Facts About Heart Transplant

Heart transplant surgeries are a life-saving procedure for several people these days. People with diseased or weak hearts can lead a life like normal people. Their hearts can normally work after the transplantation.

In this procedure, the patient’s damaged heart is substituted with the donor’s healthy heart. The donor can either be a dead person or a patient whose brain is dead. You, of course, require their family’s consent to get the heart.

It is not a small surgery. A lot of things come around with it. That is why people have many myths and curiosities.

So, to quench your thirst for curiosities, we have brought the eight most important things that you must know about heart transplants.

Age is no barrier for heart transplants

There is no such age limit for a heart transplant. Even young children might suffer from a diseased heart and require heart transplantation. People in their old age, like the ’70s or ’80s, also get this surgery. Like the people in their twenties or thirties, the younger generation has also gone through heart transplant surgery. So there are no specific age criteria for heart transplantation.

You can lead a normal life after the transplant

The most important question is would the patient be normal after the transplantation? The survival chances after heart transplant surgeries have improved over the years. You can give birth to babies, normally work in your office, go on a vacation and do anything you want. You have to be a little careful that you do not exert much exertion.

The donor’s previous illness does not matter

If your heart’s donor was suffering from a fatal disease, it does not make a difference till his heart is healthy. You could borrow his heart even if he had kidney problems, viral disease, or any other illness apart from heart disease, for that matter.

Posttransplantation care is the root of a healthy life

The patient is a little fragile for the first six months after the transplantation. Therefore, they require extra care and monitoring. A special diet, regular check-ups, medications, everything has to be monitored. There will be some medicines that will go on for a lifetime. So, you will have to take care that you give them to your loved ones from time to time.

More than one organ transplantation is possible

A lot of heart transplant patients also have kidney damage. Therefore, the medical industry allows two or more organs to be transplanted. First, the heart is transplanted, and after a day or two, the second organ is transplanted.

Just physical care is not enough

Remember that a patient went through a heart transplant surgery because he was in immense pain. That pain has, of course, left him in a devastating condition, not just physically but also mentally. So, it becomes your utmost duty to support your loved ones mentally. They will gradually get over their physical pain, but it becomes your duty to improve their condition mentally.

Everyone has a different resistance strength

The fact that someone else’s heart is inserted changes the body. Everyone has a different resistance to a new heart. Each patient’s journey is different from how their bodies react to the new heart. Hence, you should not be influenced by someone else’s heart transplant journey. Some bodies accept the new heart immediately, while some never accept it.

The doctor might only consider a heart transplant if all other therapies have failed

Even if there is a little-bit ray of hope through another treatment or therapy, the doctor will not go for the transplant. Instead, the doctors choose this remedy when there is no other option left. And not just one doctor will decide it, but you need two or more consents to go ahead with a heart transplant surgery.

These were all the important points you must know regarding Heart transplant surgery. Always remember that panicking will not lead you anyway. So, please do not pay much attention to the myths regarding the surgery. Never get influenced by anybody else’s experience. You are supposed to make sure you stay calm and make the most crucial decision for yourself and your loved ones.

Pulmonology is a branch of medicine and a subspecialty of internal medicine. It specialises in the treatment of diseases that affect the respiratory system. It deals with all disorders of the lungs, upper airways, thoracic cavity, and the chest wall. It also deals with all problems that involve the nose, pharynx, larynx, trachea, bronchi, bronchioles, and alveoli.

Pulmonology is also part of intensive care medicine because it involves providing life support and mechanical ventilation to patients who need them. It is also known as pneumology and respiratory medicine. Its subspecialties include:

• Interstitial lung disease, which focuses on lung diseases caused by lung inflammation and scarring
• Interventional pulmonology, which deals with airway disorders, lung cancer, and pleural diseases
• Neuromuscular disease, which focuses on lung disorders caused by respiratory muscle failure
• Obstructive lung disease, which focuses on conditions caused by the narrowing or obstruction of the airways
• Lung transplantation
• Sleep-related breathing problems
• Paediatric pulmonology

What is pulmonology?

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Internal medicine is the type of medical care that deals with adult health, and pulmonology is one of its many fields. Pulmonologists focus on the respiratory system and diseases that affect it. The respiratory system includes your:

• Mouth and nose
• Sinuses
• Throat (pharynx)
• Voice box (larynx)
• Windpipe (trachea)
• Bronchial tubes
• Lungs and things inside them like bronchioles and alveoli
• Diaphragm

History of pulmonology

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One of the first major discoveries relevant to the field of pulmonology was the discovery of pulmonary circulation. Originally, it was thought that blood reaching the right side of the heart passed through small ‘pores’ in the septum into the left side to be oxygenated, as theorized by Galen; however, the discovery of pulmonary circulation disproves this theory, which had previously been accepted since the 2nd century. Thirteenth-century anatomist and physiologist Ibn Al-Nafis accurately theorized that there was no ‘direct’ passage between the two sides (ventricles) of the heart. He believed that the blood must have passed through the pulmonary artery, through the lungs, and back into the heart to be pumped around the body. This is believed by many to be the first scientific description of pulmonary circulation.

