medicine, such as the protection of mucous membrane, for the general suppository, ointment two formulations. Its role is anti-inflammatory, bleeding, pain, itching and ease the procedure for prolapse and edema caused by the fall anus and a sense of block bowel movements flu. Local drug for the treatment of short-term to ease symptoms, and should not be used as long-term preventive medication. It should be noted that, in the view that if there are symptoms of hemorrhoids constipation, partial application is not recommended laxatives, the need for targeted therapy. If hemorrhoid attack again, the use of local drug treatment is still valid. Oral medication, including increased dietary fiber intake, improve bowel function in patients with Hemorrhoid, and anti-inflammatory, such as the use of intravenous agent. Dietary fiber was not referring to the intestinal absorption of dietary fiber, it can prevent the intestinal absorption of excessive moisture in order to ease the bleeding, pain and other symptoms and to prevent its onset. It is suitable with intestinal dysfunction, such as diarrhea or constipation patients. Intravenous agent microcirculation to reduce the local edema can be used to attack internal short-term treatment, not long-term application. If the hemorrhoid with local inflammation, may choose to antibiotics or steroidal anti-inflammatory drugs, which can effectively alleviate the pain caused by hemorrhoids thrombosis. It should be emphasized that the drug can alleviate the symptoms of hemorrhoids, but you can not eliminate hemorrhoids. In addition, although the treatment of hemorrhoids drugs safer, but still under the guidance of a doctor's choice

CPT® and RBRVS 2009 Annual Symposium

The upcoming CPT® and RBRVS 2009 Annual Symposium meeting is scheduled for Nov. 12-14, 2008 at the:
Hyatt Regency Chicago151 East Wacker DriveChicago, IL 60601Phone: (312) 565-1234
Hotel accomodations
Symposium attendees are responsible for their own hotel reservations. Rooms have been reserved at the Hyatt Regency Chicago.
Book your room at the Hyatt Regency Chicago , or call the hotel directly at (312) 565-1234. The group room rate per night for single or double occupancy is $239 (standard), plus tax (currently 15.4 percent).
You must mention the AMA symposium when booking your room to take advantage of the special group room rate. Remember to write down your confirmation number from the hotel to ensure your room reservation. Guest rooms are available Nov. 11–14, 2008. Reservations must be made by Oct. 21, 2008. Rooms are available on a first come, first serve basis; no additional rooms will be added.
Three ways to registerRegister online for the fastest and easiest way to register. You must have a valid credit card available to secure your space. Payment confirmations will be sent via e-mail. Please print the e-mailed confirmation for your records.
Register by telephoneCall the AMA Unified Service Center at (800) 621-8335. You must have a valid credit card available to secure your space.
Register by mailIf your company requires that you pay with a check, please print this form (PDF, 28KB). Make the check payable to “American Medical Association” and send your payment no later than Friday, Oct. 31, 2008 (no checks will be processed after this date). Payment and registration form(s) should be sent to:
CPT® and RBRVS 2009 Annual Symposium RegistrationOrder DepartmentAmerican Medical AssociationP.O. Box 930876Atlanta, GA 31193-0876
*The AMA does not accept registrations by fax or e-mail.
Registration feesDiscount rate: $750Full rate: $900Fee includes: continental breakfast, break, lunch and cocktail reception.
Registration discountsDiscounted registration rates apply for the following:
AMA members
CPT and RUC advisors or staff
Past AMA CPT or RBRVS symposia attendees
CPT® Assistant newsletter subscriber
Clinical Examples in Radiology subscriber
CPT® Network subscriber
CPT licensees
CPT® and RBRVS Symposium topicsEach presenter will discuss in detail many of the significant changes to CPT 2009 codes and descriptors, as well as 2009 payment policy and relative value unit (RVU) changes to the Medicare physician payment schedule. The following topics will be discussed:
Cardiology
Evaluation and Management
End-Stage Renal Disease Services
Spine Surgery/Neurosurgery
Medicare Medical Home Demonstration
General Surgery
Urology
Orthopaedic Surgery
Ophthalmology
Otolaryngology
Pathology and Laboratory Services
Pediatrics
Performance Measures

