Research has shown that not getting enough sleep can have a negative effect on your health. Lack of sleep may lead to weight gain over time, and it may be a factor in developing high blood pressure. Poor sleep can also impair thinking, reaction time and mood. Your individual sleep needs may vary, but most people require between seven and eight hours of sleep every night.
Kevin Gersten, M.D., Ph.D. , an Ear, Nose and Throat (ENT) doctor and board-certified sleep medicine specialist at the Palo Alto Medical Foundation, shares some tips on getting the rest you need and developing good sleep habits.
Tips for Better Sleep
Establish a regular sleep schedule. Go to bed at the same time every night, and get up at the same time every morning. Resist the urge to stay up late or sleep late on some days. If you can, avoid working night shifts and making changes to your work schedule.
Develop a relaxing pre-sleep routine. Take a warm bath, listen to calming music, read a book — anything that helps you unwind is a good sleep habit.
Observe some basic “don’ts.” Don’t take naps after 3 p.m., exercise within five or six hours of bedtime, eat large meals or drink a lot of liquids, or use nicotine or drink caffeine or alcohol close to bedtime. Each of these may keep you from falling asleep or sleeping well.
Create a restful environment. Make your bed comfortable. Keep the temperature low in your bedroom at night. Block out disturbing lights, noises or other distractions.
If you can’t sleep, get up. Don’t lie in bed for more than 20 minutes trying to fall asleep. Instead, get up and do something relaxing. Once you feel as though you might be able to sleep, head back to bed.
Bay Area News Group’s Survey Reflects Employee Satisfaction
The Palo Alto Medical Foundation (PAMF) was ranked in the top ten of the Top Work Places in the Bay Area, in the first employee-based survey of Bay Area companies. PAMF placed first as the top non-profit workplace and sixth in the Top 10 large companies to work for.
“Every day, our employees care for thousands of people and put our organizational values into action: compassion, honesty, integrity and teamwork. We are proud of the excellent job they do and are gratified that they feel that they are appreciated and supported in their efforts,” said David Druker, M.D., PAMF president and CEO.
The employee survey was conducted by Workplace Dynamics, an independent company, which announced its results in the June 20 edition of the Bay Area News Group, which includes the San Jose Mercury News, Contra Costa Times, Oakland Tribune and San Mateo County Times. More than 1,200 companies in the Bay Area were invited to participate in this survey. The results of the entire survey can be found online at the Bay Area News Group website: http://jobscareers.com/topworkplaces/
Bronchoscopy System for Minimally Invasive Diagnosis and Treatment of Lung Cancer – and Other Lung Diseases
In the United States, lung cancer causes more deaths than any other cancer and is second only to heart disease in overall mortality. Because pulmonary tumors (a form of lung cancer) are difficult to detect and biopsy, the disease is often diagnosed late—at stage III or IV. At those stages, five-year survival of lung cancer is only about 15 percent.
Two-minute video demonstration of the inReach System
The inReach electromagnetic navigation bronchoscopy system allows clinicians to non-invasively biopsy small lesions in the periphery of the lung for the first time. Using traditional methods, doctors can only direct a typical bronchoscope down two or three airway branches, however, there may be 17 to 25 branches before they get to a small nodule in the periphery of the lung. In the past, pulmonologists would either follow these nodules over time or insert a needle through the chest and into the lung, which can sometimes collapse this delicate organ. The new electromatic navigation system allows Dr. Krishna and other pulmonologists to biopsy tissue they wouldn’t have been able to reach otherwise.
In 2005, Carol Thorington was diagnosed with stage IV lung cancer—the most serious classification of cancer. With hundreds of tumors in both lungs, she was given two, at most six, months to live. Although doctors told her that it was inoperable, Carol wasn’t ready to give up. She went to see Dr. Krishna, even though she knew conventional wisdom said her cancer was incurable.
New Treatment for Lung Cancer Extends Patient Life
The new interventional pulmonary procedures Dr. Krishna performed for Carol have not only lengthened her life by five years, they have made those years much more comfortable. For the past five years, Carol’s routine has been to see Dr. Krishna regularly for removal of the lung tumors that he can reach without having to perform surgery and the insertion of stents in the lungs to ease her breathing.
