Nurse Practitioners Climbing Aboard the On-Demand Train

Over the last 18 months, we have witnessed the birth of mobile medicine made possible by the growing on-demand economy. Companies are setting up new technology-based enterprises taking advantage of internet mobility to connect doctors with patients using smartphones as the intermediary. Now the doctors have competition. Nurse practitioners are also climbing aboard the on-demand train with technology-based services of their own.

One example is a Minnesota company known as RetraceHealth. The company offers pay-as-you-go medical services that connect patients with providers through mobile apps and in-person house and office calls. The business is successful enough that investors contributed $1 million back in January and another $6.5 million in recent weeks. What sets RetraceHealth apart from the competition is that it only uses nurse practitioners to provide care.

Perfect Primary Care Model

The appeal of pay-as-you-go healthcare in a mobile world should be obvious. Anyone in their 30s or younger has been raised on technology since their earliest years while technology still plays an important role for people in their 40s, 50s and 60s. Our culture is now more likely than ever to use technology to do things more efficiently and cost-effectively; why would we not apply technology to healthcare?

It can certainly be difficult to embrace the idea of visiting with a nurse practitioner using a smartphone if you have been making regular visits to the doctor’s office for decades. But even as older Americans are living longer and demanding more by way of healthcare services, it is the younger generation that is driving the transition to mobile, on-demand, pay-as-you-go medicine. They are the ones creating the primary care model of the future.

For the record, primary care is the perfect venue for establishing mobile healthcare. It is, by its nature, care that is not dealing with life-threatening or critical illnesses requiring direct, in-person intervention. This makes it perfect for developing the technology that will eventually become as commonplace as the old doctor’s office of the past. And once the technology is perfected, it can be expanded to include other areas of healthcare delivery.

Good for Nurse Practitioners

Hopefully, nurse practitioners around the country will get on board with the on-demand economy and pay-as-you-go primary care. This model could be the single most important and influential factor in expanding the scope of care that all 50 states extend to nurse practitioners. This platform offers a golden opportunity for these fully-trained medical professionals to prove beyond all doubt that they are more than capable of providing top-notch primary care.

Because mobile healthcare is still so new, nurse practitioners have an opportunity to be major players in determining how platforms are developed. They have the chance to provide much of the feedback necessary for developers to create platforms and apps that meet the needs of both patients and their providers. In short, nurse practitioners do not have to merely go along for the ride. Their participation in the early stages of this emerging model will help define what it looks like decades down the road.

As for patients, more and more of them are comfortable with the idea of mobile medicine every day. They see mobile healthcare as just another logical progression in the on-demand economy. And with patient satisfaction now being intrinsically linked to positive outcomes, developing an effective mobile platform could be key to dramatically increasing satisfaction in the years to come.

Mobile medicine is here to stay. Now that the concept is expanding to include nurse practitioners offering primary care, we could be on the verge of a whole new way of dispensing routine, day-to-day medicine.

Nurse Practitioners and the Cost of Primary Care

A few weeks ago, we published a blog post discussing the question of whether nurse practitioners would contribute the same financial volume to hospitals and hospital-owned medical groups by taking the place of doctors in providing primary care. It was a fascinating thing to research. Now, new data from the University of California, San Francisco suggests that the conclusions we reached in that blog post were fairly accurate.

According to the research, broadening the scope of practice for nurse practitioners has actually increased healthcare spending since 2008. The increase has been slight, but it is reasonable to expect spending to increase via the care provided by nurse practitioners as more and more states get on board with expanding their scope of practice.

More Access Equals Lower Costs

Researchers at the University of California looked at healthcare spending rates between 2008 and 2012 in states in which nurse practitioners have independent practice authority. They found that during that four-year span, the actual total costs of health care in those states rose slightly, but that the price of primary care went down commensurate with the number of NPs offering primary care services.

Patients in need of primary care were more than willing to see nurse practitioners on the assumption that their quality of care would be just as good and, at the same time, cost less. The overall result was higher healthcare spending and only a slight increase in overall costs.

