Obesity Counseling

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Main Category: Medicare / Medicaid / SCHIP
Also Included In: Obesity / Weight Loss / Fitness
Article Date: 30 Nov 2011 – 12:00 PST

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Medicare beneficiaries will be able to get coverage for preventive obesity counseling, CMS (Centers for Medicare and Medicaid Services) announced today. The CMS says this is part of the widening range of preventive services CMS has been adding to its coverage since the signing of the Affordable Care Act. Covering the costs for preventive obesity counseling complements the Million Hearts initiate, CMS explained in a communiqué.

CMS Administrator Donald M. Berwick, MD., said:

“Obesity is a challenge faced by Americans of all ages, and prevention is crucial for the management and elimination of obesity in our country. It’s important for Medicare patients to enjoy access to appropriate screening and preventive services.”

Approximately one third of Medicare beneficiaries are thought to be obese.

Obesity can raise the risk of developing the following conditions and diseases:

  • Abnormal periods
  • Coronary heart disease
  • Diabetes mellitus type 2
  • Gallbladder disease
  • High blood cholesterol
  • High blood pressure
  • High triglyceride levels
  • Infertility
  • Liver disease
  • Metabolic syndrome
  • Osteoarthritis
  • Respiratory problems
  • Several cancers
  • Sleep apnea and other sleep disorders
  • Stroke
  • The risk of a cancer being a rapidly progressive one

According to the CDC (Centers for Disease Control and Prevention), the medical care costs of obesity in America in 2008 amounted to $147 billion.

The CMS says that such chronic diseases as diabetes type 2 and cardiovascular diseases affect some racial and ethnic minorities disproportionately. If obesity-related disparities can be addressed beforehand, the chances of significantly reducing obesity rates is much greater, as well as closing the wide health disparities that currently exist among Medicare beneficiaries.

Under this new benefit, eligible patients who receive obesity screening and counseling at primary care centers will be covered.

If the screening shows that the patient is obese, i.e. has a BMI (body mass index) of at least 30, the following would be covered by Medicare:

  • Four weekly counseling sessions (one per week)
  • One face-to-face counseling session every fortnight for a further five months
  • If the patient manages to reduce enough weight (6.6 pounds or 3 kilos in six months), they would be covered for further once-monthly counseling sessions for six months (providing a total of 12 months)

CMS Chief Medical Officer and Director of the Agency’s Office of Clinical Standards and Quality, Patrick Conway, MD, MSc, said:

“This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease. We at CMS are carefully and systematically reviewing the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible.”

How are underweight, normal weight, obesity calculated?

There are two ways of working this out – one is Waist-Hip Ratio, and the other is BMI.

BMI (Body Mass Index)

This measures your height and weight. It is less accurate than waist-hip ratio, and many experts believe it will gradually give way to waist-hip ratio.

The flaw in BMI is that it does not measure body fat versus muscle content in the person. A 6ft tall 100 meter Olympic champion may weigh more than a 6ft unfit couch potato – even though the athlete has a small waist and is definitely not overweight, his BMI will show he is fatter than the couch potato. A waist-hip ratio measurement will not make this mistake.
The BMI Classification is as follows:

  • Underweight – anything below 18.5
  • Normal weight – from 18.5 to 24.9
  • Overweight – from 25 to 29.9
  • Class 1 obesity – from 30 to 34.9
  • Class 2 obesity – from 35 to 39.9
  • Class 3 obesity – 40+ (also known as morbidly obese)

Measuring your BMI in metric units: The person’s weight in kilos divided by the square of their height. For example, an 80 kilogram person whose height is 1.8 meters has a BMI of 24.69 (1.82 = 3.24. 80 divided by 3.24 = 24.69).

Measuring your BMI in imperial units: The person’s weight in pounds times 703, divided by the square of their height in inches. For example, a 72-inch tall person weighing 190 pounds has a BMI of 25.76 (190 x 703 divded by 5,184 + 25.76).

3 waist
Three waist circumfurences illustrating examples of ideal, overweight and obese

Waist-Hip Ratio (WHR)

In this case, the waist measurement is divided by the hip measurement. For example, if a female’s waist is 28 inches and her hips are 36, her WHR is 0.77 (28 divided by 36).

