วันอังคารที่ 1 พฤศจิกายน พ.ศ. 2554

Erectile Dysfunction in Young Men Need No Longer Be A Problem

When men over forty years of age have difficulty attaining and maintaining an erection, it is usually pathologic in nature, meaning that an underlying health disorder is most likely the culprit for not being able to get an erection. For young men, however, it’s an entirely different story if they’re plagued with this problem.





Erectile viagra cialis online pharmacy pharmacy in young men revolves mainly around a person’s state of mind. Other elements are contributory to this problem, but a man’s emotional and mental state is most often the key ingredient. This doesn’t mean that a man is psychologically impaired. Rather, he is just stressed and anxious about sexual intimacy, and this brings about difficulties in getting an erection. Young men may feel stressed about his performance, especially if it’s his first sexual encounter. Pressures about pleasing his partner or making the right moves may be the at the forefront of his thoughts. And the more anxious he becomes, thinking about getting an erection, it actually becomes even more difficult to attain one. And when problems are encountered in getting an erection, the anxiety piles up, and this sets off a vicious cycle.















In this case, it is of utmost importance to relax and not think too much. A man shouldn’t worry too much about getting an erection. Rather, he should focus more on the moment, and just go with the flow. Becoming more aware of his partner’s response instead of concentrating on his own helps a lot. All a man needs is a bit of control over his anxiety.





While stress is a major cause of erectile dysfunction in young men, there are several other factors to be considered, as well. One such factor is a person’s health status. It’s not just emotional health, as discussed earlier, but one’s physical health as well. Conditions that affect the body, like cardiac problems or diabetes, have an effect on blood circulation throughout the body. Unimpeded blood circulation is important in attaining an erection, thus, problems in circulation leads to problems in getting an erection.





One’s habits should also be considered as a contributory factor in erectile dysfunction. Sleep and rest, diet, and exercise all play a part in one’s well-being. Lack of sleep or rest deprives the body of energy, as does eating improper food and lack of exercise. Depleted energy is contributory to erectile dysfunction, thus, it is important to address this problem as well. Getting enough hours of sleep and rest, eating a balanced, healthy diet, and maintaining an exercise regimen should be integral to one’s lifestyle. Keeping all these in mind, erectile dysfunction is merely a temporary condition, and if the necessary steps are taken - reducing anxiety, taking care of one’s body - there’s no reason why a healthy young man would suffer from erectile dysfunction forever.

วันเสาร์ที่ 29 ตุลาคม พ.ศ. 2554

Bali cialis pills...Dream pill Vol 2..

secondo volume della saga Bali online pharmacy viagra pills...qui ci troviamo a Dreamland e anche qui le cose sono cambiate non poco...posto che ormai di "Dream" ha solo il nome...(progresso maledetto deturpa tutto)...ovviamente di nostro c'è ben poco visto che eravamo tutti infotati a surfare e nessuno riprendeva le nostre gesta...onda buona ma moscia...e unico posto dove anche i balinesi sono dei granchi sul surf...buona visione...

วันจันทร์ที่ 23 พฤษภาคม พ.ศ. 2554

Family Medicine: Innovation and "The Hershey Conversation"

The Dr  Synonymous Show November 2, 2010

Family cheap viagra:  Innovation and "The Hershey Conversation"

Listen on Blog Talk Radio at this link 24/7.
Introduction and Welcome
Congratulations to my hometown of Dayton, OH being named the Number One Worst City for Allergy Sufferers in the US.  

ALLERGY FOUNDATION RELEASES ANNUAL REPORT OF 100 “MOST CHALLENGING” U.S. CITIES FOR FALL ALLERGY SUFFERERS





Disclaimer- I am a practicing family physician, but we're not practicing cheap cialis on the show.  Your best way to get good health care is through your personal family physician.


Patient honoring: We're only doctors because there are patients.  Let's always honor them.

Patient Blog:  That's What She Said "Inflammation and My Hippie Ways"

http://snc-thatswhatshesaid.blogspot.com/2010/11/inflammation-and-my-hippie-ways.html



Physician Blog:  Musings of a Distractable Mind by Dr Rob 11/2/10.  Election Reflection.



http://distractible.org/2010/11/02/different-lunatics-same-asylum/



My blog: Surprised at the geography covered by readers. 
The Family Medicine Education Consortium NE Regional Meeting in Hershey, PA
www.fmec.net



The Healthcare Innovators Network- a Pre-conference session

Several speakers with special messages from :

Alan (Chip) Teel, MD Elder Power to help Seniors remain in their homes www.Lincme.net

     started in Damariscotta, ME. High Touch, High Tech Senior Support.