Researchers also looked into the possibility that the cost of primary care to the patient would continue to go down as more nurse practitioners begin offering independent care. Their research seems to indicate that this would be the case. Researchers concluded that independent practice among nurse practitioners jobs nationwide could potentially lead to a significant price reduction for customers and better collaboration between NPs, doctors, and other healthcare professionals along the way.

Lower Costs Equals More Spending

Researchers did not implicitly draw a link between lower healthcare costs and higher healthcare spending, but their data suggests that the link exists. This is one of the fundamentals of free-market economics. When a product or service is more affordable, larger numbers of people take advantage of that product or service, thereby generating greater sales revenues. Primary care is no different.

Increasing the number of independently practicing NPs will undoubtedly bring the cost of primary care down for the consumer. In turn, that should lead more consumers who have never utilized primary care as a matter of course to begin doing so. More people spending less on primary care will cumulatively increase overall healthcare spending as a result.

In terms of revenue to hospitals, nurse practitioners can still be part of the equation by affiliating with local hospitals the same way physicians do. Patients that need certain tests and procedures can be referred to that affiliated hospital, thereby generating the same kind of revenues hospitals get from their doctors. Everybody wins without patient care suffering one bit.

It’s Time to Get on Board

With the research from the University of California in hand, there is yet another reason to push every state that does not yet recognize full practice authority for nurse practitioners to get on board. Every nurse practitioner capable of providing independent primary care is yet another medical professional who can meet the needs of patients in a timely, efficient, and cost-effective manner. If we truly want to transform healthcare for the better, we need to fully embrace the concept of the nurse practitioner as the go-to primary care provider in all 50 states.

5 Ways Chronic Pain Negatively Affects Life

Doctors that sign up for PRP and stem cell therapy training at the Advanced Regenerative Medicine Institute, do so for several different reasons. Among them is a desire to offer patients suffering from chronic pain some sort of relief beyond long-term pain medication. Chronic pain is a serious condition that affects millions of people. It is something that can be quite debilitating if left untreated.

The generally accepted definition of chronic pain is that which lasts for more than 12 weeks. Most instances of chronic pain involve some sort of pain that is nearly constant, though a patient could notice relief for a few hours per day and still be diagnosed with chronic pain.

Chronic pain is problematic because it affects more than just the body part that hurts. Over a sustained period of time, constantly experiencing pain can lead a person to develop new physical, emotional, and mental issues. So it is important for doctors to have effective tools for either managing chronic pain or eliminating it.

Here are five ways chronic pain negatively affects life:

1. Elevated Threat Level Perception

Pain is a natural reaction to a current condition that poses some sort of threat to the body. When such a threat exists, the affected part of the body sends distress signals to the brain so as to make the brain aware of the threat in question. Unfortunately, chronic pain can lead to an elevated threat level perception. In simple English, a person suffering from chronic pain can gradually become irrationally fearful of anything that he or she perceives could make the pain worse.

2. Increased Risk of Depression

Numerous studies have shown that chronic pain and depression are interrelated. People who suffer from chronic pain are more susceptible to depression if that pain limits what they can do on a daily basis. A loss of function or freedom can further drive depression, which can, in turn, increase the perception of pain. This creates a vicious cycle that often devastates a person’s life.

3. Significant Cognitive Impairment

People who suffer from chronic pain for extended periods of time may also experience cognitive impairment. In other words, they do not think as clearly and as rationally as they did before the chronic pain set in. Why does this happen? Because the brain has to work so hard to deal with the stress and elevated threat perception caused by the chronic pain that it does not have as much energy to put into cognition.

4. Strained Relationships

Chronic pain patients often undergo personality changes over time. Likewise, their caregivers may experience their own personality changes as a result of having to live with and care for their chronically ill loved one. The result is often strained relationships. These include relationships between spouses, parents and their children, and even extended family members.

