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Emerging Issues: The Privacy of Medical Records #arthritis,asthma,behavior,bioethics,cancer,diabetes,new #treatments,heart,nutrition,aging,women’s #health,other #topics,kids,dieting,exercise,healthcare,infections,men,public #health,sports #medicine,gastro,addiction,anxiety,autoimmune,depression,senior #living, #emergencies,migraine,mind,pain,stress,stroke,diet,emotional #health,fitness,sex,sleep,travel


Emerging Issues: The Privacy of Medical Records

Within the past two years, a substantial amount of attention has been paid to the issue of the privacy of patient records. The Health Insurance Portability and Accountability Act of 1996 required the Secretary of Health and Human Services to make recommendations to Congress on ways to protect the privacy of medical records. Secretary Shalala submitted her proposals to Congress on September 11, 1997. The National Academy of Sciences and the National Association of Insurance Commissioners have issued recommendations of their own. Senator Robert Bennett (R. – Utah) has circulated draft legislation entitled the “Medical Information Confidentiality Act” that may well be the focus of congressional action.

Two developments account for this flurry of interest. The first is the growth of electronic medical record-keeping in place of paper records. The National Academy of Sciences report states that the health care industry spent between $10 and $15 billion on information technology in 1996. Much of this expenditure is attributable to creating electronic records systems and converting conventionally stored data to electronic formats.

Electronic medical records (“EMRs”) appear to present new threats to maintaining the privacy of patient-identifiable medical records. An EMR can be called up instantaneously by someone with access to the data system and the relevant passwords. Although a paper record can be photocopied and faxed, it is less easy to distribute widely, and requires physical possession for accessibility. Computerized records systems are “black boxes” to many health professionals who are otherwise familiar with traditional records systems; they fear losing control of the systems and having to rely on computer experts who may not have internalized the privacy-related ethics of the medical profession. At the same time, one hears proposals to link all medical records systems so that patient data can be accessed wherever and whenever patients require medical services. This raises the prospect that access to one portion of one record may afford access to all records on an individual.

The Managed Care Conflict

A second reason for the increased concern over medical records privacy is the growth of managed care organizations. In the traditional, fee-for-service model of health care delivery, patient records would be produced and retained by the physician or other provider of services. The patient’s health insurer would be given access to selected records needed for claims review. Disclosure of the records required patient authorization, although, typically, patients executed these authorizations automatically and in blanket fashion. In a managed care organization, on the other hand, the provider of care and the insurer, in some sense, are the same entity. Any medical information in the possession of the provider also is held by the insurer. This is clearest in a closed-panel HMO like Kaiser but is present, to a varying degree, in all forms of managed care.

The fear here is that the insurer will gain access to medical records that the patient and the provider would not normally transmit and that the insurer will use the data to take action adverse to the patient’s interest, such as limiting benefits or terminating the patient’s insurance coverage.

Special problems are created by employer-sponsored health plans. Here, the plan is essentially the same entity as the employer and the concern is that the employer will have access to medical information possessed by the health plan and will use the information contrary to the employee’s interests, such as to terminate employment.

The basic solutions that are being proposed are, first, to require record makers and keepers to implement a set of technical steps to protect the security of medical records and, second, to impose penalties on makers and keepers of records who release them for unauthorized or inappropriate purposes.

Technical steps being touted include unique patient and access identifiers; “audit trails,” which are electronic methods of detecting and recording the identities of anyone who accesses a record; encryption of external transmissions of record information; appointment of internal information security officers with responsibility to police record-keeping practices; and “firewalls,” which are electronic barriers that isolate records systems from unauthorized access or penetration.