Although pulmonary medicine only began to evolve as a medical specialty in the 1950s, William Welch and William Osler founded the ‘parent’ organization of the American Thoracic Society, the National Association for the Study and Prevention of Tuberculosis. The care, treatment, and study of tuberculosis of the lung is recognised as a discipline in its own right, phthisiology. When the specialty did begin to evolve, several discoveries were being made linking the respiratory system and the measurement of arterial blood gases, attracting more and more physicians and researchers to the developing field.

Types Of Disease

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Lung Disease

Airway diseases — These diseases affect the tubes (airways) that carry oxygen and other gases into and out of the lungs. They usually cause a narrowing or blockage of the airways. Airway diseases include asthma, chronic obstructive pulmonary disease (COPD), bronchiolitis, and bronchiectasis (which also is the main disorder for persons with cystic fibrosis). People with airway diseases often say they feel as if they’re “trying to breathe out through a straw.”

Lung tissue diseases — These diseases affect the structure of the lung tissue. Scarring or inflammation of the tissue makes the lungs unable to expand fully (restrictive lung disease). This makes it hard for the lungs to take in oxygen and release carbon dioxide. People with this type of lung disorder often say they feel as if they are “wearing a too-tight sweater or vest.” As a result, they can’t breathe deeply. Pulmonary fibrosis and sarcoidosis are examples of lung tissue disease.

Lung circulation diseases — These diseases affect the blood vessels in the lungs. They are caused by clotting, scarring, or inflammation of the blood vessels. They affect the ability of the lungs to take up oxygen and release carbon dioxide. These diseases may also affect heart function. An example of a lung circulation disease is pulmonary hypertension. People with these conditions often feel very short of breath when they exert themselves.

Asthma

Asthma is a condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath.

For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.

Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust your treatment as needed.

Pulmonary fibrosis

Pulmonary fibrosis is a lung disease that occurs when lung tissue becomes damaged and scarred. This thickened, stiff tissue makes it more difficult for your lungs to work properly. As pulmonary fibrosis worsens, you become progressively more short of breath.

The scarring associated with pulmonary fibrosis can be caused by a multitude of factors. But in most cases, doctors can’t pinpoint what’s causing the problem. When a cause can’t be found, the condition is termed idiopathic pulmonary fibrosis.

The lung damage caused by pulmonary fibrosis can’t be repaired, but medications and therapies can sometimes help ease symptoms and improve quality of life. For some people, a lung transplant might be appropriate.

Pneumonia

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.

Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It’s typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.

Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions usually occur together and can vary in severity among individuals with COPD.

Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It’s characterized by daily cough and mucus (sputum) production.

Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter.

Although COPD is a progressive disease that gets worse over time, COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.

Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells. Radiation therapy most often uses X-rays, but protons or other types of energy also can be used.

The term “radiation therapy” most often refers to external beam radiation therapy. During this type of radiation, the high-energy beams come from a machine outside of your body that aims the beams at a precise point on your body. During a different type of radiation treatment called brachytherapy (brak-e-THER-uh-pee), radiation is placed inside your body.

Radiation therapy damages cells by destroying the genetic material that controls how cells grow and divide. While both healthy and cancerous cells are damaged by radiation therapy, the goal of radiation therapy is to destroy as few normal, healthy cells as possible. Normal cells can often repair much of the damage caused by radiation.

Why it’s done

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More than half of all people with cancer receive radiation therapy as part of their cancer treatment. Doctors use radiation therapy to treat just about every type of cancer. Radiation therapy is also useful in treating some noncancerous (benign) tumors.

How radiation therapy is used in people with cancer?

Your doctor may suggest radiation therapy as an option at different times during your cancer treatment and for different reasons, including:

• As the only (primary) treatment for cancer
• Before surgery, to shrink a cancerous tumor (neoadjuvant therapy)
• After surgery, to stop the growth of any remaining cancer cells (adjuvant therapy)
• In combination with other treatments, such as chemotherapy, to destroy cancer cells
• In advanced cancer to alleviate symptoms caused by the cancer

How you prepare

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Before you undergo external beam radiation therapy, your health care team guides you through a planning process to ensure that radiation reaches the precise spot in your body where it’s needed. Planning typically includes:

• Radiation simulation. During simulation, your radiation therapy team works with you to find a comfortable position for you during treatment. It’s imperative that you lie still during treatment, so finding a comfortable position is vital. To do this, you’ll lie on the same type of table that’s used during radiation therapy. Cushions and restraints are used to position you in the right way and to help you hold still. Your radiation therapy team will mark the area of your body that will receive the radiation. Depending on your situation, you may receive temporary marking with a marker or you may receive small permanent tattoos.
• Planning scans. Your radiation therapy team will have you undergo computerized tomography (CT) scans to determine the area of your body to be treated.

After the planning process, your radiation therapy team decides what type of radiation and what dose you’ll receive based on your type and stage of cancer, your general health, and the goals for your treatment.

The precise dose and focus of radiation beams used in your treatment is carefully planned to maximize the radiation to your cancer cells and minimize the harm to surrounding healthy tissue.

