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Tuesday, 7 June 2016

Princess Health and NY Times/Steve Lohr asks "Why the Economic Payoff From Technology Is So Elusive." The answer in medicine is obvious.. Princessiccia

Princess Health and NY Times/Steve Lohr asks "Why the Economic Payoff From Technology Is So Elusive." The answer in medicine is obvious.. Princessiccia

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In a June 5, 2016 article, New York Times reporter Steve Lohr (http://topics.nytimes.com/top/reference/timestopics/people/l/steve_lohr/index.html), who reports on technology, business and economics, asked the following question:

Why the Economic Payoff From Technology Is So Elusive
New York Times, Business Day
By STEVE LOHR
JUNE 5, 2016
http://www.nytimes.com/2016/06/06/business/why-the-economic-payoff-from-technology-is-so-elusive.html

Your smartphone allows you to get almost instantaneous answers to the most obscure questions. It also allows you to waste hours scrolling through Facebook or looking for the latest deals on Amazon.  More powerful computing systems can predict the weather better than any meteorologist or beat human champions in complex board games like chess.

But for several years, economists have asked why all that technical wizardry seems to be having so little impact on the economy. The issue surfaced again recently, when the government reported disappointingly slow growth and continuing stagnation in productivity. The rate of productivity growth from 2011 to 2015 was the slowest since the five-year period ending in 1982.

Healthcare becomes the gravamen of the article:

One place to look at this disconnect is in the doctor�s office. Dr. Peter Sutherland, a family physician in Tennessee, made the shift to computerized patient records from paper in the last few years. There are benefits to using electronic health records, Dr. Sutherland says, but grappling with the software and new reporting requirements has slowed him down. He sees fewer patients, and his income has slipped.

Unfortunately, the advisors who helped him with the article may have provided incomplete information:

... �The government funding has made a huge difference,� said Dr. Ashish Jha, a professor at the Harvard School of Public Health. �But we�re seeing little evidence so far that all this technology has had much effect on quality and costs.�

In the face of, among many others, a stunning letter from 40 medical societies to HHS in 2015 that the technology is unfit for purpose (http://mb.cision.com/Public/373/9710840/9053557230dbb768.pdf), known and hair-raising defects (http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html), and many other complaints from physicians and nurses (e.g., http://hcrenewal.blogspot.com/2013/11/another-survey-on-ehrs-affinity-medical.html, http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html, query link http://hcrenewal.blogspot.com/search/label/glitch as just a few examples), such a statement is anserine.

Why would anyone expect (good) effects on "quality and costs" of healthcare when the technology is so unfit for purpose in design and implementation that it has alienated most of its users?  

I've written previously about Jha's views in a May 27,  2009 post "Harvard's EMR Justification: We Just Have To Do Something" (http://hcrenewal.blogspot.com/2009/05/harvards-emr-justification-we-just-have_27.html):

 ... "I'm not suggesting EHR is going to be a panacea, but the one thing that is absolutely true is there is nothing else out there now that has any more political appeal," Jha says. "Everybody agrees, whether you are a conservative, moderate, or liberal, that we have to do something about healthcare. So the one place where we can all come to agreement is we have to do something about electronic records."

I do not think "political appeal" is a good justification for a multi-billion dollar cybernetic experiment in medicine, where the risks of the technology are considerable and where basic healthcare needs are not being well met among the poor and underprivileged.

Former ONC Chair David Brailer is quoted:

�People confuse information automation with creating the kind of work environment where productivity and creativity can flourish,� said Dr. David J. Brailer, who was the national health technology coordinator in the George W. Bush administration. �And so little has gone into changing work so far.�

Brailer was little better than Jha, and moves the goalposts with a type of circular logic.  He appears to be saying that technology that will revolutionize medicine can't work until we change how things are done in medicine so the technology can revolutionize medicine. 

The article then quotes one Tennessee physician, a Dr. Sutherland, who is "happy" to accept bad health IT, a resultant pay cut, and increased work:

... Today, Dr. Sutherland�s personal income and the medical group�s revenue are about 8 percent below where they were four years ago. But in 2015, both his earnings and the revenue of Healthstar, which employs 350 people in 10 clinics, increased slightly, by nearly 3 percent from 2014.