As one of only a few doctors in the United States who are experts in the inReach electromagnetic navigation bronchoscopy system, Dr. Krishna collaborates with doctors in Radiation Oncology, Thoracic Surgery and Medical Oncology, and offers patients cutting-edge noninvasive procedures for treating lung cancer, emphysema, benign airway disorders and pleural diseases. Palo Alto Medical Foundation’s Mountain View Center is the only medical center on the West Coast offering 22 diagnostic and therapeutic Interventional pulmonology procedures.
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Doctors at the Palo Alto Medical Foundation Research Institute (PAMFRI) today released a new study that quantifies that cardiovascular heart disease (a category of illnesses of the heart or blood vessels) is the leading cause of death for South Asians in California. More than 1.6 million South Asians live in the United States, more than one quarter of them in California.
Latha Palaniappan, M.D., M.S., is the lead PAMFRI researcher on this study. She collaborated with investigators at the University of California, School of Public Health to study California mortality records from 1990 to 2000. All of the study details are available in today’s complete press release, with the stunning conclusion: four out of every 10 South Asians in California dies of cardiovascular disease.
Once completed, this research did not just get published and filed away. Dr. Palaniappan and a group of her fellow doctors acted on their findings to help patients. They collaborated on a clinic and website directed at South Asians that stresses the importance of early screening, health education and positive lifestyles choices. It’s called PRANA (PRevention & AwareNess for South Asians). The website and communications provide health education and resources to the South Asian community, including health education classes and community lectures. The PRANA group also produces a free monthly e-newsletter, South Asian Wellness. The educational materials are in English and Hindi.
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In this post, Dr. Steven Lane describes ongoing volunteer medical relief efforts in Haiti following the earthquake in January 2010. He is part of a volunteer group of doctors, nurses and medical staff who are caring for patients and helping to establish an international standard for health IT in disaster situations by piloting the iChart mobile EHR program on the iPhone. The group sends a new team of volunteers to Haiti every month for a week of service. The fifth group returned to Haiti in May 2010. More than 82 team members have traveled so far. The volunteer teams are organized by Dr. Enoch Choi, of the Palo Alto Medical Foundation’s Urgent Care Department, and include members from other medical organizations.
Dr. Lane is a Family Medicine Physician at the Palo Alto Medical Foundation, EHR Ambulatory Physician Director at Sutter Health, Clinical Associate Professor of Medicine at Stanford University School of Medicine, and Associate Clinical Professor of Family & Community Medicine at the University of California, San Francisco.
Piloting Mobile EMRs for use in Disaster Situations
In planning for our initial trip to Haiti to provide post-earthquake disaster medical relief we felt that some sort of electronic medical record (EMR) capability would be beneficial to support our team of doctors and nurses. An EMR would provide a simple record keeping system regarding the patients seen and the care provided and could potentially allow us to make this information available to other providers who might assume ongoing responsibility for follow-up care of the same population.
We reached out to friends and colleagues who worked in medical informatics and received a number of offers of help including donated hardware, software and custom development to provide an application that would meet our needs. At the same time we learned of the work of the Harvard Operational Medicine Institute (OMI) that was working with the United Nations to pilot a number of mobile EMR applications in hopes of establishing an international standard for the use of health information technology in disaster relief situations. The Harvard group had determined that the most ubiquitous technology amongst health care workers providing disaster relief in Haiti was the Apple iPhone and that standard mobile phone technology would provide the most reliable connectivity between providers. They quickly reviewed the available applications and decided to try to use one called iChart, developed initially by an internist in Los Angeles. The volunteer medical team working at an impromptu field hospital near the Haiti-Dominican Republic border had begun using the iChart application with some success. Due to the nature of disaster relief they were not using the EMR application in the way it had been designed, but rather were redefining existing data fields to allow for the rapid entry of key demographic and clinical information.