What you can expect

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External beam radiation therapy is usually conducted using a linear accelerator — a machine that directs high-energy beams of radiation into your body.

As you lie on a table, the linear accelerator moves around you to deliver radiation from several angles. The linear accelerator can be adjusted for your particular situation so that it delivers the precise dose of radiation your doctor has ordered.

You typically receive external beam radiation on an outpatient basis five days a week over a certain period of time. In most instances, treatments are usually spread out over several weeks to allow your healthy cells to recover in between radiation therapy sessions.

Expect each treatment session to last approximately 10 to 30 minutes. In some cases, a single treatment may be used to help relieve pain or other symptoms associated with more-advanced cancers.

During a treatment session, you’ll lie down in the position determined during your radiation simulation session. You might be positioned with molds to hold you in place.

The linear accelerator machine may rotate around your body to reach the target from different directions. The machine makes a buzzing sound.

You’ll lie still and breathe normally during the treatment, which takes only a few minutes. For some patients with lung or breast cancer, you might be asked to hold your breath while the machine delivers the treatment.

Your radiation therapy team stays nearby in a room with video and audio connections so that you can talk to each other. You should speak up if you feel uncomfortable, but you shouldn’t feel any pain during your radiation therapy session.

Results

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If you’re receiving radiation to a tumor, your doctor may have you undergo periodic scans after your treatment to see how your cancer has responded to radiation therapy.

In some cases, your cancer may respond to treatment right away. In other cases, it may take weeks or months for your cancer to respond. Some people aren’t helped by radiation therapy.

The rest of the professional world might have embraced “continuous professional development” a decade or so ago, but it has always been a necessity for the medical professionals.

Billions are spend every year in lectures, seminars, conferences, training programs and related materials for keeping doctors and hospital staff up to date with the latest developments and technologies.

Those are not just for career advancement, as is often the case in other industries, but are demanded by law as a means for medical professionals to maintain their clinical competence.

Such laws can vary by country and specialty (with Arizona, for example, requiring an average of 40 hours of CME every two years, while some countries demand frequent re-certification for doctors and nurses to maintain their licenses).

eLearning technologies are a perfect fit for many aspects of continuing medical education, as they have lower costs, higher flexibility regarding time, require few resources and personnel to deploy, and can be easily updated as material changes.

eLearning is especially apt for situations were clinical or lab practice is not required, but with a capable learning management system it can also work alongside these, in a blended learning scenario.

Let’s see the benefits of E-Learning for CME one by one

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Cost

In today’s competitive medical landscape, spending tens of thousands of dollars (or millions, depending on your scale) on fancy training facilities and classrooms is a needless luxury. Factor in the cost of educators and the disruption in your clinic’s workflow due to the scheduling of classes and seminars, and it quickly adds up.

eLearning costs are comparatively trivial, costing less monthly for their overall operation than what it costs to send a single doctor to one of those frequent medical conferences. And, if you opt for a privately hosted or a public Cloud solution, you’ll be able to accommodate the training of tens to tens of thousands of doctors.

Time

As a healthcare professional or hospital manager, you know how precious a resource time is for doctors. Healthcare professionals are notoriously busy and overworked, and finding time for training can be problematic.

With eLearning, which is by nature asynchronous, doctors, nurses and other healthcare professionals can educate themselves at their own pace. And of course eLearning works remotely, enabling them to follow lessons from their office or home.

Updatability

Yes, that’s a word, and yes, it describes the ease with which you can update eLearning content perfectly.

And with techniques, medical theories and medical getting frequently outdated, new drugs being introduced all the time, and doctors having to learn to operate new (and very costly) equipment, you really want that updatability in your learning management system.

A modern LMS platform can trivially incorporate study material provided by the drug company or the medical equipment manufacturer, and of course all kinds of images, videos, visualizations and interactive animations.

This is especially important for medicine, where images and visualizations (x-rays, ECGs, ultrasounds, MRIs, anatomical diagrams and all kinds of scans, graphs and visuals) play a crucial role.

Accountability

eLearning can also be easily monitored, as it offers all the important feedback mechanisms (such as reporting and detailed statistics) to track the progress of individuals and teams and assess their performance.

For example, with the advanced reporting capabilities of our software, you can keep track of courses, groups of learners, or even specific individuals, and even automatically award specific certifications upon the successful completion of a course or a set of courses.

Onboarding

Another use of an eLearning management system in a medium or large medical facility is for employee orientation.

This is the task of introducing new hires to their working environment and giving them the basic information the need to start being productive.

This includes your hospital’s or clinic’s operating procedures, policies, restrictions and guidelines, as well as the ever more important education in professional ethics, and sexual and racial discrimination issues.

Conclusion

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eLearning is a perfect fit for a knowledge based profession such as medicine, where being kept up to date is not often crucial but a matter of life and death, time is a scarce resource, and competitiveness means you need to get maximum results with reduced costs.

If you work in a medical organization that hasn’t embraced eLearning yet, it’s not a question of “if” it will eventually embrace it, but of “when”. And that’s not just our opinion, but something that has been proven by the market: healthcare has been the industry with the most eLearning deployments in the US (followed by software and marketing companies).

What is a Cath Lab?