... Dr. Sutherland bemoans the countless data fields he must fill in to comply with government-mandated reporting rules, and he concedes that some of his colleagues hate using digital records. Yet Dr. Sutherland is no hater. Despite the extra work the new technology has created and even though it has not yet had the expected financial payoff, he thinks it has helped him provide better information to patients.

He values being able to tap the screen to look up potentially harmful drug interactions and to teach patients during visits. He can, for example, quickly create charts to show diabetes patients how they are progressing with treatment plans, managing blood glucose levels and weight loss.

He is working harder, Dr. Sutherland says, but he believes he is a better doctor. Blunt measures of productivity, he added, aren�t everything. �My patients are better served,� he said. �And I�m happier.�

While being able to provide fancy charts and check drug-drug interactions (for which a massive and expensive EHR is certainly not needed; a PDA will suffice) is fine.

However, anyone who gladly accepts a pay cut, and inconvenience, and harder work due to bad health IT, and is a happy camper with that state of affairs, either suffers from the Stockholm syndrome or has a lot of discretionary income and free time to spare that many clinicians do not.  

The article fails to mention the hundreds of thousands of other US docs and others in other lands (e.g., http://hcrenewal.blogspot.com/2016/05/hit-mayhem-canadian-style-nanaimo.html) who aren't happy at all with health IT as it is today.  

---------------------------------------

I sent this email to Mr. Lohr.

From: S Silverstein
To:Steve Lohr 
Date: Tue, Jun 7, 2016 at 10:02 AM
Subject: Re: Why the Economic Payoff From Technology Is So Elusive

Dear Mr. Lohr,

In medicine, the answer to this question is straightforward.  I don't know if Ashish Jha brought this to your attention, or if he himself is aware of it.

This letter from nearly 40 different medical societies to HHS about bad health IT is specific about how bad the current health IT is:



You should be aware of the letter's contents.  I've also attached it to this email.

In academic Medical Informatics, such matters are often ignored, as they run contrary to the narrative that IT will "revolutionize medicine"; I know, as I was Yale faculty in Medical Informatics myself. 

The assumption in academic circles and in the Administration (unfortunately) is that "all health IT is good health IT." 

Unfortunately, it is not.  From my own site "Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties" at http://cci.drexel.edu/faculty/ssilverstein/cases/ :

Definitions authored by myself and Australian informatics expert Dr. Jon Patrick:


Good Health IT ("GHIT") is defined as IT that provides a good user experience, enhances cognitive function, puts essential information as effortlessly as possible into the physician�s hands, can be easily, substantively and cost-effectively customized to the needs of medical specialists and subspecialists, keeps eHealth information secure, protects patient privacy and facilitates better practice of medicine and better outcomes. 

Bad Health IT ("BHIT") is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, is difficult and/or prohibitively expensive to customize to the needs of different medical specialists and subspecialists, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, is lacking in evidentiary soundness, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation. 

It comes as no surprise not to find productivity gains, but instead hundreds of thousands of angry physicians (and nurses), when health IT is mostly bad IT.

The health IT industry itself needs serious remediation before its products will be a boon to medicine.

Sincerely,
Scot Silverstein, MD
Drexel University, Philadelphia


p.s. I have not even broached the matter of health IT patient harms. 

Patients are being harmed and dying of bad health IT.  See for instance the CRICO insurance report at http://www.cci.drexel.edu/faculty/ssilverstein/PSQH_MalpractClaimsAnalyConfirRisksEHR.pdf
 
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I will add an addendum if I receive a reply.

-- SS

Monday, 6 June 2016

Princess Health and June 6th, 2016 Batting .500. Princessiccia

Princess Health and June 6th, 2016 Batting .500. Princessiccia

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June 6th, 2016 Batting .500

I arrived at the studio at 6am. It's eleven minutes until 8pm and I'm still here. Long day, oh my. It's important for me to remind myself--this isn't the norm, it's the exception. I have three large projects that have each taken me longer to get done than I expected. Anyway--I'm not complaining, I'm just saying--very long day here.

I did pause for the Monday night support group conference call! I needed the break and the positive energy!