Male waist-hip ratios:

  • Less than 0.9 – ideal weight. The risk of health problems is generally low.
  • 0.9 to 0.99 – overweight. There is a moderate risk of some health problems.
  • 1 or more – obese. There is a high risk of health problems.

Female waist-hip ratios:

  • Less than 0.8. Ideal.
  • 0.8 to 0.89 – overweight.
  • 0.9 or more – obese.

Written by Christian Nordqvist

Copyright: Medical News Today

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Economic Savings With Tobacco Control Programs

Main Category: Smoking / Quit Smoking
Also Included In: Public Health;  Medicare / Medicaid / SCHIP
Article Date: 29 Nov 2011 – 0:00 PST

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States that have shifted funds away from tobacco control programs may be missing out on significant savings, according to a new study co-authored by San Francisco State University economist Sudip Chattopadhyay.

If these programs were funded at the levels recommended by the Centers for Disease Control and Prevention (CDC), states could save an astonishing 14-20 times more than the cost of implementing the programs. The costs of smoking are felt by the states, mostly through medical costs, Medicaid payments and lost productivity by workers.

The evidence is clear that state tobacco control programs have a “sustained and steadily increasing long-run impact” on the demand for cigarettes, Chattopadhyay and his colleague David R. Pieper at University of California, Berkeley write in a paper published online today in the journal Contemporary Economic Policy. Chattopadhyay is the chair of the Economics Department and professor of economics.

The study uses data from 1991 to 2007, during which time the states paid for the programs with the help of the tobacco tax, public and private initiatives and funds from the Tobacco Master Settlement Agreement between the nation’s four largest tobacco companies and 46 states.

Unfortunately, says Chattopadhyay, funding for the programs has been declining steadily since about 2002. In 2010, states on average were spending 17 percent of the total investment recommended by the CDC for the programs. And in tough economic times, many states have turned to cigarette taxes to raise revenue.

Chattopadhyay said the shift in spending priorities was part of his motivation for examining the benefits and costs behind the programs. “Almost all states are facing financial crisis, and they are really diverting their funds, possibly moving funds from productive use.”

Unless the benefits of fully funding the programs are shown to outweigh the costs, the researchers suggest, states may continue to divert revenue away from the programs.

After accounting for multiple factors, the researchers determined that tobacco control programs do reduce the demand for cigarettes. It’s a trend that grows over time, in part because it takes smokers time to quit and because the programs become more efficient at delivering their services.

Unlike earlier studies, Chattopadhyay and Pieper even examined the effects of different state tobacco taxes, and how the differences might affect cigarette demand. Smokers in a state with a high tobacco tax could be more easily tempted to buy cigarettes if they share a border with a low-tax state, for instance. Tobacco taxes can range from less than 20 cents per pack in some states to nearly $5 in others.

In 2007, the CDC revised its recommendations on how much states should spend on tobacco control programs to make them successful. If individual states would follow the new CDC guidelines, they could realize future savings of 14-20 times what the programs cost, the study concluded. Chattopadhyay said he would like to deliver the results of the study to the states, “to convince them that they can use that money for more productive purposes” and to encourage them not to let their past investments in tobacco control programs go to waste.

“They would save money in terms of reduced Medicaid, and reduced medical and productivity costs,” he said. “Those kinds of costs are only going to go up.”

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Statement On Dr. Donald Berwick’s Departure As Administrator Of The Centers For Medicare And Medicaid Services

Main Category: Medicare / Medicaid / SCHIP
Article Date: 26 Nov 2011 – 0:00 PST

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Donald Berwick, MD, MPP, the departing CMS Administrator, brought his deep expertise and vision for health care improvement to all he did at CMS. We thank him for his leadership there, in particular the role he played in helping shape the Medicare Shared Savings Program, Accountable Care Organizations regulatory framework. Dr. Berwick has been a friend to medical groups and the high standards of care which they practice and espouse. While Dr. Berwick will be leaving the Federal health care stage, he will not be exiting from the arena and we wish him well.