5. Chronic Exhaustion

Lastly, chronic pain takes its physical toll on the body due to elevated stress and threat levels. Constantly living under such a stressful circumstance leads to chronic exhaustion that only makes the pain worse. Patients are always tired, they are frequently sleepy, and they complain of persistent lethargy throughout the day. Interestingly enough, it’s quite common for chronic pain patients to have trouble sleeping despite their exhaustion.

As you can see, chronic pain can be a debilitating condition if left untreated. Now you know why Advanced Regenerative Medicine Institute and the doctors they train are so enthusiastic about PRP and stem cell therapies. If the therapies can bring an end to chronic pain for patients, then proponents of those therapies want to see them become mainstream.

Nurse Practitioner Career Paths: There Are Many

The emergence of nurse practitioners (NPs) as advanced practice caregivers in the 1940s and 50s was the direct result of a doctor shortage. Along with nurse anesthetists and midwives, NPs were thought of as assistants to medical doctors that acted as an extension of private practice. So much has changed over the last 70 years that it is rather hard to quantify. Today’s nurse practitioner jobs are more of an extension of what physicians do.

No fewer than 21 states have actively expanded the scope of care that nurse practitioners are licensed to offer. The remaining states are in the process of either writing legislation or reviewing their own regulations for the purposes of scope expansion. The result is that there are significantly more options for nurse practitioners today as compared to what was available in the 1950s.

Below is a partial list of the career path options available to nurse practitioners:

  • Family/Primary Care – Whether working independently or in concert with a doctor, a nurse practitioner can enjoy a long and productive career as a family provider offering primary care in a local office. This seems to be a very popular model for nurse practitioners right now.
  • Rural Care – A rural care specialty involves providing family/primary care in rural environments where very little exists by way of healthcare. This is an exciting opportunity to help communities that do not have access to doctors, communities in which residents typically have to drive an hour or longer just to receive basic care.
  • Women’s Health – The nurse practitioner who chooses to specialize in women’s health will undergo comprehensive training to that end. Licensed NPs working in women’s health tend to work at outpatient facilities such as community clinics, private practices, and hospital-owned medical groups. Some do work in long-term care facilities including hospitals and assisted-living centers.
  • Adult Care – The growing U.S. population is creating a greater demand for nurse practitioners among older patients. This specialty affords the opportunity to work with a group of people with some unique needs, individuals who have the experience of life behind them and who bring an entirely different perspective to the healthcare they receive.
  • Acute Care – Acute care nurse practitioners work in emergency departments, surgical centers, walk-in clinics, and other similar environments. Their primary focus is to help treat patients suffering from acute conditions or injuries. These nurse practitioners are more likely to work directly with doctors rather than independently.
  • Neonatal Care – The NP specializing in neonatal care focuses on caring for newborn infants. More often than not, they work in hospital maternity wards and the neonatal intensive care unit. Some also provide research and support services for family members of sick infants.
  • Perinatal Care – The other side of neonatal care is perinatal care. NPs working in this field provide healthcare services to women during their pregnancies, through childbirth, and during the postpartum period. This kind of work is an opportunity to work with women who are under lots of stress.

Growing Independence from Physicians

Nurse practitioners and associated professional groups are delighted with the fact that they are gaining increasing independence from physicians. This is enabling the nation’s NPs to offer more care to more people, in a larger variety of settings.

At no time in the past did the career prospects of NPs look as bright as they do today. Anyone thinking of going into advanced practice nursing as a career can now do so with the knowledge that there is a virtual buffet of career path choices one can take after training.

Psychosocial Problems Another Downside of Knee Replacement

A study of patients undergoing total knee arthroplasty, known in layman’s terms as total knee replacement, has revealed that patients often develop psychosocial problems that lead to never fully recovering. Among those problems are depression, anxiety, persistent pain, and sleeping disturbances.

Findings from the study are very important given the increasing number of seniors undergoing total knee arthroplasty as a treatment for osteoarthritis. One of the study’s co-authors, Dr. Inna Belfer, says that “treating osteoarthritis with total knee arthroplasty is expensive and painful, and in many cases patients do not get better because their chronic pain persists.”