The Harvard team was also in discussion with the developers of Open MRS, an open source EMR that has been used extensively in the third world, particularly to support HIV care. As we made contact with Harvard they were hoping to finalize a handheld front end for the Open MRS application that our team might be able to pilot to provide a comparison with the early field experience with iChart. As our departure date approached we did not know which application or what sort of mobile devices we would be using in Haiti. Four days before our departure we learned that the Open MRS application would not be ready in time and we were invited to join the iChart pilot. As our team would be working in tent cities providing primary and urgent care this would provide a very different use case than the experience thus far in the field hospital where they were caring for post-op patients and managing children who had lost their families.
iPhones Loaded with iChart Software for EMR Application
In the days before our departure for Haiti we needed to obtain iPhones, load them with the iChart software, arrange for cellular connectivity in Haiti and learn how to use the EMR application. We were lucky enough to get 10 iPhones on indefinite loan through a friend at Apple and to hook them up with AT&T mobile service which was being offered for free to disaster relief workers in Haiti. While it was possible to learn the basic functionality of the iChart EMR application, it was not until we arrived in Haiti and could visit the field hospital where the application was being used that we received the specific instructions on how the Harvard team had decided to enter clinical data.
Our initial goal in using the EMR was to support our clinical workflows, having the triage staff enter basic demographic data, synchronize with the server over the cellular connection, and then have the physician providing definitive care access the patient record and document the diagnosis, treatment, etc. As we began to see patients we realized that this was not going to be possible. There was no reliable cellular service where we were working and the volume of patients that needed to be seen did not allow for the extra time required to enter even minimal demographic and clinical data into a hand-held device in real time. We came to Haiti prepared with half page paper forms that we had designed to facilitate rapid clinical documentation in case the EMR didn’t work out. We found that even these simple documentation tools were more than we were able to utilize in the rush to care for the hundreds of patients who presented themselves at our clinics each day.
As our team was committed to contributing to the effort to pilot health information technology to support disaster medical relief, each night, after clinic, we entered data from our paper records into the EMR application. By walking out into the front yard of the house where we were staying we were able to catch a sufficiently strong mobile signal to upload our data to the server maintained by the iChart vendor.
After our first team returned from Haiti, we had a series of calls with the Harvard team to provide feedback regarding the iChart application itself, as well as the challenges of utilizing a hand-held EMR in the context of disaster relief field medicine.
Before our second medical team departed for Haiti, we had a chance to upgrade the iChart software on the iPhones with a version that had been modified in response to initial feedback from pilot use. Our second team was prepared with full instructions on how to use the application and had every intention to use it in real time patient care. Team Two’s experience was similar to that of Team One, finding it impossible to use the EMR application in the process of care. They again, documented care on paper, entering data after the fact into our growing database of patient information.
Challenges and Limitations of a Volunteer Project
One of the goals of the EMR pilot in Haiti is to build a database of clinical information that can be handed over to the Haitian government, the UN or some other NGO to serve as the foundation of a national EMR database. After each of our trips we discussed with the Harvard team and the iChart vendor the possibility of merging our databases. While this has still not been accomplished everyone agrees that this is desirable, doable and should be accomplished in time. As with many of the challenges we have faced with this project, we are limited by the fact that the software vendor and all of the pilot participants are volunteering their time and energies, so turn around times are limited by people’s ability to work after hours on this project. As the situation in Haiti has evolved after the earthquake there have also been changes at the UN. The UN mission in the Dominican Republic, which initially supported this work, is no longer primarily responsible for medical disaster relief efforts in Haiti, so connections are being made with the re-established UN mission in Haiti. Also it is not clear whether or when a local entity will be established in Haiti that will be able to take ownership of a national health information database.
As fifth team starts works in Haiti this week, they are again prepared with an updated version of the EMR application. This time, multiple changes have been made based on our feedback and we are again hoping to be successful in using the application in real time.
Promise of Disaster Relief EMR and an International Standard
The promise of a disaster relief EMR is compelling. If we are able to collect and manage clinical data in real time it would support continuity of care for individual patients, provide critical data to direct the distribution of scarce human and material resources, and allow for the early identification of disease trends. The ideal disaster relief EMR would also provide real time decision support, which is sorely needed by clinicians working in a foreign country, with unfamiliar diseases and severely limited access to diagnostic testing, medications, supplies and other therapies. An international standard, specifying a minimum data set, decision support functionality and back end database characteristics would allow developers to provide various hardware and software solutions that might be deployed immediately after a disaster as well as a community of relief organizations and individuals prepared to operationalize these tools quickly and effectively when the need arises.
Research has shown that not getting enough sleep can have a negative effect on your health. Lack of sleep may lead to weight gain over time, and it may be a factor in developing high blood pressure. Poor sleep can also impair thinking, reaction time and mood. Your individual sleep needs may vary, but most people require between seven and eight hours of sleep every night.