But I mustn't skim over last night. I'm batting .500 with the bedtime deal. I planned on being in bed by 10pm--even mentioned it in the blog--and to some of my support connections--and still, I crashed through that bedtime without touching the brakes. Amber and I enjoyed our visit with mom very much! In hindsight, we should have left a couple hours earlier. That was my thing.

It's a work in progress. Again, I'm batting .500 so far.

I'm headed home shortly where my grandson is waiting patiently for me. I have a friend taking care of him while I work. He's staying with me tonight. He's been playing all day, so I'm sure it'll not be a challenge to get him to go to bed.

The following is an excerpt of a DDWL blog post from more than seven years ago.

March 2009:

Every now and then I write a blog, post it, then the next day I'll think of something I wanted to mention but didn't. Last night after the �Lose To Win� seminar, I was approached by a nice lady who expressed concern for a loved one. She told me that the loved one that had her concerned was where I was when I started. Just in case she convinced that loved one to read this blog, here's what I hope he reads:

I don't know your name, what you look like, or anything about you other than a couple of clues I've been given. I know that you're right around 500 pounds and I know that you have loved ones that care deeply about you. That's all I know for certain about you. But I'll take it a little deeper. I was over 500 pounds for years, so I can safely assume that perhaps you're feeling some of the emotions that became a fixed part of my life for so long. You might feel completely hopeless, I did. You might feel like you're out of control, I did. You probably turn to food when you're stressed, scared, sad, happy, it doesn't matter the occasion or emotion huh?

Yep, me too. It's hard to get around isn't it? A short walk can feel suffocating, I know. Maybe you feel like your weight has started chipping away at your personal relationships, I know I did. Are you scared of dying like I was, every single day? Be honest, when a little twinge of pain crosses your chest do you start praying it's anything but what you fear the most? I sure did. Is your wardrobe severely limited because of your size? Mine was. I once wore the same pair of pants every day for six months straight, washing it every couple of days, just because it was the only pair that fit, and driving to OKC or Tulsa to buy more was too inconvenient.

When you get scared for your life, do you feel like you're in a non-stop self-destructive cycle? Please say you haven't given up. I never did.

Listen, I knew that if I kept going, I would die very soon. Only God knows how soon, but soon for certain. I also knew that I had to be the one to stop the endless cycle. I had to get very honest and very serious with myself. You're not hopeless and you can do this. I'm not special, I don't have any kind of secret potion, I'm not perfect in any way. I'm just a guy who knew that if I really wanted to live, and I mean really live, I had to do something now. I'd argue that I'm no different than you my friend. 192 days ago I reached my limit. My world was becoming unraveled, my weight was doing it's best to crush me and any sliver of hope I may have had for the future.

Can you relate? I bet you can. I'm here to tell you that you can reclaim your life. You have the power within you to do amazing things, and grabbing control of your weight is just the beginning. But how? I'm not going to say that my way is right or wrong, bad or good. It's what I did. I immediately started eating 1,500 calories a day and exercising however I could, and trust me, it wasn't much, but remember, anything is better than nothing. And you'll be amazed at how far you'll progress along the way if you stay consistent.

Read the labels, buy a calorie book, look calories up on the internet. All the information you need is out there. Even before you do that, it's very important to sit down and have a long internal discussion with yourself. Write down what you want out of life. Dream a little! Get it on paper or on a computer screen, whatever, just write. Form your motivating thoughts and hold onto them tight, you're gonna need them to get through this.

Make your motivating thoughts one of the most important things you think about daily. Then DECIDE that you will defend the pursuit of those desires every waking minute. DECIDE to live, DECIDE to change, DECIDE to once and for all take a stand for yourself. Stand up and demand respect from the one that has given you the least, and that's you. DECIDE that it isn't going to end this way, obesity is no longer in charge of your destiny, you are. BELIEVE you have the power to render powerless every hang up that stopped you before, because YOU DO. DECIDE that no matter the struggles in your day to day life, one thing will never be compromised, and that's your commitment to this journey.

