Lifestyle Medicine: Overcoming Systemic and Cultural Barriers to Better, More Affordable Care.

The 6 pillars of lifestyle medicine have strong scientific backing and plenty of supportive evidence to validate their integration into routine clinical practice. However, two barriers stand in the way of their widespread adoption: the system of healthcare and the culture of medicine. This article describes changes necessary to overcome these systemic and cultural obstacles and outlines steps necessary to achieve what traditional healthcare has so-far failed to deliver: higher quality, lower costs, and greater access to care.

Infection Rates for Open Distal Phalangeal Fractures Treated with Kirschner Wire: A UK Regional Hand Centre Experience.

: Phalangeal fractures are common in hand injuries which: comprising of 23% of all hand and forearm fractures. The current consensus is that focus of treatment should be on prompt irrigation and debridement to reduce infection risk. These infections are significant as they can lead to serious sequelae including osteomyelitis.

Burnout among urologists linked to status and hierarchy.

This article includes partial excerpts from Dr. Robert Pearl's upcoming book, "Uncaring: How The Culture Of Medicine Kills Doctors And Patients." This book contains specific and detailed solutions for reforming both the system and culture of healthcare.

Fulminant necrotizing fasciitis to the hand in a patient on high-dose steroids: A case report of successful limb salvage.

Glucocorticoids are commonly used in the management of patients with brain Tumour for reducing peritumoral and vasogenic edema. However, they may lead to development of limb and life-threatening conditions such as necrotizing fasciitis (NF). NF is a rare but potentially lethal condition.

causing a subcutaneous palmar cyst in an otherwise healthy UK resident.

is a ubiquitous genus encompassing more than forty species, a number of which have been associated with superficial or systemic infections in humans, and other hot- or cold-blooded animals. Here we report a human case of subcutaneous mycotic cyst caused by . To our knowledge, this is only the third reported human infection caused by , all three of which involved subcutaneous nodules in patients who had resided in the United Kingdom.

Association of Anxiety With High-Cost Health Care Use Among Individuals With Type 2 Diabetes.

Objective: People with type 2 diabetes vary greatly in their use of high-cost health care resources. We examined the association of anxiety with high-cost use after accounting for depression and medical comorbidity.

Research Design And Methods: Using electronic health record data, we assessed past anxiety diagnosis, health care use and costs, demographics, comorbidities, and diabetes control status and complications during 2008-2012 for 143,573 adult members of an integrated health care system with type 2 diabetes.

Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs.

A high proportion of U.S. health care costs are attributable to a relatively small proportion of patients.

U.S. healthcare failing in cost, quality, safety; together we can cure what's ailing our system.

The American healthcare system is headed toward a cliff, and the fall will be long and painful. Healthcare consumes 18% of our nation's gross domestic product, almost 50% more than the second highest-spending nation. High-deductible health plans are the new norm for one-third of insured patients.

Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking.

Kaiser Permanente Northern California: current experiences with internet, mobile, and video technologies.

The US health care system has been slow to adopt Internet, mobile, and video technologies, which have the capability to engage patients in their own care, increase patients' access to providers, and possibly improve the quality of care while reducing costs. Nevertheless, there are some pockets of progress, including Kaiser Permanente Northern California (KPNC). In 2008 KPNC implemented an inpatient and ambulatory care electronic health record system for its 3.

The safety of autologous fat transfer in breast cancer: lessons from stem cell biology.

Autologous fat grafting is versatile tool in plastic surgery and is increasing used for reconstruction following breast conserving surgery for breast cancer. Part of the reconstructive qualities of the transferred fat may be due to the presence of adipose derived mesenchymal stem cells (ADMSC) playing an angiogenic and an adipogenic role. In this context it must be considered if autologously engrafted fat tissue could contribute to carcinogenesis following breast conserving surgery.

Reconstruction following traumatic partial amputation of the ear.

Background: Reconstruction following traumatic amputation of the external ear remains a unique challenge to the plastic surgeon. The authors report a series of ear reconstructions with autologous costal cartilage in patients following traumatic partial amputation of the ear. Technical points regarding the carving of the cartilage framework and methods of skin coverage are discussed.

A case of large sporadic neurofibroma of the hand.

We report the case of a large sporadic neurofibroma arising in the palm of the 40 year old nurse. Isolated neurofibroma in the hand are rare and pose both diagnostic and treatment challenges for the surgeon. Preoperative imaging can be useful to delineate the anatomical relationships of a soft tissue lesion but is not always diagnostic.