The American Medical Group Association represents medical groups, including some of the nation’s largest, most prestigious medical practices, independent practice associations, and integrated healthcare delivery systems. AMGA’s mission is to improve health care for patients by supporting multispecialty medical groups and other organized systems of care. More than 117,000 physicians practice in AMGA member organizations, providing healthcare services for 110 million patients in 49 states (nearly one in three Americans). Headquartered in Alexandria, Virginia, AMGA is the strategic partner for these organizations, providing a comprehensive package of benefits, including political advocacy, educational and networking programs, publications, benchmarking data services, and financial and operations assistance.

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Adolescents With Fibromyalgia

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Academic Journal
Main Category: Fibromyalgia
Also Included In: Depression;  Psychology / Psychiatry;  Arthritis / Rheumatology
Article Date: 22 Nov 2011 – 5:00 PST

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According to a recent multi-site trial published in Arthritis Rheumatism, a peer-reviewed journal of the American College of Rheumatology (ACR), cognitive-behavioral therapy (CBT) reduces functional disability and depressive symptoms in adolescent with juvenile fibromyalgia. The trial demonstrated that the psychological therapy was safe and effective as well as superior to disease management education.

According to medical evidence approximately 2 to 7% of school-aged children are affected by juvenile fibromyalgia syndrome, which similar as in adults, predominantly affects adolescent girls. The characteristics in both adult and juvenile fibromyalgia patients are widespread musculoskeletal pain, fatigue together with sleep and mood disturbances. Earlier studies have established that juvenile fibromyalgia patients suffer from substantial physical, school, social and emotional impairments. So far, there are only few studies for treating the juvenile form of the disorder.

Study leader Dr. Susmita Kashikar-Zuck from the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital Medical Center in Ohio and her team decided to investigate fibromyalgia in juveniles and enrolled 114 adolescents who were diagnosed with the disorder between the ages of 11 to 18 years. The trial was carried out at four pediatric rheumatology centers from December 2005 to 2009. Participants were randomized to cognitive-behavioral therapy or fibromyalgia education in form of eight weekly individual therapy sessions and two additional sessions in the six months after completion of the active therapy.

At the end of the trial, the findings demonstrated that both patient groups showed a substantial reduction in functional disability, pain, and depressive symptoms. According to the researchers, pediatric participants in the cognitive-behavioral therapy group displayed a substantially lower functional disability with an improvement of 37% in disability compared with those in the fibromyalgia education group who achieved a 12% disability improvement. At study-end both groups had scored in the non-depressed range, however, pain reduction was clinically insignificant with a decrease in pain of less than 30% in both groups.

More than 85% of the participants attended all therapy sessions, meaning that only few participants dropped out, and researchers reported no study-related adverse events.

Dr. Kashikar-Zuck concludes:

“Our trial confirms that cognitive-behavioral therapy is a safe and effective treatment for reducing functional disability and depression in patients with juvenile fibromyalgia. When added to standard medical care, cognitive-behavioral therapy helps to improve daily functioning and overall wellbeing for adolescents with fibromyalgia.”

Written by Petra Rattue

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

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“A Randomized Clinical Trial of Cognitive Behavioral Therapy for the Treatment of Juvenile Fibromyalgia.”
Susmita Kashikar-Zuck, Tracy V. Ting, Lesley M Arnold, Judy Bean, Scott W. Powers, T. Brent Graham, Murray H. Passo, Kenneth N. Schikler, Philip J. Hashkes, Steven Spalding, Anne M. Lynch-Jordan, Gerard Banez, Margaret M. Richards and Daniel J. Lovell.
Arthritis Rheumatism; Published Online: November 22, 2011 (DOI: 10.1002/art.30644)

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Titanium Debris From Artificial Joints May Trigger Painful Inflammation

Main Category: Arthritis / Rheumatology
Also Included In: Medical Devices / Diagnostics
Article Date: 22 Nov 2011 – 1:00 PST

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Many people with painful, creaky knees and hips find relief after replacing their bad joints with new artificial joints made from titanium. But some of these people develop painful inflammation that can lead to bone destruction and loosening of the new joint. A new study led by researchers at the University of Medicine and Dentistry of New Jersey and published by the Journal of Immunology suggests that tiny titanium particles that flake away from the artificial joints through normal wear and tear may play a direct role in that inflammation.