The problem is that these techniques are expensive and no one is sure how well they work. I received a glimpse of how unrealistic these solutions might be at a meeting on medical records privacy I attended as a member of a joint working group of the Joint Commission on the Accreditation of Healthcare Organizations (“JCAHO”) and the National Committee for Quality Assurance (“NCQA”), the organization that accredits managed care organizations. One member of the working group, the person in charge of medical records at a large managed care plan, pointed out that neither she nor anyone else in her organization knew what records existed or where they were! She suspected that this was likely to be true of most managed care plans and provider organizations. Moreover, she explained that the greatest single threat to the privacy of medical records was post-it notes: people jotted down their passwords and pasted them on or near their computers. The more passwords, personal identifiers and other electronic steps a person had to take to access records, the more these little reminders would be necessary, rendering the fancy security techniques ineffective.

Some of the other issues that are being debated by policy-makers include:

  • Whether to require patient enrollees to authorize each release of medical records or only to require them to give a blanket release, say upon enrollment. Advocates of blanket releases argue that requiring a signed authorization for every record release would be burdensome and most patients don’t care. Proponents of individual authorization respond that this is necessary to alert patients that their records are being disclosed so they can take steps to prevent inappropriate disclosures.
  • Whether to establish uniform standards or minimum standards. Managed care organizations and other record makers and keepers like uniform standards because it tells them clearly what they have to do. Some patient advocates propose minimum standards to enable plans to compete for enrollees on the basis of how well they maintain privacy: plans that adopted more stringent security measures could publicize this fact to potential enrollees who have a choice of plan.
  • Whether to enact a federal law that pre-empts stricter state laws. A uniform law would facilitate interstate business by allowing a managed care plan to comply with one standard nation-wide. But some patient advocates urge that states be allowed to adopt more stringent security requirements, if only to permit experimentation to see what works best at protecting privacy.
  • How much control to give patients over what goes in and what stays in their medical records. Most privacy proposals would give patients the right to correct inaccuracies in their records but not to delete material. Some patient advocates argue that patients should have the right to block the entry or remove information that they fear would stigmatize them or lead to insurance or employment discrimination. Health care professionals are concerned that incomplete records could interfere with proper medical management. Patient advocates respond that, so long as the incomplete records are marked as such, patients should be permitted to weigh the risks of stigma or discrimination against the risks of a reduced quality of care.

There is almost certainly going to be federal legislation on medical record privacy. But this will not end the debate. Accreditation organizations such as the JCAHO and the NCQA will establish their own standards; managed care plans and provider organizations will adopt their own internal policies and procedures. Meanwhile, the science of electronic records and their security will develop, presenting new options and challenges. Stand by for further reports.

NOTE: We regret that we cannot answer personal medical questions.

Diabetic Retinopathy and Lasik, PRK, LASEK, Epi-Lasik, etc #lasik #and #diabetes


Diabetic Retinopathy

In most cases, refractive surgery of all kinds should be avoided in a patient with diabetic retinopathy. conventional or custom wavefront Lasik. Epi-Lasik. and Bladeless Lasik require a microkeratome that increases IOP when affixed to the eye with suction. PRK and LASEK do not require this dramatic rise in IOP and may (emphasis on may ) be appropriate in some cases. Any patient with diabetic retinopathy should be fully evaluated by a retina specialist before considering refractive surgery.

Diabetic retinopathy damages the tiny blood vessels that supply the retina (the light-sensitive nerve tissue at the back of the eye that transmits visual images to the brain). In the early stages of this disease-called non-proliferative or background retinopathy, the retinal vessels weaken and develop bulges (microaneurysms) that may leak blood (hemorrhages) or fluid (exudates) into the surrounding tissue. Vision is rarely affected during this stage of retinopathy.

If proliferative retinopathy is left untreated, about half of those who have it will become blind within five years, compared to just 5% of those who receive treatment. Yet only half of all diabetic patients in the U.S. have a yearly eye examination by an ophthalmologist. even though regular eye exams offer the best chance of catching retinopathy at its treatable stage.