Stop one minute and let that sink in. Belfer and her team are suggesting that total knee replacement surgery intended to relieve the chronic pain of osteoarthritis is not doing that for a growing number of patients. Those patients get completely new knees but still stuffer persistent pain – in addition to the other psychosocial issues already mentioned. How is that a good deal?

No Answers Yet

Belfer’s research took place at the University of Pittsburgh Medical Center with the participation of 153 adult patients with an average age of 64. Each of the patients underwent a total knee arthroplasty procedure. Prior to surgery, the patients completed a series of five questionnaires designed to gauge their psychosocial state. The questionnaires dug into issues like depression and anxiety, perceived stress, current symptoms, and pain level.

Patient pain was assessed at baseline and then six months after surgery. Data showed that 88% of the patients reported moderate to severe pain prior to surgery while 24% reported the same level of pain at six months. Despite the discrepancy, there are no clear answers as to why. Researchers crunched the data and surmised that there is a correlation between continued post-surgical pain and a patient’s psychosocial state before and after surgery.

If that link can be established through future studies, it would indicate that surgeons and primary care physicians should be working together prior to total knee arthroplasty to determine a patient’s psychosocial state. A less than optimal assessment may indicate a patient is not a good candidate for knee replacement. Alternatively, the orthopedic community could look for ways to improve a patient’s psychosocial state so as to allow for surgery.

There Is Another Way

Utah-based Advanced Regenerative Medicine Institute (ARMI) says there is another way to treat chronic osteoarthritis pain in patients who are not good candidates for surgery. That way is regenerative medicine, something that ARMI teaches doctors and surgeons who want to add it to their practices.

Regenerative medicine utilizes platelet-rich plasma (PRP) and stem cell therapies to treat osteoarthritis and its subsequent pain by encouraging the body to fix what is broken. PRP contains several different growth factors along with vital nutrients the body needs to self-repair. Stem cells can be encouraged to grow into new tissue to replace what has been lost in the affected joint.

Advanced Regenerative Medicine Institute is clear that PRP and stem cell therapies are not right for every patient suffering from osteoarthritis and chronic pain. By the same token, surgery is not the right solution for every patient either. Some will benefit from one, some will benefit from the other. The idea is to not assume that every osteoarthritis patient will automatically benefit from total knee replacement.

It is unfortunate that a growing number of osteoarthritis patients are undergoing total knee arthroplasty and still finding no relief. For them, there’s not much to be done once a knee has been replaced. But there is hope for others who have not yet undergone surgery. That hope is regenerative medicine.

What Is The Process Of Dental Veneers Placement?

Dental veneers adhere to the front of the teeth. They are used as a way to improve the aesthetic appearance of a person’s mouth. The patients who have discolored or fractures on the teeth usually choose to get dental veneers. As soon as you make a decision to get this treatment, you can start getting ready for the procedure.

Having the dental veneers fitted is a process that requires several visits to your dentist’s clinic. Depending on the number of dental veneers you are getting, the condition of your teeth and the size, facilities and the experience of the dentist, this process can be extended over a period of several weeks or can be done in just a few days.

The dentist may go for the anesthesia in case your teeth are very sensitive or if you are concerned about the procedure. While the whole process is not particularly painful, it can be annoying for some people. It will help you avoid interruptions once the dental veneers have been installed.

You can schedule your first appointment near the weekend or on a day when you can go home later. As part of the first stage in which the dental veneers are equipped, your dentist forms and grinds the surface of your teeth in order to prepare them for the placement of the dental veneers. This can cause discomfort in the gums as well as some of the dental sensitivity, so it is highly likely that you will want to rest after this appointment.

You should ask your dentists to explain how to take care of your teeth between the appointments. After teeth have been ground, they will be covered with a temporary varnish, often attached to the teeth with a light cement. To avoid the loss of temporary veneers or cause the damage to the teeth, special care should be taken when eating hard foods, flossing or doing certain activities such as playing sports.