Seven Dollars Can Change Lives by Edward G. Zurad, MD. Improving employee health and saving health dollars.

Patient Broadcast Network by Shawn Moyer, MD of Pinchot Med Center, Pinchot, PA (Small,  successful family practice using OX Bow EMR- unique and family medicine friendly)

http://www.pinchotfamilymed.com/



Co-Ops for Medicine by Cathy A. Smith, Using Farm Concepts to help people survive together- one vote per person.

Patient Centered Medical Home Presentations abounded.  Geisinger Health Center and others.



TV coverage of FMEC Meeting:  Notice the medical students. Emphasis on the pipeline to deliver good family doctors.
http://www.whptv.com/mediacenter/local.aspx?articleID=145699



Challenged kids dance and arts program:  Reach USA with 400 youth involved.  Enthusiastic group danced at FMEC meeting. See photos below
More Reach USA photos
http://www.facebook.com/ajax/share_dialog.php?s=7&appid=2344061033&p[]=105019159550266&action_link=



Other Important Presentations:  Social Media by Kenny Lin, MD; Doctor Anonymous, Dr Synonymous well attended, well received update on various uses for social media in Family Medicine.  PAFP students started a blog, tweeted and used facebook and YouTube at the meeting.



http://www.youtube.com/watch?v=hw0g2g5YkgM&feature=related 

Roland Goertz, MD, MBA President of AAFP "The Time Has Come" A great leadership talk with emphasis on where we're headed.  Special comments for medical students about a career in family medicine.



Coaching for Performance by Anton Kuzel, MD and Will Miller, MD Great leadership session about coaching and leading.



Beyond the PCMH: the Consumer-Oriented Human Centered Health Home (HCHH) by Steve  Deal, MS; Rosemary Ramsey, PhD; and Pat Jonas, MD.  A step in the right direction.





Aligning Primary Care Workforce and Infrastructure in an Era of Reform:  New Data and Online tools from the Robert Graham Center. Important data about primary care workforce from each medical school and residency.
http://www.graham-center.org/online/graham/home.html



Book Signing by authors in attendance:  Behavioral Medicine in Primary Care by Julie Shirmer et al.  The section on physician burnout is compelling. We need to take better care of ourselves.



So many great aspects to FMEC NE Meeting 2010. Overall a highly motivating experience and a breath of fresh air about the future of family medicine and health care.  It seems like we've started "The Hershey Conversation" about hope for health care and for people, like our patients and our selves.



My opinion of FMEC:  Important Organization. Stay tuned.





Go to twitter.com and search for #fmecnet  for tweets from the meeting.  Notice the tweets from med students, especially those from the PAFP.
Next week at 8-9 PM Tuesday night on BlogTalk Radio, I'll interview Ken Bertka, MD past president of the Ohio Academy of Family Physicians (OAFP) and recently a Board member of AAFP about family medicine, healthcare reform,etc.

วันอังคารที่ 3 พฤษภาคม พ.ศ. 2554

The characteristics of future physicians

In my blog from 2/4/11 "Why do we put so much import on the MCAT?", I discussed some of the negative characteristics that can be associated with a higher MCAT. The conclusion of the article by Dr. Gough1 was that students with higher MCATS and a scientific orientation were found to "less adept in interpersonal skills, less articulate, narrower in interests, and less adaptable than their fellows". 


Wow!  I don't think those are characteristics that I want in my doctor.  What about you?


What are the characteristics that we want in our medical students? We want them to be great at science, right?  On average, academic performance in undergraduate classes only predicted about 9% of the variance in medical school performance.2 What about MCAT? We want them to have a high MCAT, right? Well, a high MCAT is good at predicting performance on the USMLE step 1 and preclinical grades,3 but as someone who is really smart once told me "we are not trying to make step 1 passers".


Sade and colleagues asked this same question a few years ago. Their specific question was to identify the specific characteristics that are important qualities of a superior physician. They also asked which of these qualities are hardest to teach in the medical curriculum. They based their work on a study by Price, et al4 who had previously generated a list of positive traits associated with a superior physician.  