Proliferative retinopathy, a later stage of the disease, involves the growth of fragile new blood vessels on the retina and into the vitreous — a jelly-like substance inside the eyeball. These vessels can rupture and release blood into the vitreous, which causes blurred vision or temporary blindness. The scar tissue that may subsequently develop can pull on the retina and cause retinal detachment, which may lead to permanent vision loss. Macular edema – swelling due to fluid accumulating around the macular, the part of the retina most crucial for fine vision – may also occur.

Much later on, however, fragile new blood vessels may begin to grow on the retina and into the vitreous (the jelly-like substance inside the back of the eye). These abnormal vessels are prone to rupture and bleed into the vitreous, causing blurred vision or temporary blindness. As a result, the formation of scar tissue can eventually pull the retina away from the back of the eye (retinal detachment), and lead to permanent vision loss. In addition, at any stage of retinopathy, severe blurring of vision may occur if fluid accumulates around the macula -the most sensitive portion of the retina that is crucial for seeing fine detail-a condition called macular edema.

Lowering blood glucose levels can significantly reduce the risk of developing retinopathy or slow its progression, even in people who have had diabetes for a number of years, according to a recent study.

This study involved 834 people who were over 30 when they developed diabetes and who were, on average, 65 at the start of the study. A glycohemoglobin test was performed at the start of the study and at a four-year follow-up. Eye exams were conducted at both these points in the study and then again at a ten-year follow-up. In non-insulin treated participants, those with the highest levels of glycohemoglobin at the start of the study had a nearly three-fold greater chance of having developed retinopathy after ten years than those with the lowest levels. Among those who already showed evidence of retinopathy at the start of the study, elevated glycohemoglobin resulted in a 4 times greater risk of retinopathy progression and a 14 times greater risk of proliferative retinopathy. In people taking insulin, those with the highest glycohemoglobin levels had a 90% increased risk of developing retinopathy than those with the lowest levels; patients with the highest levels also had twice the risk of retinopathy progression and triple the risk of proliferative retinopathy.

The researchers concluded that reduction in hyperglycemia at any time in the course of diabetes will result in a significant decrease in the long-term incidence and progression of retinopathy and in the development of visual loss.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik. Bladeless Lasik. PRK. or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated Certified Lasik Doctor .

Personalized Answers

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.

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Can I Have Laser Eye Surgery If I Have Diabetes?

Wednesday, August 18, 2010

Can I Have Laser Eye Surgery If I Have Diabetes?
Source: Tim Harwood/Blog

The quickest and easiest answer to this question is it depends and during this blog post I will try and give you are more complete explanation! I am not going to use this blog to go into lots of detail about diabetes, but I will try and explain the main points in a simple and easy to understand way. The 2 main types of diabetes are type 1 and type 2 and their main features are as follows:

Type1 is the condition you generally get when you are young (below the age of 20) and people with this type of diabetes will typically need to use Insulin to control their blood sugar levels.
Type 2 normally affects people as they get older and can sometimes (not always) be associated with obesity. People with type 2 diabetes can be diet controlled diabetics (e.g. control their blood sugar levels by watching what they eat), medication controlled (e.g. metformin) or if they are struggling to control their blood sugar levels they may need Insulin.

People with diabetes are normally assessed annually to check that they do not have any diabetic retinopathy. This is the test when you have your pupils dilated (made bigger) and then have a photograph taken of the back of your eyes. If you are found to have significant retinopathy you will be referred to an ophthalmologist who may consider treating your retinopathy with laser. This is not the same type of laser that is used in laser eye surgery. It is completely different and this diabetic laser treatment is used to treat the damage to the blood vessels on your retina at the back of your eyes. Laser eye surgery is carried out on your cornea at the front of your eyes. Having laser for diabetic retinopathy will not mean you will no longer have to wear glasses or contact lenses, which is the aim of laser eye surgery.