AMA establishes the CPT ® Assistant Editorial Board

The American Medical Association (AMA) has established an editorial board for the CPT ® Assistant newsletter. The CPT ® Assistant Editorial Board will give specialty societies, payers, and other CPT stakeholders the opportunity for formal input into the process of selecting topics for articles, reviewing the publication's coding content, and contributing content for publication.
BackgroundIn 2004, the AMA's Board of Trustees responded to an AMA House of Delegates Resolution that called on the AMA to study the feasibility of developing a national standard for the utilization of codes, code combination, and modifiers that is consistent with all CPT codes, guidelines, and conventions and that would be used by all commercial and governmental payers. Shortly after the 2004 Annual Meeting, the AMA contracted with an external consulting group that specializes in evaluating and designing legislative and regulatory proposals, developing and analyzing options to achieve the strategic goals of its clients, drafting legislation, and developing ideas on a wide array of health policy and related areas.
A study was conducted based on a review of a wide range of written documents and on-line reference materials. It was also based on more than two dozen structured interviews with representatives of key stakeholders in the CPT coding community and other individuals with relevant expertise and experience. These individuals included:
Representatives of the CPT Editorial Panel, the CPT Advisory Committee, the Health Care Professionals Advisory Committee (HCPAC), and the AMA/Specialty Society RVS Update Committee (RUC)
Physician and staff representatives of national medical specialty societies, state medical associations, and national organizations representing nonphysician health professionals
Representatives of hospitals, professional coders, and coding consultants
Representatives of the Centers for Medicare and Medicaid Services (CMS), Medicare contractors, the National Center for Health Statistics (NCHS), the National Committee on Vital and Health Statistics, and other agencies within Health and Human Services
Physician and staff representatives of health insurance companies and managed care organizations and the national associations representing their interests
Individuals knowledgeable about proprietary claims editing programs
The New BoardAfter reviewing the report recommendations, it was decided that the AMA should move forward with the creation of an editorial board. The board represents a departure from the past 17 years, during which the newsletter was primarily a product of AMA staff with CPT Editorial Panel and/or CPT Advisory Committee review of content. In the past, the focus and purpose of the CPT ® Assistant was to impart coding advice from the AMA perspective based on discussion of the use and interpretation of the codes at panel meetings and as reflected in the official Panel minutes. With the creation of the editorial board, the focus of the newsletter will subtly shift from providing strict CPT coding guidance and interpretation to responding to “real world” coding issues.

Chemical Weapons: Researcher Working On Their Destruction

America's war on terror includes fighting the dark side of deadly chemical agents, and Texas A&M University chemist Dr. Frank Raushel is helping with the fight by developing an enzyme that might neutralize one such chemical agent, the organophosphates. Synthetic organophosphates started their journey as insecticides in the 1930s but soon made their way into the dangerous alleys of chemical warfare during World War II. Raushel, who has been working on detoxification of organophosphates for nearly 10 years, says that the toxic properties of the organophosphate nerve agents are a serious threat to the health and well being of civilized societies. Although outlawed by several international treaties, some countries have used chemical agents during times of war. In 1988, the Iraqi Kurdish village of Halabja was exposed to multiple chemical agents, killing about 5,000 of the town's 50,000 residents. After the incident, traces of mustard gas and the organophosphates sarin, tabun and VX were discovered. Raushel, the Davidson Professor of Science at Texas A&M, has been awarded a four-year grant of $1.2 million by the National Institutes of Health to carry out his work on organophosphates. Organophosphates are neurotoxins - they attack the nervous system by blocking the function of the enzyme acetylcholine esterase, which carries nerve signals. When organs such as the lungs do not receive appropriate nerve signals, control is lost over respiratory muscles, and it usually results in death by asphyxiation. Today, some classes of organophosphates are used as insecticides while others have been categorized as chemical weapons. Researchers have discovered a bacterial enzyme, phosphotriesterase, which can recognize and destroy the toxicity of a broad spectrum of organophosphate nerve agents. What Raushel aims to do is design and characterize bacterial phosphotriesterases that are better at detecting, destroying and detoxifying those organophosphates that pose the most serious threats to human health.