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The name cath lab sounds a little like something out of a science fiction movie. And in fact, the way that medical professionals use these spaces is a bit futuristic. Cath labs are used to treat patients with heart conditions minimally, without resorting to major surgeries or other invasive procedures. Your healthcare provider may recommend a test or treatment in the cath lab if they need to better understand the state of your heart.

Cath labs are an important part of treating heart conditions. A catheterization laboratory, or cath lab, is a procedural hospital room where minimally invasive tests and procedures are performed to diagnose and treat cardiovascular disease. The procedures performed in a cath lab involve tiny, flexible tubes called catheters which is where the name is derived from. These catheters can be used as an alternative to surgery to access the heart and blood vessels.

What are some reasons a patient would be sent to a cath lab by their care team?

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Cath labs are an important part of treating heart conditions. A doctor may send a patient to a cath lab to diagnose and treat coronary artery disease, heart attacks, chest pain, congestive heart failure, peripheral (limb) vascular disease, pulmonary hypertension and even pulmonary embolisms, also known as blood clots.

Inside the cath lab, interventional cardiologists work with a team of nurses, procedural X-ray technicians and other support staff to quickly evaluate cardiovascular conditions and treat blockages and other problems in the arteries.

Common cath lab procedures include

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• Cardiac coronary angiogram: This procedure evaluates the blood vessels supplying the heart using catheters and X-ray dye.
• Coronary stent placement: A procedure in which small metal scaffolds are placed within a blocked coronary artery to keep an artery open.
• Right heart catheterization: A procedure in which physicians examine blood flow and pressure filling in the right side of your heart
• Peripheral angiogram: A procedure that evaluates the flow of blood through arteries in the upper and lower extremities, similar to a coronary angiogram.
• Valve replacement: This minimally invasive procedure is done to implant an artificial valve in your heart to replace a narrowed heart valve.

Why do you need a cath lab?

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Cath lab is a crucial component of treating heart issues. A catheterisation laboratory, sometimes known as a cath lab, is a procedural hospital room where tests and operations with a low risk of infection are carried out to identify and treat cardiovascular illness.

Catheters are small, flexible tubes used in procedures carried out in a cath lab, hence the name. These catheters might be used instead of surgery to reach the heart and blood vessels.

Diagnostics & Imaging for Cardiac Set-up

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ECG, Echo, Ultrasound and Spirometer are the most common/basic diagnostic equipment available in all cardiac hospitals. Typical diagnostic equipment needed and related procedures that may be done in a cardiac facility are as follows:

• Electrocardiogram (ECG) for 12-lead resting, ambulatory and Stress ECG
• Echocardiography (Cardiac ultrasound) for transthoracic echocardiography (2D, 3D and Doppler echo), Contrast echocardiography, Transesophageal echocardiography, Stress echocardiography etc.
• Ultrasound – investigations of the blood vessels in the neck, arms and legs
• Spirometry to help diagnose and monitor certain lung conditions by measuring how much air one can breathe out in one forced breath.
• Cardiac CT for non-invasive angiography or vascular imaging
• Cardiac MRI
• TMT (Treadmill Test/ Stress Test system)

Equipment for Cardiac CathLab

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The most basic equipment required in a cardiac unit is the Cath Lab consisting of Angiography X-Ray system. All other advanced systems are used less frequently today in India and their usage depends on the case load and complexity being handled in the hospital.

• Cath Labs – A catheterization laboratory or cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found. Cath Labs are commonly used for coronary angiography and angioplasty procedures. Popular makes and models in Cath Labs are Philips Allura Xper FD20/10, Philips Allura FC 9, FD 10, Siemens Artis family (Artis Pheno, Axiom Artis, Artis Z, Artis U), Toshiba Infinix 8000, GE Innova, Optima and Discovery family products.
• Intravascular ultrasound (IVUS) for the sonographic visualization or OCT (Optical Coherence Tomography) for Optical Visualization of coronary stenosis. Main IVUS makers are Boston Scientific, Volcano Therapeutics and Terumo. Abbots (St Jude Medical) OCT is popular.
• Intracoronary pressure measurements or Fractional Flow Reserve (FFR) using pressure wires, which is used as an assessment of the severity of coronary stenosis. Cardiac CTs are also getting popular for FFR measurements in a non-invasive manner. Both GE and Siemens have Cardiac CTs.
• Ablation devices such as Excimer laser for the removal of scar tissue as part of device lead extraction procedures involving pacemakers and ICD devices or Rotablator for atherectory (An atherectomy is a procedure that utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel)
• Electrophysiology systems for the invasive diagnosis and treatment of cardiac arrhythmias
• 3D mapping systems allowing precise visualization and 3D guidance during procedures to treat complex cardiac arrhythmias and pulmonary vein isolation
• Robotic navigation system used in the treatment of complex cardiac arrhythmias and pulmonary vein isolation
• Fibrillator

CVTS – Operating Room

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• Cardiopulmonary bypass – Heart and lung machine or Mini extracorporeal circuit cardiopulmonary (MECC) bypass machine
• Intra-aortic balloon pump (IABP)
• OT Table, OT Light, Anesthesia workstation and Cautery machine

Cardiac Intensive care Unit

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• Ventilators
• Patient monitors
• Hemodynamic monitoring and management
• Dialysis
• Defibrillator

VR is the use of software to create an immersive simulated environment. Unlike traditional user interfaces, to experience VR, users put on head-mounted display (HMD) which places the user inside an experience, where they can engage with the environment and virtual characters in a way that feels real. VR has a unique power, more than any other technology that has ever existed, to make users believe they are in a different environment. This allows them to learn from experience as they would do in real life. This ability to deliver experiences on demand is where the power of VR lies.