I will now return back to the original question of whether or not diabetics are suitable for laser eye surgery. The following lists the problems associated with performing laser eye surgery on diabetics:

Fluctuating prescription(strength of glasses/contact lenses) as a result of poorly controlled blood sugar levels. The reason this is a problem is that the optician/surgeon needs to be able to get an accurate measurement of your prescription as this is what the laser will be programmed to correct. If your blood sugars were high on the day of your laser eye surgery consultation then the readings may not be accurate. This could mean that the laser would not correct the prescription accurately as your eyes may be different once your blood sugar levels have returned to their normal level.

Slower healing: Diabetics generally have slower and less efficient healing of the cornea following laser eye surgery. Some surgeons will insist that you have Intralase as opposed to standard Lasik as healing time is generally quicker with this procedure.

Pre-existing diabetic retinopathy. If you already have diabetic retinopathy your vision may well be slightly impaired. Laser eye surgery will not improve your diabetic retinopathy.

Every clinic and every surgeon will have slightly different guidelines on who they will consider to be suitable for laser eye surgery. The following lists what is generally required for diabetics to be safe for surgery:

Well controlled blood sugar levels: This is to ensure an accurate and long lasting laser vision correction. Most surgeons will insist on a letter from your general practitioner stating that your blood sugar levels are stable.

Minimal diabetic retinopathy: What constitutes minimal will vary from one surgeon to the next. Most surgeons will be happy to carry out laser eye surgery if you have mild background retinopathy which is not affecting the central part of your vision.

In summary, laser eye surgery has been carried out successfully on thousands of diabetics and most surgeons are happy to carry out the procedure. If you have well controlled blood sugar levels and minimal diabetic retinopathy you are unlikely to have any issues. Insulin dependent diabetics (type 1) and those who have had the condition for many years are less likely to be suitable as there is a higher chance of them having retinopathy. The only way you will know for certain if you are suitable for surgery is by having a consultation. You should ask your GP for a letter stating how well controlled your blood sugar levels are and take this along with you. Attending aftercares and sticking diligently to the post surgery instructions is especially important if you suffer from diabetes.

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Originally posted by on August 19, 2010

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LASIK again ten years later?

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LASIK again ten years later?

10-01-2012 05:09 AM by otte

Re: LASIK again ten years later?

Originally Posted by Newton418

I had my first LASIK at age 40, when I was nearsighted and astigmatic. Now, at age 50, my eyes have (of course) aged to the point where I’m very farsighted. Can I safely get a second LASIK procedure to correct?

I am with Guy448. It is a gamble – you may have great results, you may not. I chose the life time plan, had both eyes done twice last year and they are still not right. I’ll stick with glasses when I need them.

11-17-2012 10:53 PM by david590

Re: LASIK again ten years later?

Originally Posted by Newton418

I had my first LASIK at age 40, when I was nearsighted and astigmatic. Now, at age 50, my eyes have (of course) aged to the point where I’m very farsighted. Can I safely get a second LASIK procedure to correct?

Hi, I’m 2 1/2 weeks post surgery and I’m far sighted which is much worse than near sighted but, I’m told, it may get better. In any case, I’ve read various things about lasik enhancements and I’ve made the decision to not to do it. There are risks specifically with the cornea flap and I’m going to leave well enough alone and get along with glasses.

My vision is correctable with glasses and is currently only slightly far-sighted (+.75) so I’m just going to live with it.

11-17-2012 10:55 PM by david590

Re: LASIK again ten years later?

Originally Posted by Newton418

I had my first LASIK at age 40, when I was nearsighted and astigmatic. Now, at age 50, my eyes have (of course) aged to the point where I’m very farsighted. Can I safely get a second LASIK procedure to correct?

Hi, I’m 2 1/2 weeks post surgery and I’m far sighted which is much worse than near sighted but, I’m told, it may get better. In any case, I’ve read various things about lasik enhancements and I’ve made the decision to not to do it. There are risks specifically with the cornea flap and I’m going to leave well enough alone and get along with glasses.

My vision is correctable with glasses and is currently only slightly far-sighted (+.75) so I’m just going to live with it.

How far-sighted are you? Do you need glasses for distance. Or is it that you just can’t see near due to the age?