Does alcohol contribute to vitamin and mineral deficiencies?

When alcohol replaces food, there can be numerous deficiencies caused by the lack of an adequate intake of nutrients. Nutritional deficiencies are common among alcoholics, but they can also be found in people who consume alcohol on a regular basis. The following are common deficiencies brought on by alcohol consumption:
Folate: Folate helps produce and maintain new cells. Alcohol interferes with dietary folate intake, folate absorption, transport of folate to necessary tissues, and the storage and release of folate by the liver.
Vitamin B12: Vitamin B12 is needed to help make DNA and to maintain healthy nerve cells and red blood cells. Studies have shown that both moderate and heavy alcohol consumption will affect vitamin B12 levels. One study showed a 5% decrease in mean serum vitamin B12 concentrations when consumption of alcohol increased from 0 to 30 grams of alcohol/day.
Vitamin A: Vitamin A is needed for vision, to regulate the immune system, for bone growth, for reproduction, cell division, and differentiation. Alcohol has been found to promote a deficiency of vitamin A and also enhance its toxicity when taken in excessive amounts.
Calcium: Calcium is needed for blood vessel and muscle contraction and expansion, for the secretion of hormones and enzymes, and for transmission of messages through the nervous system. Alcohol consumption can cause a loss of calcium in the body by increasing urinary calcium excretion. Calcium deficiency can also lead to osteoporosis.
Numerous other deficiencies will occur when alcohol replaces nutrients in a balanced diet. The damage to your liver and other organs brought on by chronic, excessive alcohol consumption will cause severe problems that can lead to vitamin and mineral deficiencies. The long-term consequences of these deficiencies far outweigh the small amount of health benefits that have been found with alcohol consumption.

Are there any safety concerns with sugar alcohols?

Sugar alcohols are regulated as either GRAS or a food additive. The FDA has filed GRAS affirmation petitions for isomalt, lactitol, maltitol, HSH, and erythritol. Sorbitol is on the GRAS list, while mannitol and xylitol are listed as additives.
The reason that sugar alcohols provide fewer calories than sugar is because they are not completed absorbed in our body. For this reason, high intakes of foods containing some sugar alcohols can lead to abdominal gas and diarrhea. Any foods that contain sorbitol or mannitol must include a warning on their label that "excess consumption may have a laxative effect." The American Dietetic Association advises that intakes greater than 50 grams/day of sorbitol or greater than 20 grams/day of mannitol may cause diarrhea.
The presence of sugar alcohols in foods does not mean that you can eat unlimited quantities. Sugar alcohols are lower in calories, gram for gram, than sugar. They are not calorie-free, and if eaten in large enough quantities, the calories can be comparable to sugar-containing foods. You will need to continue reading the food labels for the calorie and carbohydrate content regardless of the claim of being sugar-free, low-sugar, or low-carb.

What are nonnutritive sweeteners?
The use of nonnutritive sweeteners began with the need for cost reduction and continued on with the need for calorie reduction. Since the 1950s, nonnutritive sweeteners have become a weight-loss wonder that allowed us to have our sweets without the calories and cavities. These sweeteners are also referred to as intense sweeteners, alternative sweeteners, very low-calorie sweeteners, and artificial sweeteners. The celebration and consumption of nonnutritive sweeteners came to a halt in the '70s when cancer connections were discovered. To this day, there is a great deal of controversy surrounding the safety of nonnutritive sweeteners. For every compelling positive argument in favor of using these sweeteners, there is an equally compelling negative argument opposing their use.
The five FDA-approved nonnutritive sweeteners are saccharin, aspartame, acesulfame potassium, sucralose, and neotame. Each of these is regulated as a food additive. These sweeteners are evaluated based on their safety, sensory qualities (for example, clean sweet taste, no bitterness, odorless), and stability in various food environments. They are often combined with other nutritive and/or nonnutritive sweeteners to provide volume that they lack on their own and a desired flavor. An Acceptable Daily Intake (ADI) for each additive has been established. The ADI is the amount of food additive that can be consumed daily over a lifetime without appreciable health risk to a person on the basis of all the known facts at the time of the evaluation.