Virtual reality in healthcare uses computer-generated technology for several healthcare applications, like providing virtual medical training to students and doctors or carrying out diagnoses, and many others.

There have been a lot of talks and discussions about the use of VR in the healthcare industry, with numerous applications of virtual reality already being implemented in healthcare. Applications such as robotic surgery, healthcare devices, etc. are slowly gaining popularity and are now more likely to be adopted by various healthcare organizations and accepted by the people. In this article we have talked about virtual reality and its applications in healthcare.

Applications of Virtual Reality in Healthcare

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Medical Training

Virtual reality medical training is a modern method of training specialists in healthcare. This technology allows users to experience various scenarios in virtual surroundings. For example, users can immerse themselves by seeing a virtual human body from various angles and scales. Thanks to this, students and interns can train interactively at a higher level, while doctors can polish their professional skills.

VR is a technology that generates a virtual environment with an immersive effect. It is presented via a headset that includes VR glasses, headphones, and usually hand controllers for movement imitation, creating a sensation of reality. Therefore, users can experience situations they would never be able to in the real world because of physical limitations.

Virtual Reality in Diagnostics

VR is being used as a powerful diagnostic tool, which helps doctors and physicians to carry out accurate diagnosis. This is done in combination with other methods, such as MRI/CT scans, and eliminates the need for any kind of invasive techniques, making it a pain-free experience for the patient.

Mental Illness Treatment

Exposure therapy is one of the standard procedures for treating different types of mental illness. VR is slowly changing the way exposure therapy is being carried out for mentally ill patients, by providing a low cost, flexible and low-risk solution to treat mental illnesses. By providing new ways to keep the body relaxed and calm, VR also helps in treating anxiety and panic attacks.

Pain Management

Cognitive distraction methods have been used by physicians to treat different types of pain for a long time now. VR provides a new face to these distraction methods by providing various interactive games. These games are played in a simulated environment and are loaded with interactive features. While some apps provide therapeutic VR for burn victims, there are also significantly advanced measures that facilitate efficient limb pain management. Furthermore, VR serves as a drug-free pain management alternative, which can be used with or without clinical care settings.

Physical Fitness and Therapy

The fitness industry is experiencing a huge change in the way exercises are carried out today. Many startups in the industry are combining cardio routines with VR and changing the way we exercise. Stepping further, VR also has a major role in physical therapy, where patients are subjected to an exercise routine that incorporates VR instead of drugs or invasive surgeries.

Human Simulation Techniques

VR is very helpful in various human simulation techniques and enables doctors, physicians, nurses, and other medical professionals to interact with others. They can engage in different training sessions and interact with a patient, but only in a 3D environment. This is an immersive experience which determines the emotions of the participant using a series of sensors.

Every day, oral healthcare providers must synthesize patient data such as intra- and extraoral exams, radiographs, clinical images and oral histories to develop treatment options. From there, a shared decision-making process between provider and patient serves to define the treatment plan, but the quality of the data and our ability to communicate and educate helps to inform patients’ decisions and shape the treatment path. The process of collecting patient data, documenting the clinical situation and planning treatment has been impacted by several key technologies.

The use of technology is no different. Tech advancement is usually created out of a need or a pain that is being addressed. As such, it is positioned to address those.

However, as you know, in life you cannot get anything without sacrificing something else. In the case of technology, you will be sacrificing both time and money. Time to learn the technology and its application and money to purchase the rights to use it ahead of your counterparts. This short article aims to put this sensitive balance in perspective and help you determine which technologies fit who you want to be as a dentist.

Considering the fallout of the COVID pandemic that is running rampant throughout the world, you have probably been exposed to hundreds of tech solutions that are being pushed with an increased sense of urgency. Having said that, the key is to remember that technology must enable your vision and purpose for your patients and not the other way around. The most important aspect of technology adoption is the understanding of the value received versus the price paid for the service.

We, understand that your ability to use the latest technology requires you to not only accept the cost of it, but to also ensure that you and your team are properly trained in using the new technology. It is imperative that you understand the benefits of pivotal technology and build it into your clinic plan. As we dive into the 3 main technologies to take advantage of in 2021.

Digital Impressions

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Traditional impressions have been one of the most obnoxious activities a patient can have in a dental clinic. A patient cannot have a positive experience in a clinic, if the impression material is sliding down their throat. Now that you had this unpleasant feeling We urge you to join the “digital dentistry” movement and ensure that you are working in a clinic that offers digital impressions and is incorporating digital tools to remove awkward experiences for patients.