Don't do what I did for years, I don't know you , maybe you've done it for years too...Don't lie to yourself. Don't assume you have time to worry about it later. DECIDE to do it NOW and leave the worry behind. I'm right at about half way through my journey, and I've never been happier. That happiness I speak of comes from hope that I never had before. That happiness exist regardless of my current circumstances. Regardless of the stress level from whatever it is that's stressing us out, that happiness and hope remains and carries us through. DECIDE that you're worth it, because YOU ARE. DECIDE to LOVE YOURSELF enough to make the changes that will set you free.

Listen, I've never been one for dramatics, and I know this page is full of dramatics, but please know that it comes from a very sincere place. I wish you could take my place and feel what I'm feeling. Please go back in the archives and read from day 1. Every day is indexed on the left hand side of the page. And if you want, send me an e-mail and we'll communicate directly. Whoever you are, best wishes.
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Well, that was interesting. That was written in early 2009. I still had so much to learn, so much to experience and so much more to consider along the way. And you know what? I'll be able to say the same thing in seven years when I revisit June 2016. The learning/evolving continues every day.

I'm certainly learning all about schedules of late. Work schedules, personal schedules and sleep schedules--and how all three dramatically affect the others.

I'm headed home to see my grandson and prepare dinner.

I'm maintaining the integrity of my calorie budget, I'm remaining abstinent from refined sugar, I'm drinking a minimum 64oz water (some days a bunch more!) and I'm staying in contact with great support connections.

Continuous Live-Tweet Stream:












































Thank you for reading and your continued support,
Strength,
Sean
Princess Health and Youth injuries from e-cigarettes spike; FDA is starting to regulate them, but study authors say not enough to protect children. Princessiccia

Princess Health and Youth injuries from e-cigarettes spike; FDA is starting to regulate them, but study authors say not enough to protect children. Princessiccia

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By Melissa Patrick
Kentucky Health News

The number of young children swallowing or being exposed to the liquid nicotine used in electronic cigarettes has "skyrocketed," jumping 1,500 percent from 2012 to 2015, one co-author of a recent study says.

"E-cigarettes and liquid nicotine can cause serious poisoning, and even death, among young children," Dr. Gary Smith, co-author of the study, told Randy Dotinga for HealthDay. "Like other dangerous poisons, they should be kept out of sight and reach of children, preferably in a locked location."

The research, published online May 9 in the journal Pediatrics, follows an announcement that the U.S. Food and Drug Administration will now regulate e-cigarettes. The rule bans the sale of e-cigarettes to minors, requires health warnings on all packaging and advertisements and requires manufacturers to get federal approval on all products introduced to the market after Feb. 15, 2007. It does not address marketing or advertising. The measure goes into effect Aug. 8, and gives affected industries two years to comply.

E-cigarettes, which are battery-powered devices that heat up fluid that includes nicotine and other ingredients such as flavors and chemicals, have become increasingly popular. They are now the most common form of nicotine use among teenagers. Researchers found that it is the liquid nicotine that poses the greatest danger to children.

The study looked at calls to the National Poison Data System about nicotine and tobacco products from January 2012 to April 2015, and focused on calls about children under the age of 6. The NPDS received 29,141 calls for nicotine and tobacco product exposure during this time, averaging 729 child exposures per month.

It found about 14 percent, or 4,128 of the calls were about exposure to e-cigarettes and involved children aged 2 or younger. Most of the exposures were due to ingestion.

"Children exposed to e-cigarettes had five times higher odds of a health care facility admission and almost 3 times higher odds of having a severe outcome than children exposed to cigarettes," says the report. "One death occurred in association with a nicotine liquid exposure."

"These are not trivial exposures. There were comas, seizures, and even one death in the 40-month period we studied, and these exposures were predictable and preventable," Smith told MedPage Today. "E-cigarettes and vaping liquids are products that should never have entered the market without adequate consideration of the harms they could cause to young children."

Smith, also the director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Ohio, told HealthDay that more needs to be done.

"Other prevention steps include prohibiting the use of flavors, as was done for cigarettes since 2009, restricting the use of packaging and labeling attractive to children, ensuring that liquid nicotine compartments on e-cigarettes are child-resistant, and limiting the concentration and/or quantity of nicotine in refill products," he said.

Gregory Conley, president of the American Vaping Association, a nonprofit group dedicated to education about e-cigarettes and vapor products, told HealthDay that the concern about e-cigarettes is "overblown."