What is the difference between GRAS foods and food additives?

The World Health Organization (WHO), the Scientific Committee on Food (SCF) of the European Commission, the Joint Expert Committee of Food Additions (JECFA) of the United Nations Food and Agricultural Organization, and the United States Food and Drug Administration (FDA) are each involved.
In the United States, sweeteners fall under the Generally Recognized as Safe (GRAS) list or as food additives under the 1958 Food Additives Amendment to the Federal Food, Drug, and Cosmetic Act. According to the FDA, "Regardless of whether the use of a substance is a food additive use or is GRAS, there must be evidence that the substance is safe under the conditions of its intended use. FDA has defined "safe" as a reasonable certainty in the minds of competent scientists that the substance is not harmful under its intended conditions of use. The specific data and information that demonstrate safety depend on the characteristics of the substance, the estimated dietary intake, and the population that will consume the substance."
The guidelines about what constitutes a sweetener to be on the GRAS list versus being listed as a food additive are as follows:
For a GRAS substance, generally available data and information about the use of the substance are known and accepted widely by qualified experts, and there is a basis to conclude that there is consensus among qualified experts that those data and information establish that the substance is safe under the conditions of its intended use.
For a food additive, privately held data and information about the use of the substance are sent by the sponsor to FDA and FDA evaluates those data and information to determine whether they establish that the substance is safe under the conditions of its.
Throughout the remainder of this article, you will learn about the positive and negative sides of the story behind each of the FDA approved nutritive and nonnutritive sweeteners.

Energy Drinks: The Report

Energy drinks are popular with teens and young adults, Griffiths found in his research. In a 2007 survey of 496 college students, 51% said they had consumed at least one energy drink during the past month.
Bad reactions to energy drinks have been reported to U.S. poison control centers, Griffiths writes in the report, published in the journal Drug and Alcohol Dependence. From 2002 to 2004, he says, 41 cases of caffeine abuse from caffeine-enhanced beverages were reported.
In a report of nine cases of adverse reactions to the energy drink Redline, the patients reported nausea and vomiting, high blood pressure, tremors, dizziness, and numbness.
Data also suggest those who drink the energy drinks may combine them with alcohol, Griffiths tells WebMD. In the college student survey, 27% said they mixed alcohol and energy drinks at least once in the past month. One danger to that: Users may feel alert enough to drive, even if they are inebriated.
Griffiths worries that the energy drinks are sometimes "gateways" to use of other substances. In one study, college students who used energy drinks were more likely to later use stimulants for recreational use, he says.
Energy Drinks: Industry View
Storey, of the American Beverage Association, took exception with Griffiths' view. "It's a review, not a study," she says of his report. "We need to be careful about taking too much out of one review. He looked at some studies."
In a statement issued by the association, officials note that most "mainstream" energy drinks typically contain half the caffeine found in regular coffeehouse coffee. A 16-oz cup of coffeehouse coffee has about 320 milligrams of caffeine, according to the statement, while a typical 16-oz mainstream energy drink has 160 mg.
If labels should be required on energy drinks, Storey says, coffeehouse coffee should also be required to label caffeine content.
Most companies market their energy drinks responsibly, the association contends. Only a few companies give the products illicit or suggestive names (such as Cocaine, an energy drink that triggers controversy).
"Energy drinks can be part of a balanced lifestyle when consumed sensibly," the statement reads.
Energy Drinks: Griffiths' Response
Griffiths stands by his proposal to require warning labels on the energy drinks with the highest caffeine content, although he is not certain what that threshold should be.
There's a difference, he says, in the marketing of energy drinks and marketing of traditional caffeine beverages. The energy drink makers, he says, ''are marketing to vulnerable populations."
SOURCES: Roland Griffiths, PhD, professor of psychiatry and neuroscience, Johns Hopkins University School of Medicine, Baltimore, Md. Maureen Storey, PhD, spokeswoman, American Beverage Association, Washington, D.C. Siobhan DeLancey, FDA spokesperson. Reissig, C. Drug and Alcohol Dependence, manuscript received ahead of print.
©2008 WebMD, LLC. All Rights Reserved.

