How is organized hospital medicine coping with the problem of post hospital transitions? By gradually dismantling the hospitalist model!

How is organized hospital viagra cialis online pharmacy pharmacy coping with the problem of post hospital transitions? By gradually dismantling the hospitalist model!

Yes, I said it. It won't sound so absurd after you read this article in a recent issue of The Hospitalist, especially the concluding paragraph:

The blurring of lines between outpatient and inpatient providers has created questions for hospitalists, too. For example, at what point does a hospitalist working much of the time in an outpatient clinic or skilled nursing facility no longer fit the traditional definition of a hospitalist? Does that detract from the doctor’s hospital duties?

Wachter and Goldman in their classic NEJM paper in 1996 coined the term hospitalist to describe a new practice model which was springing up out of the economic necessities of managed care. Economic advantages continued even after the pressures of managed care waned as ambulatory providers realized the added efficiency of avoiding the competing demands of the hospital. Now there are new economic realities. Will the new pressures for accountability across the transition from hospital to ambulatory care make the hospitalist model obsolete? That increasingly seems to be the opinion of many hospitalist leaders. I was surprised at the degree to which this idea was promoted at HM 2010 and it seems to be gaining traction.





Discontinuity between the hospital and the ambulatory side has always been the principal weakness of the hospitalitst model. It's so inherent in the model (in fact Bob Wachter has often said that it was deliberately designed into it) that in the minds of some it can't be addressed without altering the model.





The idea of a post discharge clinic run by hospitalists never made sense to me. Having the hospitalist see the recently discharged patient in clinic for one or two visits will not eliminate the hand off. It will only delay it by those one or two visits. The patients who are at greatest risk for readmission are those who are on a continuous, long term trajectory with their complex medical illnesses. The need for intensive follow up is ongoing, and one or two post hospital visits will not address the problem. The real fix needs to be on the ambulatory side.





As pressure to address the problem of readmissions increases the leadership of the Society of Hospital Medicine will have to take a more definitive stand on this issue. Will they support the preservation of the hospitalist model or allow it to unravel?

Viagra TV Commercials: Enough, Already!

THE FOLLOWING IS AN ENCORE TIM MOORE BLOG:

The FDA approved of the drug online pharmacy viagra thirteen years ago this week.

Designed to treat men with erectile dysfunction, mercifully shortened (pardon the pun) to “ED” for the sake of the incessant TV commercials. Of course, other drugs such as Cialis and Levitra arrived “shortly” thereafter, with the same…uh…mission.

When Pfizer first developed Sildenafil (the chemical name for Viagra), it was for the treatment of high blood pressure. Chemists found that although it had little effect on hypertension, it did cause a certain “side effect”. Company officials quickly saw the commercial “upside” of this new drug—and in two short years—a very quick time for the FDA to do anything, Viagra hit the market. Getting former Senator and presidential nominee Bob Dole to endorse the drug was a huge coup as well. The History.com website says that although unconfirmed, the drug was invented by…are you ready?: PETER DUNN and ALBERT WOOD. (Very funny)

OK…so this is really about the TV ads. Frankly, no matter how “subtle” they attempt to be, there is no escaping the innuendo—and parents across America are embarrassed on what seems like an hourly basis as they endure these spots while watching TV with their children. Even when they put Mom and Dad in side-by-side bathtubs, the implication is rather obvious.

I’m waiting for my 11 year old to ask me what E.D. is. Guess “that talk” will happen sooner than I had planned….thank you, pharmaceutical companies! What’s worse is watching TV with your teenage daughter when these ads come on. Of course, they have had to survive watching TV with men when feminine hygiene products are advertised.

For Viagra, at $8-$10 a pill, the first-year take alone was in the billions of dollars. So, do any of them really NEED to advertise? Stealing market share from each other means they must feel it’s necessary, but the onslaught of ads is getting to be a bit much.

Below is one of the more creative ads—but as you’ll see, the teenage girl-in-the-house makes it all so creepy (for all of us) Enjoy!



http://www.youtube.com/watch?v=dFuuHPkORsA

My advice is to have a supply of topic-changers handy whenever these spots come on TV. Having the remote in your hand to MUTE is a good idea , too. Let’s practice: When the TV man says: “Are you having trouble with….E.D.?”, you:

a) Hit the MUTE button and
b) Say, “hey, how ‘bout them Red Sox?”

Good luck!

If you’d like my blog in your inbox daily, just let me know. It won’t cure E.D., but it is FREE….and that’s “hard” to beat! (ahem) tim.moore@citcomm.com

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Let's try Vigamed

One fellow with similar problems than me, drop a comment in this blog some days ago, and I’ve had the opportunity of have a little message exchange with him through a website we have in common.  I’ve tried order cialis, a  PDE-5 inhibitor, but in my case is useless because my anxiety blocks the desire and the excitement. His advices have been very good, and he discovered me this medicaments named Vigamed, so I’m gonna give it a try and see what happens. Maybe all my problems are in my head, but if I never feel like if “sex” is something that I’m able to do… the anxiety is gonna be always present in my mind at that moment.

Vigamed (phentolamine mesylate) can help to alleviate sexual dysfunction symptoms such as impotence, and ejaculatory failures. Phentolamine as an alternative to Viagra, cialis, Levitra and Uprima has met with success with many men suffering from ED. Phentolamine works by directly or indirectly addressing the blood flow to the genitalia via several different biologic pathways. Two physiological systems, the sympathetic and the parasympathetic, play a role in sexual response. Phentolamine controls the erection process through the body’s sympathetic system allowing blood to flow into the penis to form an erection. 

Vigamed vs Viagra: The ability to control erectile performance via the body’s sympathetic system can speed up the erection process. Alpha adrenergic blockers, such as Vasomax (phentolamine mesylate), can produce an effect in as little as 15 to 20 minutes.  Viagra works to inhibit the enzyme phosphodiesterase, this process generally takes one hour or more.

I’ve seen some websites where the people says that it works.

I’ve bought it in an online pharmacy, it should be here in 7 days or something like that. Once I have it in my hands, I’ll trace a plan for test it … and of course I’ll explain here the result