11-19-2012 01:58 PM by Pablo7703

Re: LASIK again ten years later?

the risk in a second Lasik is lower than that of the first lasik because the flap is already there.

11-19-2012 02:55 PM by otte

Re: LASIK again ten years later?

Originally Posted by PabloPicasso

the risk in a second Lasik is lower than that of the first lasik because the flap is already there.

I would think all the risks are the same. The only difference is the flap is already cut. I did ask my doctor what the time frame was for lifting the flap and he said he has done them 10 years later which means to me it never really fully heals. The risks are still the same with the flap being positioned properly, and as with any cuts there is scarring, again lifting the flap is an injury to the body. There is also the risk of infections, getting the correction correct, induced sight problems like astigmatism like I have, dry eye, and more.
This is a major operation and I look back thinking how weird it was that a person can just walk into a room and have the cornea cut and lifted without a whole lot of sterilization done.

11-20-2012 12:20 AM by Pablo7703

Re: LASIK again ten years later?

You are absolutely right. the only problems you will not have the risk of when the flap is already created are problems related to cutting blood supply to the retina and increasing the intraocular pressure in the process of creating the flap..
I am glad you are thinking this through and taking your time before rushing into it. if only I was like you before I had mine done good luck


8 Ways To Beat Your Sugar Addiction #sugar #blockers #diet, #diabetes, #sugar #addiction, #carbohydrates, #low #carb, #heart #disease, #blood #sugar, #sugar #absorption


The information presented on this website is not intended as specific medical advice and is not a substitute for professional medical treatment or diagnosis. Read our Medical Advice Notice.

Copyright 2017 Rodale Inc. “Prevention” and “” are registered trademarks of Rodale Inc. All rights reserved. No reproduction, transmission or display is permitted without the written permissions of Rodale Inc.

8 Ways To Beat Your Sugar Addiction

Use these rules to naturally slow your sugar absorption—and keep eating meals you love

How do you break this cycle and get your body to work optimally again? Happily, you don’t need to go on an extreme diet. The first step is just to reduce the blood sugar spikes that produce sharp increases of insulin. The substance in our diet that’s most responsible for these surges is starch—namely, anything made from potatoes, rice, flour, corn, or other grains. (Think pasta, lasagna, white bread, doughnuts, cookies, and cakes.) You could cut out these foods entirely. But wouldn’t it be great if there were a way to solve the problem without completely eliminating these carbs?

It turns out there is. You can blunt the blood sugar-raising effects by taking advantage of natural substances in foods that slow carbohydrate digestion and entry into the bloodstream. No matter what kind of sugar blocker you use, your waistline (and health) will win in the end.

Have a fatty snack 10 to 30 minutes before your meals.
Reason: You remain fuller longer. At the outlet of your stomach is a muscular ring, the pyloric valve. It regulates the speed at which food leaves your stomach and enters your small intestine. This valve is all that stands between the ziti in your stomach and a surge of glucose in your bloodstream. But you can send your pyloric valve a message to slow down. Fat triggers a reflex that constricts the valve and slows digestion. As little as a teaspoon of fat—easily provided by a handful of nuts or a piece of cheese—will do the trick, provided you eat it before your meal.

Start your meal with salad.
Reason: It soaks up starch and sugar. Soluble fiber from the pulp of plants—such as beans, carrots, apples, and oranges—swells like a sponge in your intestines and traps starch and sugar in the niches between its molecules. Soluble means “dissolvable”—and indeed, soluble fiber eventually dissolves, releasing glucose. However, that takes time. The glucose it absorbs seeps into your bloodstream slowly, so your body needs less insulin to handle it. A good way to ensure that you get enough soluble fiber is to have a salad—preferably before, rather than after, you eat a starch.