You can ask to schedule your second appointment, for which dental veneers have been made and shaped. The time it takes depends on the laboratory and the technology available to your dentist. You are supposed to go to the cosmetic dentists with an external laboratory for this job. During this appointment, you will have the dental veneers ready.

It is time to have your dental veneers permanently attached to your teeth. This may involve a second remodeling session, depending on how well the dental veneers fit. Once the tooth surface is ready, the dentist will fix the dental veneer using a permanent cement and a sealing substance to secure it.

What is the Procedure of Dental Implants?

Dental implants help restore a natural look to your smile by providing permanent replacement of the teeth. Since they’re anchored in the jaw bone, the implanted teeth feel and look like the natural ones. The success rate of dental implants is approximately 95 percent.

You can be approved for the dental implants if you’re willing to go through a long process of implanting and have enough bone in the jaw so as to support the dental implants. You may need bone graft in case your jaw bone isn’t strong enough for the implants. If you have health condition which can slow the healing process, it may be less likely to be successful. The dental implants aren’t usually applied in children until complete jaw bone growth is achieved.

Before beginning the procedure, dentist will evaluate your teeth and take x-rays of the mouth and he will also determine if you need a bone graft before the implantation. Bone graft may be necessary if the bone is too thin or soft and will not be able to support the dental implant. During the procedure of bone grafting, a small piece of bone is removed from another area of the jaw or hip and placed in the weak area of the jaw. If the grafted area is large, it may take several months for the new bone area to support the implant.

Placement of the dental implant is a multi-step process that often takes between three to nine months to complete. The first step in the process is to drill holes in the bone to place metal implant cylinder which serves as implant’s root. It may take up to six months for the bone to grow around it and fix it in place. You’ll be given local or general anesthesia or sedation while the holes are perforated and may need to eat soft foods for several days after the procedure. Because part of the dental implants that is visible above the gum line has not yet been received, it can be given a provisional to cover the gap in mouth.

When the metal cylinder is firmly anchored in jaw bone, the abutment is placed which connects the crown, portion of the dental implants that resembles a tooth to the metal cylinder. Abutment’s placement requires a small incision in gingiva to reach the metal cylinder. Local anesthesia is usually used for this step. After placement of the abutment, your gums will have to heal for a few weeks before the process of dental implants can continue.

Once the area around heals, your dentist will make an impression of your mouth. The impression will be sent to a prosthetist, who specializes in manufacture of artificial teeth, so that the crown can be made. You can choose to have a fixed dental implant prosthesis, a crown definitely consolidated on the abutment, or you can opt for a removable prosthesis. A removable prosthesis fits in place and can be removed for cleaning, somewhat similar to prostheses.

What is Root Canal Treatment and Its Procedure?

What is a Root Canal Treatment?

The teeth are made up of many parts, that is, not only that strong white structure that delineates our smile, in fact, are much more complex than we think. To know what the root canal is, we must know how the teeth are formed, in addition to that white part that exercises the dental function and is known as a crown, each tooth has a root that is inserted to the bone to permanently retain the tooth.

In addition, each dental piece has a protective layer on the crown that is called enamel and difficult to destroy. If we pass through the enamel, we find the dentin and later the pulp, which is the center of the tooth and is located in the deepest part of its structure. The pulp is a kind of soft tissue where all the nerve endings of the tooth are found. While dentin and enamel protect the pulp, caries is so abrasive that if it does not stop in time, it can reach that part of the tooth and affect the nerves and cause a lot of pain.

Procedure of a Root Canal

Endodontics is the dental treatment that is carried out to save a tooth whose pulp is badly affected. Endodontics is also known as root canal treatment and consists of removing the pulp in whole or in part to prevent inflammation of the periodontal ligament, removing all damaged structure of the tooth, filling the cavity left by the pulp and sealing the tooth very well and prevent new bacteria or food residues from entering.