Prior studies have suggested that inflammation is caused by bits of bacteria that stick to dislodged titanium particles and activate an immune response. But Pankaj Mishra in the laboratory of William Gause in the Department of Medicine and the Center for Immunity and Inflammation, in collaboration with Joseph Benevenia in the Department of Orthopedics, at UMDNJ-New Jersey Medical School now finds that titanium particles themselves trigger inflammation in mice.

The type of inflammatory response that ensued when titanium particles were introduced known as a Th2 response is typically associated with allergic responses and parasitic worm infections and results in the generation of immune cells called alternatively activated macrophages (AAMs). The immune system thus responds to these “inert” micron-sized particles as if they were allergens or invading multicellular parasites. The potential effects of a Th2 response in the joint are not completely clear, but there is increasing evidence that AAMs contribute to bone destruction in prosthesis recipients and in patients with certain type of arthritis.

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Free Guided Care Training And Tools Available For Accountable Care Organizations Seeking To Be Part Of Medicare Shared Savings Program

Main Category: Medicare / Medicaid / SCHIP
Article Date: 19 Nov 2011 – 0:00 PST

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The Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health will offer free training and technical assistance for organizations that seek to use the Guided Care model to participate in the Medicare Shared Savings Program. The Centers for Medicare Medicaid Services (CMS) developed the Shared Savings Program to improve care quality and reduce costs for Medicare beneficiaries and is now accepting applications for an April 2012 launch as part of the Affordable Care Act. The free assistance is made possible by a grant from the John A. Hartford Foundation.

Guided Care is a model of comprehensive primary care in which a registered nurse, co-located in a primary care practice, partners with 2-5 physicians and other team members to provide coordinated, patient-centered, cost-effective care to 50-60 patients with multiple chronic conditions. A three-year, multi-site, cluster-randomized controlled trial showed that, compared to traditional care, Guided Care significantly improved the quality of patients’ care and physicians’ satisfaction with chronic care. Results also include a reduction in the use of expensive services, especially in well-managed health care delivery systems.

“The Guided Care model can help Accountable Care Organizations (ACOs) serve chronically ill adults,” said Chad Boult, MD, MPH, MBA, leader of the multidisciplinary team that developed Guided Care and a professor with the Bloomberg School’s Department of Health Policy and Management. “We have been testing and perfecting Guided Care for nearly 10 years, and we are pleased to assist health care providers improve the quality, efficiency and outcomes of care for their high-risk patients.”

The Medicare Shared Savings Program incentivizes hospitals and doctors to work together to improve the quality and efficiency of health care. Organizations that meet quality targets will get to share in the program’s cost savings.

A limited supply of the following resources is available for free to organizations that plan to implement the principles of Guided Care as they become ACOs:

An online course for nurses. This six-week, 40-hour, web-based course prepares registered nurses to become Guided Care Nurses. It features self-paced modules, live webinars and support from expert faculty. After passing an online exam, nurses receive a “Certificate in Guided Care Nursing” from the American Nurses Credentialing Center (ANCC). The course is offered by the Institute for Johns Hopkins Nursing.

An implementation manual titled “Guided Care: A New Nurse-Physician Partnership in Chronic Care” provides detailed, practical information and advice on assessing practice readiness, preparing to launch, providing and managing Guided Care.

An orientation booklet for patients and families titled “Transformation: A Family’s Guide to Chronic Care, Guided Care, and Hope,” that describes what Guided Care is and how it can help them.

Also available is a low-cost, online course for practice leaders. This asynchronous, CME (Continuing Medical Education)-eligible, nine-module course provides physicians, practice administrators and other practice leaders with an introduction to the competencies that facilitate effective physician practice within ACOs. Tuition is $15 per module. Physicians receive a certificate and one CME credit per one-hour module. The course is offered by the Center for Teaching and Learning with Technology at the Johns Hopkins Bloomberg School of Public Health.