He told HealthDay that the child who died "consumed a homemade nicotine liquid concoction that's much stronger than retail versions." He also pointed out that the number of cases have declined since this study was conducted, saying that this is likely due to increased publicity about the risk.

Co-author Henry Spiller, director of the Central Ohio Poison Center at Nationwide Children's Hospital, encouraged parents of young children who vape to treat liquid nicotine like a poison, suggesting that they keep refill containers "up, away and out of sight, preferably in a locked location" and to not leave vaping devices laying around.

Study authors encourage parents to call the Poison Help Line immediately, at 1-800-222-1222, if their child has been exposed to e-cigarettes.

Princess Health and WellCare provides twist-on naloxone nasal atomizers for free, encourages those who know addicts to have naloxone on hand. Princessiccia

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WellCare of Kentucky and the Kentucky Pharmacists Association have teamed up to provide 1000 twist-on naloxone nasal atomizers for free, in hopes of making it easier for people to administer the drug.

Dr. Paul Kensicki
"We believe this will make it easier, and less intimidating, for people with no medical background to administer it in an emergency situation," Paul Kensicki, medical director of behavioral health at WellCare of Kentucky, said in op-ed released by Wellcare.

WellCare will provide the atomizers to pharmacists, who will then distribute them to Medicaid recipients and individuals with no insurance coverage.

Kentucky's 2015 anti-heroin law allows pharmacists to dispense naloxone (brand name Narcan), a drug that can reverse the effects of a heroin overdose, without a prescription.Traditionally, the drug has been given as an injection, but the atomizer transforms the syringe to allow it to be administered as a nasal spray.

Naloxone immediately reverses the effects of an opioid overdose by physiologically blocking the effects of the drug. It has no side effects and cannot be abused. "It�s nothing short of a miracle drug," Kensicki writes. "It can absolutely save a life."

More than 1,000 Kentuckians die each year from drug overdoses, with more than 200 of these deaths from heroin. It has become a more common cause of death than car accidents in Kentucky.

"People who know someone who is using opioids, such as a spouse, parent or a roommate, should have naloxone readily available in case they discover an overdose in progress," Kensicki writes.

He notes that patients may be at the most risk of an overdose during recovery, because if they relapse their bodies aren't able to process the same amount of the drug they had been accustomed to before trying to quit.

"Making naloxone available does not mean it is �okay� to use heroin, and we are certainly not removing all the risks of addiction," Kensicki writes. "But we are giving friends and families a tool they can use to help save their loved ones in emergency situations � buying people the time they need to fight their addiction."

Princess Health and Kentucky's life expectancy, a basic measure of health status, is 76; it fluctuates as many as 9 years from county to county. Princessiccia

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By Danielle Ray
Kentucky Health News

A life lived in Kentucky is expected to vary up to nine years in length depending on the county in which it's spent.

Life expectancy is perhaps the most basic measure of a community's overall health. Health researchers say life expectancy is driven by a complex web of factors that influence health: opportunities for education and jobs, safe and affordable housing, availability of nutritious food and places for physical activity, and access to health care, child care and social services.

The state average is 76 years. Twenty-four of 120 Kentucky counties exceed that figure, mostly in the counties near Louisville, Lexington, Frankfort, Bardstown, Elizabethtown, Owensboro and Bowling Green, with a few exceptions. Oldham County has the state's highest life expectancy, 79 years. Nine counties (Fayette, Jessamine, Scott, Garrard, Shelby, Bullitt, Meade, Boone, and Calloway) share a life expectancy of 78.

Differences become more apparent moving east along the Bert T. Combs Mountain Parkway and down its KY 15 extension. In general, the starkest comparisons in the state exist between the metropolitan areas of Louisville and Lexington versus southeastern Kentucky counties. Only one Eastern Kentucky county, Morgan, has a life expectancy equal to the state�s. Others range from 70 (Perry, Breathitt and Wolfe counties) to 75, mostly found in counties in northeastern Kentucky.

Eastern Kentucky counties are not the only ones with below-average numbers. Other counties ouitside that region with life expectancies of 74 or below are Fulton, Webster, Muhlenberg, Gallatin, Carroll, Casey, Monroe, Metcalfe, Cumberland and Clinton.