A tooth that needs to be treated with endodontics is a dental piece in very poor condition and this treatment is the only alternative to save the dental bone and prevent the detachment of the piece. Therefore, if your dentist advises you to perform a root canal treatment, do not hesitate to do so, otherwise later you will have to make use of the dentures or dental implants. Having had the treatment of root canal, your dentist will advise you to follow a proper dental clearing routine for maintaining the oral hygiene. You must listen to his or her advice or else you will be highly prone to face dental issues again.

What Is Endodontics And When It Is Performed?

Maintaining proper oral hygiene is imperative to preserve the health of the teeth and prevent the accumulation of food residues and dental plaque. The plaque is a sticky substance that adheres to the teeth and is made up of mucus, food residues and bacteria. When the bacterial plaque is abundant in the oral cavity, it is very probable that the bacteria present in that substance gradually wears out the dental enamel or penetrate the tooth through the interdental line causing little by little the formation of a caries.

Tooth decay is the main enemy of oral health. This disease occurs due to the acid that bacteria generate when they metabolize the sugar from food. This acid gradually wears out all the tissues of the dental structure until it significantly impairs the health of the tooth and jeopardizes its permanence in the oral cavity. When caries progresses and until it enters the deepest part of the tooth known as pulp or nerve, it is necessary to immediately do the root canal in order to save the tooth.

When is a Root Canal Performed?

As explained earlier, the endodontics takes place when the pulp is so affected by the accumulation of bacteria in the deepest part of the tooth and it becomes necessary to remove it so as not to compromise the useful life of the dental structure. There are a few factors that can cause a dental infection, the most common are as follows;

Tooth Decay

It is the most common cause of the pulpal infection that results in root canal treatment. When caries is very aggressive and quickly passes the enamel and dentin, it meets the nerve endings of the pulp and begins to cause significant pain. Once the decay has reached the pulp, endodontics is the only thing that can be done to deal with this issue.

Periodontal Disease

It is one that affects the health of the gums and begins with gingivitis which causes inflamed gums, bleeding, bad breath and pain in the tooth tissue. When the gums are inflamed and retracted, the bacteria more easily penetrate the tooth through the interdental line, which facilitates their access to the pulp.

Tooth Infection

Any oral infection can penetrate the teeth and reach its deepest part.

What are the Types of Dental Implants?

Dental implants are metal devices used to replace lost teeth instead of using dentures or bridges. They’re made of titanium and are implanted surgically in the mouth. There are a few different types of successful replacements for the natural teeth lost when you do not want to deal with dentures or bridges.

Dental Root Implants

Dental implants in the form of root are as close as it can get to the natural teeth you lost. They’ve right shape and size for the same look as a natural tooth. Each root implant is placed into the bone through an incision in the gums. In the coming months, the bone attaches to the implant, leaving you with a solid, natural-looking tooth replacement. It is good for the replacement of a single tooth or several substitutes, as long as there is enough healthy, solid bone remaining to maintain the dental implants.

Plate Form Dental Implants

It is used when there is not enough bone mass or the maxillary bone is too narrow for a root implant. Bone grafting may be an option to increase bone area and use of root implants, but if that is not an option, the dental implant in the form of plate is the next step. It’s long and narrow to fit the smallest bone available, placed through an incision just like the root shape, although a much larger one to accommodate its size. Like the shape of the root of the dental implants, it will take a few months for the healing and growth of the bone on the implant.

Subperiosteal Implants

It is applied when there is extreme case of bone loss, leaving the other two types of implants unusable. It’s designed to sit under the gums but on the top of the jaw bone. There’re two ways to get the fit as subperiosteal dental implant requires i.e. the impressions of the jaw after your surgeon has exposed the bone through an incision or a tomography taken before surgery. As with the two previous dental implants, surgery is required to expose the jawbone for implants and several months of recovery time is required.

Intramucosal Implants

It is applied with removable prostheses. The metal inserts are placed in the maxillary bone with small passage exposed to the left above the gums. The lower part of the prosthesis is hooked into the exposed part, leaving the dentures solidly in place.