Energy Drinks: Caffeine Content

Griffiths and his colleagues contacted more than two dozen makers of energy drinks, asking for caffeine content. Here are some of the findings:
(The caffeine content is in milligrams per serving. Although serving sizes vary, Griffiths contends that most people will drink the entire can, whatever the number of ounces.)
Red Bull: 80 milligrams per 8.3-ounce serving
Tab Energy: 95 mg per 10.5-oz serving
Monster and Rockstar: 160 mg per 16-oz serving
No Fear: 174 mg per 16-oz serving
Fixx: 500 per 20-oz serving
Wired X505: 505 mg per 24-oz serving
In comparison, according to Griffiths:
Brewed coffee: 200 milligrams per 12-oz serving
Instant coffee: 140 mg per 12-oz serving
Brewed tea: 80 mg per 12-oz serving
Mountain Dew: 54 mg per 12 oz. serving
Dr. Pepper: 41 mg per 12-oz serving
Pepsi Cola: 38 mg per 12-oz serving
Coca-Cola Classic: 34.5 mg per 12-oz serving
Canned or bottled tea: 20 mg per 12-oz serving
Some of the energy drinks have lower caffeine contents, Griffith says. Among the lower doses:
Bomba Energy has 75 mg per 8.4-oz serving

Energy Drinks: The Back Story

Since Red Bull, the first energy drink to hit the U.S. market, launched in 1997, the market has boomed, Griffiths says, now totaling at least $5.4 billion a year in the U.S. Hundreds of brands are available.
Although the FDA limits the caffeine contents of cola-type soft drinks to 71 milligrams per 12 fluid ounces, no such limit is required on energy drinks, Griffiths tells WebMD.
"Makers of so-called "energy" drinks generally market them as dietary supplements," says Siobhan DeLancey, an FDA spokesperson. Dietary supplements are regulated differently than food. The FDA does not approve or review the products before they are marketed.

Products Need Warning Labels, Scientist Says; Industry Contends They're Safe to Drink

Sept. 24, 2008 -- Caffeinated energy drinks that promise super alertness -- and sometimes imply better sports performance -- should carry labels that specify their amount of caffeine, says a Johns Hopkins University scientist.
Drinks with the highest caffeine content should also warn of potential health dangers, says Roland Griffiths, PhD, a professor of psychiatry and neuroscience at Johns Hopkins University School of Medicine, Baltimore, and senior author of a new report on the beverages.
"Many of these drinks do not label the caffeine content," he says, and some energy drinks contain as much caffeine as found in 14 cans of soda.
The industry begs to differ, with spokespeople pointing out that most "mainstream" energy drinks contain the same amount of caffeine, or even less, than you'd get in a cup of brewed coffee. If labels listing caffeine content are required on energy drinks, they should also be required on coffeehouse coffee, says Maureen Storey, PhD, a spokeswoman for the American Beverage Association.