We have rev  switched clinics. Not because they were performing bad dentistry, but because they were not using the most advanced tools to ensure my comfort. If no one is going to educate patients in your vicinity, you will be safe. However, I can guarantee that there are passionate and driven dentists in your vicinity who are planning and implementing strategies to win over these patients through education.

As the cheapest technology piece in this article, I can confidently say that the long-term benefits of having it outweigh the cost of both the system and the training required. In time, digital impression will become a standard of practice. Until then, you have the option of leveraging it towards building a strong patient base with patient comfort at the forefront.

Laser – Minimally Invasive Dentistry

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Minimally invasive dentistry (using a laser) has been around for quite a while now. The composers of this technology have failed to penetrate the market to the point of laser use becoming mainstream. Without getting into the politics of why that is, we like to urge you to explore this technology. The ability to treat conditions in a minimally invasive way with tools that are better than your metal instrument is another option you can offer your patients for conditions you traditionally just “watch”.

Considering that there are two main types of laser (soft and hard tissue), it is imperative you leverage industry training to ensure you profoundly understand this technology ahead of making it a unique provisioned service in your clinic. The versatility of laser technology in the treatment of a myriad of conditions is enough of an incentive to make it attractive to any young dentist in today’s industry.

As mentioned above, there are both soft and hard tissue lasers, which are grouped by their frequency. As you consider this technology, it is imperative you select the right vendor and the appropriate type of laser and education. This path requires a substantial investment as laser technology rapidly changes, but you can compensate for it by providing a wider array of services to your patients.

Digital Radiography

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Digital capture of intraoral radiographs is simple, predictable and, just like loupes, has changed world. From the elimination of chemicals to the instant gratification of digital sensors and the ability optimize views on a large viewing monitor, digital radiography allows you to better diagnose potential problems. It is almost hard to believe that we were capable of appreciating early carious lesions on the small film we used to use!

Digital Scanning

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The most recent technology is digital scanning. When combined with the electronic record, digital images and digital radiography, we can now not only educate patients about what their current situation is, but also show how we can address their complaints and even plan/predict the final outcome. For orthodontic, crown and bridge, and implant cases, we utilize digital scanning not only to plan treatment but also for communication between providers and laboratory technicians.

Digital Records

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Perhaps it is because you run a software company that specializes in dental electronic records. Unfortunately, there are (too) many clinics that are still using paper charts for record keeping. After using a paper chart for over 20 years, electronic charts will be quick and efficient to document the patient’s needs. Having said that, the management and administration of recommended treatment through paper charts is a complete disaster.

If you are still reading, you agree that maintaining digital records is the way to go. Although this is true, and although colleges create a strict and clear outline of how records should be kept in a digital form, looking at the reality of record keeping, it appears that much is left to interpretation.

Digital X-Rays

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There is much research out there with regards to digital radiations. Even if you prefer to take additional images, it will expose the patient to less radiation versus traditional x-ray equipment. The ability to have more angles of x-ray, while not exposing the patient to additional radiation, increases the probability rate of the acceptance and success of the proposed treatment. On top of digital x-rays, it is important to mention intra-oral images and fluorescent light images. Using these tools, you are better equipped to help patients with prevention of dental conditions.

Digital Charts

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Let’s face it, you are looking for a quick way to document what you must so that you are able to continue caring for the patient. The problem is that the paper never translates into a database that easily. There is a substantial amount of manual entry by the existing administration team. Once you have transformed the information into digital patient files, you are able to continue and leverage the digital platform to create the appropriate treatment plan for the individual in question.

Mouth cancer refers to cancer that develops in any of the parts that make up the mouth (oral cavity). Mouth cancer can occur on the:

• Lips
• Gums
• Tongue
• Inner lining of the cheeks
• Roof of the mouth
• Floor of the mouth (under the tongue)

Cancer that occurs on the inside of the mouth is sometimes called oral cancer or oral cavity cancer.

Mouth cancer is one of several types of cancers grouped in a category called head and neck cancers. Mouth cancer and other head and neck cancers are often treated similarly.

Causes

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Tobacco and alcohol use. Tobacco use of any kind, including cigarette smoking, puts you at risk for developing oral cancers. Heavy alcohol use also increases the risk. Using both tobacco and alcohol increases the risk even further.

HPV. Infection with the sexually transmitted human papillomavirus (specifically the HPV 16 type) has been linked to oral cancers.

Age. Risk increases with age. Oral cancers most often occur in people over the age of 40.

Sun Exposure. Cancer of the lip can be caused by sun exposure.

Symptoms

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If you have any of these symptoms for more than two weeks, see a dentist or a doctor.

• A sore, irritation, lump or thick patch in your mouth, lip, or throat.
• A white or red patch in your mouth.
• A sore throat or a feeling that something is caught in your throat.
• Difficulty chewing, swallowing, or speaking.
• Difficulty moving your jaw or tongue.
• Swelling of your jaw that causes dentures to fit poorly or become uncomfortable.
• Numbness in your tongue or other areas of your mouth.
• Ear pain.

Diagnosis

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Tests and procedures used to diagnose mouth cancer include:

Physical exam. Your doctor or dentist will examine your lips and mouth to look for abnormalities — areas of irritation, such as sores and white patches (leukoplakia).