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China’s medical equipment

China is already the third largest medical equipmentl market in the world, after the United States and Japan. Within 5 to 7 years, China will surpass Japan and become the second largest medical equipment market in the world.

Meantime, the exports of the medical bed are also hot. China exported 12.7 billion USD worth of medical device to the world, is three times the amount of imports. One of the typical products is medical bed.

A hospital Bed apparatus is provided that has a body frame, a hoisting assembly and a hammock supported from the hoisting assembly by hanging strings. The body frame is positioned over a hospital bed or the like and a person is placed on the hammock.

A pair of drums is provided in the hoisting assembly so that the hanging strings may be hoisted or wound on the drums in a first direction to lift the hammock. The drums are preferably cone-shaped such that the head portion of the hammock is initially lifted at a rate that is faster than the rate the foot portion of the hammock is lifted.

Once the person’s upper torso is substantially upright, the lifting rate for the head and foot portion of the hammock are substantially equal. Once the person is lifted, the hoisting assembly is horizontally movable in directions so that the person may be maneuvered away from the medical equipment and positioned in an upright sitting position over a urinal, bath or chair.

The lifting and maneuvering procedure may be reversed so that the person is repositioned over the hospital Bed and returned to a substantially horizontal position by reversing the hoist direction of the drums. The hanging strings are maintained in a substantially vertical orientation by moving the drum hoisting the head portion and the drum hoisting the foot portion of the hammock toward each other as the person is lifted and moving the drums away from each other as the person is lowered.

You can read electric medical hospital bed,manual hospital medical bed, ldr bed, delivery bed in your interesting.

 

Rheumatologists Update Assessments For Adult Pain

Main Category: Pain / Anesthetics
Also Included In: Arthritis / Rheumatology;  Seniors / Aging
Article Date: 17 Nov 2011 – 3:00 PST

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Assessment of patient outcomes allows physicians and researchers to measure the success or failure of diagnostics and treatments that patients receive. One set of measurement tools focuses on assessing adult pain and is included in a special issue of Arthritis Care Research (link below), a journal of the American College of Rheumatology (ACR), providing physicians and researchers with a single resource of 250 patient outcomes measurements in rheumatology.

The World Health Organization (WHO) indicates that more than 150 rheumatic or musculoskeletal diseases can contribute to pain and disability in adults. Rheumatoid arthritis is a painful, autoimmune disease which causes inflammation in the joints and is estimated to affect up to 1% of the global population. Osteoarthritis is caused by failed repair of injury from various joint stresses, resulting in total joint breakdown. Osteoarthritis which causes pain, stiffness and reduced movement of affected joints, such as knees, hips, fingers and lower spine, leading to disability affects close to 10% of men and 18% of women over age 60, worldwide, according to WHO reports.

“Pain is the most significant complaint of patients with rheumatic conditions. Thus, assessment of pain, including its intensity, frequency and impact on the patient’s physical function, sleep, mood and overall quality of life is integral to good care,” explains Dr. Gillian Hawker, a rheumatologist and clinical epidemiologist at the University of Toronto in Canada. “Our overview of available pain questionnaires provides both clinicians and researchers with a quick reference for comparing and selecting the most appropriate assessment tool for their purpose.” Details regarding questionnaire content, ease of use, and measurement properties are included in the review of each questionnaire.

The authors present a review of generic uni- and multi-dimensional pain assessment tools including the Visual Analog Scale, Numeric Rating Scale, Short-form McGill Pain Questionnaire, Chronic Pain Grade Scale, Short Form-36 Bodily Pain Scale, and the Measure of Intermittent and Constant Osteoarthritis Pain. The latter is a relatively new osteoarthritis-specific pain questionnaire designed to evaluate pain patterns and impact that is distinct from the impact of pain on physical function. A discussion of the strengths and weakness of each questionnaire is also provided.