The numbers are on a Kentucky life expectancy map released Monday by researchers at the Virginia Commonwealth University Center on Society and Health and the Robert Wood Johnson Foundation. It shows that chances to lead a long and healthy life can vary dramatically by county.

�Health differences between communities are rarely due to a single cause,� the researchers said in a press release. �The health differences shown in these maps aren�t unique to one area. We see them in big cities, small towns, and rural areas across America,� said Derek Chapman, the VCU center�s associate director for research.

The map is the latest effort by the Robert Wood Johnson Foundation to raise public awareness of the many factors that shape health, particularly social and economic factors.

Another is the County Health Rankings, done annually by the University of Wisconsin Population Health Institute. The rankings don�t provide a comprehensive explanation for life expectancy, but they provide helpful correlations.

For example, Harlan County, with a life expectancy five years below the average, ranks 117thin overall health outcomes and last in health factors. The county has rates of smoking, obesity and teen births that are higher than statewide. It also has less access to exercise opportunities. The rankings show that the county's unemployment rate is nearly 14 percent, more than double the state's. In addition, 43 percent of Harlan County children live in poverty, compared to the statewide figure, 26 percent.

The complete rankings are available at the County Health Rankings web site.

The state Department for Public Health says it and partners have several efforts underway to tackle the many factors that shape health:

�          Promotion of farmers� markets and their acceptance of federal food assistance benefits such as SNAP, WIC and Senior Farmers� Market Nutrition Program Vouchers, incentive programs to help with affordability and community outreach.
�          Promotion of walking and walkability by providing communities with targeted training and technical assistance to develop pedestrian plans.
�          Protecting youth from tobacco exposure through the �100 percent Tobacco Free Schools� program, which provides guidance to districts that wish to reduce tobacco use by students and staff.

Experts say local efforts are needed, too. �We must build a society where everyone, no matter where they live, the color of their skin, their financial or family situation, has the opportunity to lead a productive, healthy life,� said RWJF President and CEO Risa Lavizzo-Mourey.  �There�s no one-size-fits-all solution. Each community must chart its own course, and every person has a role to play in achieving better health in their homes, their communities, their schools and their workplaces.�

Sunday, 5 June 2016

Princess Health and June 5th, 2016 I Needed A Day. Princessiccia

Princess Health and June 5th, 2016 I Needed A Day. Princessiccia

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June 5th, 2016 I Needed A Day

I slept a solid seven hours last night. Oh wow, needed it. I tried to do more, but couldn't seem to will it any longer. I've accomplished a lot today in the rest and relaxation department! I needed a day like today.

Irene and Allen brought Noah by for a short visit this afternoon. That little guy lights me up with so much joy. He radiates joy. Unless he's throwing a fit about something--then he radiates something different--but still, he's an absolute joy!

I'm having dinner with mom and Amber this evening. We always enjoy the opportunity to get together, share a great meal, conversation and plenty of laughs! We look forward to these opportunities!

I prepared an awesome breakfast this morning and as I started to weigh the ingredients, I thought--hey, why not a Tweet of these? You'll see it below. Accuracy like that gives me a nice measure of certainty in my calorie counts. And trust me, it's great practice for when I'm not at home or work, away from the scale--like tonight's dinner out.

I'm leaving a little later than I planned. But I'm not cancelling on mom and Amber. My planned bedtime is 10pm and I'll reset my alarm for 5am instead of 4:30am. As long as I still have time for my morning non-negotiable daily practices, and I will--I'll be fine.

By the way, the next 8 week support group session starts tomorrow and Tuesday! I just posted on Facebook about this--so allow me to share it, here:

What does $2.14 a day buy? A cup of coffee? A gallon of gas? A couple of items from a fast food value menu? 

What if I told you $2.14 a day could enter you into a private-exclusive weight loss support group facilitated by two certified Life Coaches and me?

What if that support group was much more than a weekly Live-conference call? What if it was also 24/7 spot support via text and direct communications with fellow group members and facilitators...and the opportunity to take advantage of daily accountability and support measures on the "secret" Facebook group page?

Could this make the difference you've been searching for, for so long? 