Removal of tissue for testing (biopsy). If a suspicious area is found, your doctor or dentist may remove a sample of cells for laboratory testing in a procedure called a biopsy. The doctor might use a cutting tool to cut away a sample of tissue or use a needle to remove a sample. In the laboratory, the cells are analyzed for cancer or precancerous changes that indicate a risk of future cancer. Determining the extent of the cancer

Once mouth cancer is diagnosed, your doctor works to determine the extent (stage) of your cancer. Mouth cancer staging tests may include:

Using a small camera to inspect your throat. During a procedure called endoscopy, your doctor may pass a small, flexible camera equipped with a light down your throat to look for signs that cancer has spread beyond your mouth.

Imaging tests. A variety of imaging tests may help determine whether cancer has spread beyond your mouth. Imaging tests may include X-ray, CT, MRI and positron emission tomography (PET) scans, among others. Not everyone needs each test. Your doctor will determine which tests are appropriate based on your condition.

Mouth cancer stages are indicated using Roman numerals I through IV. A lower stage, such as stage I, indicates a smaller cancer confined to one area. A higher stage, such as stage IV, indicates a larger cancer, or that cancer has spread to other areas of the head or neck or to other areas of the body. Your cancer’s stage helps your doctor determine your treatment options.

Treatment

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Treatment for mouth cancer depends on your cancer’s location and stage, as well as your overall health and personal preferences. You may have just one type of treatment, or you may undergo a combination of cancer treatments. Treatment options include surgery, radiation and chemotherapy. Discuss your options with your doctor.

Surgery

Surgery for mouth cancer may include:

• Surgery to remove the tumor.Your surgeon may cut away the tumor and a margin of healthy tissue that surrounds it to ensure all of the cancer cells have been removed. Smaller cancers may be removed through minor surgery. Larger tumors may require more-extensive procedures. For instance, removing a larger tumor may involve removing a section of your jawbone or a portion of your tongue.
• Surgery to remove cancer that has spread to the neck.If cancer cells have spread to the lymph nodes in your neck or if there’s a high risk that this has happened based on the size or depth of your cancer, your surgeon may recommend a procedure to remove lymph nodes and related tissue in your neck (neck dissection). Neck dissection removes any cancer cells that may have spread to your lymph nodes. It’s also useful for determining whether you will need additional treatment after surgery.
• Surgery to reconstruct the mouth.After an operation to remove your cancer, your surgeon may recommend reconstructive surgery to rebuild your mouth to help you regain the ability to talk and eat. Your surgeon may transplant grafts of skin, muscle or bone from other parts of your body to reconstruct your mouth. Dental implants also may be used to replace your natural teeth.

Surgery carries a risk of bleeding and infection. Surgery for mouth cancer often affects your appearance, as well as your ability to speak, eat and swallow.

You may need a tube to help you eat, drink and take medicine. For short-term use, the tube may be inserted through your nose and into your stomach. Longer term, a tube may be inserted through your skin and into your stomach.

Your doctor may refer you to specialists who can help you cope with these changes.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells. Radiation therapy is most often delivered from a machine outside of your body (external beam radiation), though it can also come from radioactive seeds and wires placed near your cancer (brachytherapy).

Radiation therapy is often used after surgery. But sometimes it might be used alone if you have an early-stage mouth cancer. In other situations, radiation therapy may be combined with chemotherapy. This combination increases the effectiveness of radiation therapy, but it also increases the side effects you may experience. In cases of advanced mouth cancer, radiation therapy may help relieve signs and symptoms caused by the cancer, such as pain.

The side effects of radiation therapy to your mouth may include dry mouth, tooth decay and damage to your jawbone.

Your doctor will recommend that you visit a dentist before beginning radiation therapy to be sure your teeth are as healthy as possible. Any unhealthy teeth may need treatment or removal. A dentist can also help you understand how best to care for your teeth during and after radiation therapy to reduce your risk of complications.

Chemotherapy

Chemotherapy is a treatment that uses chemicals to kill cancer cells. Chemotherapy drugs can be given alone, in combination with other chemotherapy drugs or in combination with other cancer treatments. Chemotherapy may increase the effectiveness of radiation therapy, so the two are often combined.

The side effects of chemotherapy depend on which drugs you receive. Common side effects include nausea, vomiting and hair loss. Ask your doctor which side effects are likely for the chemotherapy drugs you’ll receive.

Targeted drug therapy

Targeted drugs treat mouth cancer by altering specific aspects of cancer cells that fuel their growth. Targeted drugs can be used alone or in combination with chemotherapy or radiation therapy.

Cetuximab (Erbitux) is one targeted therapy used to treat mouth cancer in certain situations. Cetuximab stops the action of a protein that’s found in many types of healthy cells, but is more prevalent in certain types of cancer cells. Side effects include skin rash, itching, headache, diarrhea and infections.

Other targeted drugs might be an option if standard treatments aren’t working.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy treatments are generally reserved for people with advanced mouth cancer that’s not responding to standard treatments.