Along with Dr. Hawker’s review of “Measures in Adult Pain,” assessment tools to measure patient outcomes in areas such as sleep, fatigue, physical function, and depression are also available in this special issue. Dr. Patricia Katz with the University of California and Guest Editor of the Arthritis Care Research special issue, “Patient Outcomes in Rheumatology, 2011” said, “In this issue, we update and expand the number of patient outcomes measures originally published in 2003 to include more than 250 measures twice as many as previously covered. This single-source reference provides rheumatologists and researchers with a valuable, up-to-date resource for evaluating current patient assessment tools.”

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Adult Pain

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Academic Journal
Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics
Article Date: 17 Nov 2011 – 5:00 PST

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Physicians and researchers can measure patients’ diagnoses and treatment successes or failures by evaluating patient outcomes. A special issue of Arthritis Care Research, a journal of the American College of Rheumatology (ACR) describes one set of measuring tools that is based on evaluating adult pain providing physicians and researchers with a single resource of 250 patient outcomes measurements in rheumatology.

According to the World Health Organization (WHO), over 150 rheumatic or musculoskeletal diseases can contribute to pain and disability in adults. About 1% of the global population is affected by rheumatoid arthritis, a painful autoimmune disease that causes inflammation in the joints. WHO reports that worldwide osteoarthritis affects almost 10% of men and 18% of women over the age of 60 years.

Osteoarthritis is characterized by pain, stiffness and reduced movement of the affected joints and is most common in the joints of the hands, feet, spine and the large weight bearing joints, such as hips and knees. Caused by failed repair of injury from various joint stresses, it can result in a total degradation of the joint leading to disability.

Dr. Gillian Hawker, a rheumatologist and clinical epidemiologist at the University of Toronto in Canada explains:

“Pain is the most significant complaint of patients with rheumatic conditions. Thus, assessment of pain, including its intensity, frequency and impact on the patient’s physical function, sleep, mood and overall quality of life is integral to good care.

Our overview of available pain questionnaires provides both clinicians and researchers with a quick reference for comparing and selecting the most appropriate assessment tool for their purpose.”

The review of each questionnaire includes details regarding its content, ease of use as well as measurement properties.

The authors present a review of the generic single- and multi-dimensional pain assessment tools. They include various scales, including the Numeric Rating Scale, Short-form McGill Pain Questionnaire, Chronic Pain Grade Scale, Short Form-36 Bodily Pain Scale and Visual Analog Scale. Also included are the Measure of Intermittent and Constant Osteoarthritis Pain, which is a fairly new questionnaire on osteoarthritis-specific pain, developed to assess pain patterns and impact, particularly the impact of pain on physical function. It also allows clinicians and researchers to discuss the strengths and weakness of each questionnaire.

The special issue of Arthritis Care Research Along also contains Dr. Hawker’s review of “Measures in Adult Pain”, which are assessment tools to measure patient outcomes regarding sleep, fatigue, physical function and depression.

Guest Editor of the Arthritis Care Research special issue, “Patient Outcomes in Rheumatology, 2011” Dr. Patricia Katz from the University of California said:

“In this issue, we update and expand the number of patient outcomes measures originally published in 2003 to include more than 250 measures – twice as many as previously covered. This single-source reference provides rheumatologists and researchers with a valuable, up-to-date resource for evaluating current patient assessment tools.”

Written by Petra Rattue

Copyright: Medical News Today

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Everyday Health Network

The Diagnostic Medical Imaging Equipment Business (http://www.integritymed.com)

After 23 years of brokering, refurbishing, selling, installing, and exporting both new and used diagnostic medical imaging equipment, I feel as though I’m a pretty good gauge of how the business looks currently, how it has changed over the past couple of decades, and where it is all headed.

I’ve sold refurbished/used CT, MRI, PET, PET/CT, Digital Mammography, C-Arms, Nuclear Medicine Gamma Cameras, Bone Densitometers, Digital X-Ray, Ultrasound, PACS, CR, DR, Linear Accelerators, and a half dozen other types of medical equipment.

Instead of grand proclamations, I’d like to use this space to relate some anecdotes, tell some (true) stories, and impart whatever very small amount of wisdom I’ve accumulated after being “educated” in this ever challenging, always interesting medical equipment marketplace.

David