Cafe society takes on health care

GOOD, a do-gooder media company “serving people who want to live well and do good” and Starbucks are partnering to provide “The GOOD Sheet,” a weekly page that explores key political topics. It’s an exclusive arrangement, so you won’t see these sheets at Peet’s. For 11 weeks leading up to and following the US presidential election, GOOD Sheets will be produced and distributed on specific topics, including gas prices, voter turnout and the environment.
Health care is the topic for the second Sheet. You can see a reproduction here in case you miss it at Starbucks. It includes quite a bit of interesting information such as:
“A look at what’s wrong”
Spending breakdowns
International comparisons of costs and outcomes
A matrix of “how to health the system,” which lays out various alternatives (like single payer), compares them on key dimensions, and notes which aspects Obama or McCain have endorsed
Along the bottom is a timeline of “how we got into this mess,” covering key events and trends over the past couple hundred years
I like the idea of the GOOD Sheet. It presents useful, relevant information in a visually compelling way without dumbing down the issue or taking too strong a stance in favor of a particular outcome. I can imagine the Sheet elevating the discussion about health care to a level where arguments are productive and informed.
The next topic is immigration, which is another area where it would be beneficial to elevate the conversation.
Although I’m not a frequenter of Starbucks –I don’t drink coffee and don’t like the atmoshphere– GOOD Sheets might just get me to go.
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Posted in Policy and politics

Army Can Boost Mission Success by Better Managing Environmental Considerations

By better managing environmental issues during deployments, U.S. Army units can gain tactical and strategic advantages that will help in combat and post-conflict operations, and boost overall mission success, according to a RAND Corporation study issued today.
The study finds that commanders have not usually given environmental concerns high priority during planning, despite the effect environmental conditions can have on troop health, safety and security, and the importance they have for the local population.
Researchers recommend that Army leaders give more weight to strategic, operational and tactical aspects of environmental considerations during planning and operations, and develop comprehensive standards and best practices to address environmental issues during contingencies.
This is consistent with the Army's new counterinsurgency doctrine, which highlights the importance of environmental improvements (especially sewage, water and trash) to gain support of the local population.
U.S. experience in Iraq suggests that providing clean water, electricity, sewage and trash management can tip the balance between the local residents supporting the U.S. mission or the insurgency, according to the study. Public opinion surveys suggest that Iraqis care about these issues almost as much as security.
Environmental considerations encompass anything related to the environment that affects the planning and execution of military operations or is affected by those operations. They include (but are not limited to) clean water, sewage-related infrastructure, soldier health, compliance with environmental laws, sustainability, protection of historical and cultural sites, and management of agricultural and natural resources.
“Perhaps the most underappreciated aspect of environmental considerations is the role that they can play in achieving U.S. national objectives in counterinsurgency and stability operations,” said report co-author David Mosher, a researcher at RAND, a non-profit research organization.
In countries where environmental conditions and infrastructure are severely degraded, clean drinking water, effective sewage and trash systems, and viable farmland are crucial to local inhabitants. Providing these things can influence whether inhabitants support the local government and U.S. goals and objectives.
“Commanders and planners can take steps in the combat phase to preserve existing environmental infrastructure and resources that will be vital once combat has ended,” Mosher said. “Determining what to preserve will demand that leaders and planners take a strategic view of the operation, including what the end result ought to be.”
The Army also can have a positive influence on the environment. In operations in Afghanistan, Iraq and the Balkans, U.S. soldiers have helped to build wells, sewage treatment plants and other water infrastructure systems, which were beneficial to both U.S. soldiers and local communities, said report co-author Beth Lachman.
In Iraq, the U.S. Army Corps of Engineers is helping to restore the Mesopotamian Marshlands that are significant to both regional and migratory bird species, and the local economy.
Environmental issues can also affect soldier health and safety, the costs of an operation, the logistical burden of supporting forces, and diplomatic relations. The study finds that long deployments and extended post-conflict operations like those in Iraq, Afghanistan, and the Balkans expose U.S. forces to a variety of environmental problems. At one base camp in Afghanistan, legacy pollution problems caused short-term respiratory illnesses for U.S. soldiers until the problem was identified and addressed.
The relationship between the Army and the environment is a two-way street, according to the study. On the one hand, soldiers and operations affect the environment; on the other, the environment affects soldiers and operations, especially because many contingency operations are often conducted in locations that have significant legacy pollution and other environmental problems.
The study finds that base camps raise a host of environmental issues. In most contingencies over the last 20 years, U.S. forces have remained in theater much longer than expected. As a result, base camps that were hastily constructed for temporary use are occupied for many years and often have inadequate environmental systems and procedures, such as insufficient waste management.
Pollution from base camps can affect relations with locals, cause health problems for soldiers, and require costly cleanup efforts. The authors state that Army leaders should anticipate longer stays and design and build base camps accordingly.
Operations that require less fuel, water and other resources, and produce less waste, will reduce the logistics burden. A well-designed, efficient base camp can reduce the resources required to sustain it and free logistics assets to support U.S. troops or reduce the number of convoys that must travel along dangerous roads, the report finds.
Environmental conditions can also extend beyond national borders because air and water pollution may travel great distances, affecting diplomatic relations with countries that could be crucial to the mission's success.
The authors make several recommendations:
Improve policy and guidance for environmental considerations in contingency operations. Work with the Department of Defense to develop guidance that would clarify the need to anticipate and address environmental issues in contingency operations.
Encourage an environmental ethic throughout the Army that extends to contingency operations.
Better incorporate environmental considerations into planning, particularly those that relate to achieving U.S. strategic objectives and to base camps.
Improve pre-deployment and field environmental training so that soldiers and leaders understand the importance of the environment in contingency operations and techniques for reducing the Army's impact.
Invest more in environmental resources and good environmental practices for field operations, including training for base camp managers and unit environmental personnel, developing efficient base camp designs, and creating new technologies to manage and reduce the environmental effects of Army operations.
Use a “sustainability” model for planning for and managing environmental issues during contingency operations to reduce the logistic burdens and costs of base camps, decrease waste streams and lessen the need for cleanup.
Other authors of the study are Michael D. Greenberg, Tiffany Nichols, Brian Rosen, Henry H. Willis. The report, “Green Warriors: Environmental Considerations in Army Contingency Operations,” is available at www.rand.org.
The study was prepared by the RAND Arroyo Center, which provides objective analytic research on major policy concerns to leadership of the U.S. Army, with an emphasis on mid- to long-term policy issues intended to improve effectiveness and efficiency. The center also provides the Army with short-term assistance on urgent problems and acts as a catalyst for needed change.