Eat some vinegar.
Reason: It slows the breakdown of starch into sugar. The high acetic acid content in vinegar deactivates amylase, the enzyme that turns starch into sugar. (It doesn’t matter what kind of vinegar you use.) Because it acts on starch only, it has no effect on the absorption of refined sugar. In other words, it will help if you eat bread, but not candy. But there’s one more benefit: Vinegar also increases the body’s sensitivity to insulin. You should consume vinegar at the start of your meal. Put it in salad dressing or sprinkle a couple of tablespoons on meat or vegetables. Vinegar brings out the flavor of food, as salt does.

Include protein with meals.
Reason: You won’t secrete as much insulin. Here’s a paradox: You want to blunt insulin spikes—but to do that, you need to start secreting insulin sooner rather than later. It’s like a fire department responding to a fire. The quicker the alarm goes off, the fewer firefighters will be needed to put out the blaze. Even though protein contains no glucose, it triggers a “first-phase insulin response” that occurs so fast, it keeps your blood sugar from rising as high later—and reduces the total amount of insulin you need to handle a meal. So have meatballs with your spaghetti.

Nosh on cooked veggies.
Reason: You digest them more slowly. Both fruits and vegetables contain soluble fiber. As a rule, though, vegetables make better sugar blockers, because they have more fiber and less sugar. But don’t cook your vegetables to mush. Boiling vegetables until they’re limp and soggy saturates the soluble fiber, filling it with water so it can’t absorb the sugar and starch you want it to. Also, crisp vegetables are chunkier when they reach your stomach, and larger food particles take longer to digest, so you’ll feel full longer. Another tip: Roasted vegetables like cauliflower can often serve as a delicious starch substitute.

Sip wine with dinner.
Reason: Your liver won’t produce as much glucose. Alcohol has unique sugar-blocking properties. Your liver normally converts some of the fat and protein in your blood to glucose, which adds to the glucose from the carbs you eat. But alcohol consumed with a meal temporarily halts your liver’s glucose production. A serving of any alcohol—beer, red or white wine, or a shot of hard liquor—will reduce the blood sugar load of a typical serving of starch by approximately 25%. That doesn’t mean you should have several drinks (especially if you have diabetes, as multiple drinks can cause hypoglycemia). Not only does alcohol contain calories, but it also delays the sensation of fullness, so you tend to overeat and pile on calories. Be especially mindful about avoiding cocktails that are made with sweetened mixers—yet another source of sugar.

Save sweets for dessert.
Reason: All of the above. If you eat sweets on an empty stomach, there’s nothing to impede the sugar from racing directly into your bloodstream—no fat, no soluble fiber, no protein, no vinegar. But if you confine sweets to the end of the meal, you have all of the built-in protection the preceding rules provide. If you want to keep blood sugar on an even keel, avoid between-meal sweets at all costs—and when you do indulge, don’t eat more than you can hold in the cup of your hand. But a few bites of candy after a meal will have little effect on your blood sugar and insulin—and can be quite satisfying.

Move your body.
There are other ways of blunting sugar spikes, and exercise is one of the best. Your muscle cells are by far the biggest users of glucose in your body and the target of most of the insulin you make. When you exercise, your muscles need to replenish their energy stores, so each cell that you work out begins making glucose “transporters.” These sit on the surface of the cell and allow glucose to enter. In the meantime, while cells are still making the transporters, they also open up special channels that allow glucose in, independent of insulin. So to reduce sugar spikes, try going for a walk after eating.

Quick quiz: Are you at risk of diabetes?
If you have any three of the following signs, the odds are about 5 to 1 that you have insulin resistance—a condition that puts you in danger of metabolic syndrome and diabetes.
1. A waist that measures 35 or more inches if you’re a woman—or 40-plus inches for that man in your life
2. A blood triglyceride level of 150 mg/dL or greater
3. An HDL level of less than 50 mg/dL if you’re a woman—or less than 40 for a man
4. Blood pressure of 130/85 mmHg or higher
5. Fasting blood sugar greater than 100 mg/dL

From The Sugar Blockers Diet . Get more tips on how to beat your sugar addiction while eating the foods you lovetry the book for free!