Is it worth an average of $2.14 a day?

If you're tired of doing the same thing and getting the same outcomes, perhaps it's time to try something different.

Our 8 week support group is small, exclusive and personal. It's powerful support. It's different. And it's available to you from wherever you are located. Currently, we have members from Canada, all over the United States and as far away as Australia. Let's put a pin in our map where you are, with support designed to meet you, right where you are--no matter how much you have to lose. 

The Monday night conference call 8 week session starts tomorrow night at 7pm Eastern, 6pm Central, 5pm Mountain and 4pm Pacific.

The Tuesday night conference call 8 week session starts Tuesday night at 8pm Eastern, 7pm Central, 6pm Mountain and 5pm Pacific.

Members from both nights are combined into the same "secret" Facebook page and we all have access to the call recordings of both groups.

Are you ready to experience the powerful difference solid accountability and support can make for you?

Each session is $120 for 8 weeks, payable upon registration. A limited number of spaces are available.

If you have any questions, feel free to Facebook message me or send an email to transformation.road@gmail.com

Register by clicking your preferred night's link:

Monday night only has a space or two available. Tuesday night has a few spaces remaining.

Monday night registration - http://lifecoachgerri.com/events/june-6-group/
Tuesday night registration - http://lifecoachgerri.com/events/june-7-group/

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Today, I'm maintaining the integrity of my maintenance calorie budget, I'm remaining abstinent from refined sugar, I'm getting a minimum 64oz water (and poised to easily exceed) and I'll be working later, right before bed. I've also experienced some wonderful support connections today. I needed a day like today.

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Thank you for reading and your continued support,
Strength,
Sean
Princess Health and KET programs focus on oral health, 'just as critical to the well-being of Kentuckians' as problems that have a higher profile. Princessiccia

Princess Health and KET programs focus on oral health, 'just as critical to the well-being of Kentuckians' as problems that have a higher profile. Princessiccia

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Kentucky Educational Television has turned its attention to oral health, which it says is "just as critical to the well-being of Kentuckians" as the state's "alarmingly high rates of cancer, heart disease, diabetes, and obesity."

KET's John Gregory, in a story about three recent programs, notes that two in five Kentucky children have never been to a dentist and "Poor oral health can contribute to other physical problems like diabetes, cardiovascular disease, and possibly even Alzheimer�s. It can impact how students learn."

�There�s thousands of children on a daily basis attending school with pain that is totally preventable,� Louisville health-care consutant Lacey McNary said on KET's "Connections" with Renee Shaw. �It is really hurting them with their success rates in school and otherwise overall well-being.�

McNary and Dr. Laura Hancock Jones, a dentist with the University of Kentucky's Western Kentucky Dental Outreach Program, blamed the lack of dentists in rural Kentucky and the refusal of many dentists to accept Medicaid, which covers 1.3 million Kentuckians.

But there are more longstanding factors, such as smoking, which makes periodontal disease six times more likely, and eating habits. "Jones says foods rich in carbohydrates and beverages that are high in sugar create the perfect breeding ground for bacteria that feed tooth-eating acids," Gregory reports.

And Jones says we have other bad habits, too: "She says studies show that almost a third of the population never flosses, and brushing and flossing twice a day is recommended. She adds that fear also contributes to bad oral health outcomes."

Other recent reports from KET have reported on a study of the state's oral health, the importance of good oral-health practices to seniors, and how the use of dental sealants in schools with high-risk populations has helped improve oral health.

The latter program featured Dr. M. Raynor Mullins, professor emeritus at UK's College of Dentistry, who "was instrumental in getting dental sealants added to Kentucky�s Medicaid program as a preventive service in the 1990s and has been involved with numerous oral health outreach initiatives across the state during the past 40 years," Gregory reports.

�A tooth has multiple surfaces � smooth surfaces and pit-and-fissure surfaces,� Mullins explains. �Smooth surfaces are the sides of the teeth, and fluorides are very effective about strengthening them. On the other hand, you have these pits, crannies, and fissures on the tops of the teeth and in certain locations on the sides of the teeth, where they are very susceptible to the infection of tooth decay. Sealants are very effective in preventing pit-and-fissure decay.�

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