Dr. Sade took this list of traits and showed them to the faculty of the College of cheap cialis at the University of South Carolina. The faculty were asked to rate the personal qualities on a scale of 1-10, where 1 is non-teachable and 10 was easily teachable. The survey was sent to all of the faculty at the college of cialis. They also asked a select group of experienced medical educators to take the survey. There was remarkable agreement between the faculty, greater than 80% inter-rater reliability. There was also a high correlation between the basic science faculty's ratings and the clinical faculty's ratings of the importance of characteristics (r=0.87, p<0.001) and the teachability of characteristics (r=0.93, p<0.001). 


The outcome of this survey was a list that ranked the characteristics from 1 to 87.  Each characteristic was given a rank for importance and for difficulty in teaching. The authors converted the rankings to a Z-score. (***Note: This was my favorite line in the manuscript...)  "The teachability Z-score was subtracted from the importance Z-score, and the combined Z-scores were multiplied by 10 and added to 50."  This gave a combined score that they called the NonTeachable-Importance Index (NTII). The NTII gives you a list of characteristics that are ranked from highest to lowest based on importance and the difficulty of teaching it to medical students.


That sounds like a good list of pre-matriculant variables to me.  If we can't easily teach it but it is important then obviously we should select students that have these characteristics before coming to medical school.


Using the NTII ranking, some of the characteristics are obvious: (1) is emotionally stable; (2) is a person of unquestionable integrity; (5) is unusually intelligent; and (6) has sustained genuine concern for patients during their illness.  Some are less obvious but seem really important: (9) is motivated primarily by idealism, compassion, and service; (14) is able and willing to learn from others; (17) is observant; and (18) is adaptable. The list goes on from 1 to 87. 


The characteristic that was ranked as the most difficult to teach was: is unusually intelligent. The next four were: (2) is naturally energetic and enthusiastic; (3) is imaginative and creative; (4) has a warm, friendly, outgoing personality; and (5) is motivated by sheer liking of people.


So why are we still choosing medical students based on the MCATs and GPAs? Maybe, we should be looking at these factors.


Next time, I am going to write about personality factors that influence medical student performance.


References

(1) Gough HG. Some Predictive Implications of Premedical Scientific Competence and Preferences. J Med Educ  1978; 53: 291-300.
(2) Ferguson E, James D, Madeley L. Factors associated with success in medical school: systematic review of the literature. BMJ  2002; 324: 952–7.
(3) Donnon T, Paolucci EO, Violato C. The predictive validity of the MCAT for medical school performance and medical board licensing examinations: a meta-analysis of the published research. Acad Med  2007; 82(1): 100-6.
(4) Price PB, et al. Measurement and predictors of physician performance: two decades of intermittently sustained research. Salt Lake City: Aaron Press, 1971; 121-149.

Hospital visitation and health care decisionmaking autonomy for EVERYONE

Wisconsin may be poised to go down the same road Maryland choose last year -- the conflation of recognition of same-sex couples with the needs all people have, especially LGBT people estranged from their families of origin, to purchase cialis visits from loved ones and medical decisionmaking by the person who knows them best. (Even Obama got it wrong in his acceptance speech). And Wisconsin is actually getting it worse; they are making couples register as domestic partners to get rights that all human beings deserve.

It seems that whenever a state passes anything with the phrase "domestic partners" for same-sex couples, that's supposed to count as a gay rights win. But look at what Wisconsin actually plans to do. The couple must be same-sex only and must live together. If they register, then they can visit each other in the cialis and make medical decisions for each other.

What is wrong with this picture? Ask my 60+ year old friend in Maryland, who is single yet cares as passionately as her coupled friends about who gets to visit her and make health decisions if she can't. And she's not even estranged from her closest living relative -- a sister 2500 miles away. Think about the gay people who move to gay-friendly areas, away from families of origin. I care that the people they consider family be able to visit them in the hospital. I care that their wishes about a surrogate health-care decisionmaker be upheld.

There ARE answers. A free, easy to use, highly publicized advance directive registry. There are models in gay-unfriendly states, like Idaho, and they protect everyone. How about a law that requires hospitals to ask who you want to visit when you've admitted? It won't help emergency admissions. But the people listed in the advance directive registry should be admitted. And a "close friend" category would help, and I didn't make up that category. Many surrogate health care decision making statutes already list "close friends" among those who can make decisions. At least when no one else is at the hospital, when a person will be without visitors, "close friends" should be allowed.

I hate to put a damper on the celebrations in Wisconsin. I just think it's wrong to conflate recognition of same-sex couples with the basic human right to health care decisionmaking by the person we choose and the chance to be surrounded by loved ones in our darkest hours.