A Government Takeover of Health Care? If Only!

"I want families making decisions about health care, not the federal government."
This, of course, is John McCain's--and every conservative's--favorite line about proposals for universal health care. So in case anybody is visiting this site for the first time, and perhaps hasn't followed this debate, here are the essential points.
1. Obama has not proposed to have the federal government take over health insurance. He would set standards for what private insurance must provide--and how private insurance carriers must sell their policies. That means making sure everybody gets benefits as good as what members of Congress gets and making sure everybody can get coverage. Most Americans think those are good things--and they are right.
2. Obama would create a public health plan, something that looks like Medicare, into which anybody can enroll. One reason for doing this is to provide a safety check on private plans: If private insurers know they must compete with a public plan, they can't play the same games--that is, they can't try to exclude people with serious medical conditions or short-change beneficiaries. Private insurers have been known to do these things. It's possible everybody could end up in the public plan--but, if so, that would only be because everybody wanted to join. (What Obama is proposing looks a lot like this.)
3. For the record, if we did have a government-controlled health care system in this country, we'd probably be better off. The most popular insurance program in America is Medicare, a government-run health care system. Most experts will tell you that the most efficient, high-quality health care in this country comes from the Veterans Administration (thanks mostly to its high-tech patient information system). That's as close to socialized medicine as you'll find in this country. But nothing Obama has proposed would come close to putting everybody into a VA-like system. (Also, for what it's worth,sSome of the best health care systems in the world--namely the systems in France and Taiwan--are truly government-run.)
4. Nobody should know the benefits of govenrment-run health care better than McCain, who over the years has benefitted from eligibility in the VA system, the Federal Employees Health Benefits Plan, and Medicare.
5. McCain's health plan would not make health insurance more affordable and accessible. More likely, it will lead to people losing good coveage. And the impact will be felt most by those with pre-existing medical conditions--that is, the people who need insurance the most. More on that here and here and here.