The term “stenosis” is derived from Greek and refers to the process of narrowing that constricts or “chokes” the spinal nerves. The cause of spinal stenosis in the lumbar spine (lower back) is commonly associated with degenerative changes, also known as spondylosis, that occur as a result of aging.

Lumbar spinal stenosis is a common cause of low back and leg pain, or sciatica.

As we age, the normal wear-and-tear effects of aging can lead to narrowing of the spinal canal, which houses the spinal nerves and spinal cord. This condition is called spinal stenosis.

Degenerative changes of the spine are seen in up to 95% of people by the age of 50. Spinal stenosis most often occurs in adults over 60. Pressure on the nerve roots is equally common in men and women.

A small number of people are born with back problems that develop into lumbar spinal stenosis. This is known as congenital spinal stenosis. Typically, this occurs in people who are born with a smaller spinal canal; because there is less space within the canal, degeneration, or arthritis, can affect them sooner. Congenital spinal stenosis occurs most often in men. People usually first notice symptoms between the ages of 30 and 50.

Spinal stenosis occurs when the space around the spinal cord and spinal nerves narrows. This puts pressure on the spinal cord and the spinal nerve roots, and may cause pain, numbness, or weakness in the legs.

Arthritis is the most common cause of spinal stenosis. Arthritis refers to degeneration of any joint in the body.

In the spine, arthritis can result as the disk degenerates and loses water content. In children and young adults, disks have high water content. As we get older, our disks begin to dry out and weaken. This problem causes settling, or collapse, of the disk spaces and loss of disk space height.

As the spine settles, two things occur. First, stress is transferred to the facet joints. Second, the tunnels through which the nerves exit (the foramen) become smaller.

As the facet joints experience increased pressure, they also begin to degenerate and develop arthritis, similar to that occurring in the hip or knee joint. As the facet joint wears down, the body responds by forming bone spurs to stabilize the joint. In addition, the ligaments around the joints that typically connect the bones together, called the ligamenta flava, increase in size. The combination of bone spurs and thickened ligaments crowds the space for the nerves, resulting in stenosis.

Symptoms

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• Back pain. People with spinal stenosis may or may not have back pain, depending on the degree of arthritis that has developed.
• Burning pain in buttocks or legs (sciatica). Pressure on spinal nerves can result in pain in the areas that the nerves supply. The pain may be described as an ache or a burning feeling. It typically starts in the area of the buttocks and radiates down the leg. As it progresses, it can result in pain in the foot.
• Numbness or tingling in buttocks or legs. As pressure on the nerve increases, numbness and tingling often accompany the burning pain, although not all patients will have both burning pain, and numbness and tingling.
• Weakness in the legs or foot drop (difficulty lifting the front part of the foot).  Once the pressure reaches a critical level, weakness can occur in one or both legs. Some patients will have a foot drop, or the feeling that their foot slaps on the ground while walking.
• Acute cauda equina syndrome. This rare condition is considered a medical emergency that requires prompt treatment. If the compression of the nerves is severe, you can experience numbness in you private area and lose control of your bowel and/or bladder. You may also lose strength in your legs and not be able to walk. If these symptoms occur, you may need emergency surgery.

Who does spinal stenosis affect?

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Lumbar spinal stenosis primarily affects those over the age of 50. It has been shown that while nearly 50% of individuals over the age of 60 have lumbar spinal stenosis, not all cases require attention (Fritz et al., 2014). According to current research, there are three principal avenues that one can take to mitigate the degenerative condition that is known as spinal stenosis: physical therapy, epidural cortisone injections and decompressive surgery.

So I have spinal stenosis – what are my next steps?

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For patients with spinal stenosis ranging from mild to moderate, physical therapy is the common route chosen. Even with patients suffering from severe spinal stenosis, it is usually recommended that they try some physical therapy before considering surgery. long with physical therapy, treating spinal stenosis through the use of epidural cortisone injections has become quite common. Containing a glucocorticoid and an anaesthetic, the purpose of the injection is to relieve pain by reducing the inflammation caused by the closing of the spinal canal or lateral recesses. The final path that one can choose for treating spinal stenosis is through decompressive surgery. It has been shown that the effectiveness of this method is higher the more severe the case.

How can Physiotherapy help?

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Your physiotherapist can help determine which kind of stenosis you have (spinal or lateral).  They can provide you with education on your condition (including ways to help), some local manual therapy for your spine and corrective exercises to help improve your core strength and help you to move better.

Which exercises can I try to help?

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We’ve listed a few different exercises to help.  Some are for general mobility, some are for strength.  If you have pain with any of these exercises, then stop and speak with one of our physiotherapists in Markham to help you with symptom relief and to get you moving better.

Knee to Chest stretch

Start in a lying position

Bring one knee to chest and hold for 30 seconds.  Repeat for the other side.

Knee to chest exercise

Cat-Camel; Cat-Cow exercise

Start in a four-point position.

Arch your back in one direction then move into the opposite arch.  Continue to move from one position to the other.  Try 8-12 repetitions.  There is no need to hold at the end.  There should be NO pain or tingling going down your legs – if there is, discontinue this exercise.

Hip Abduction 

Lie on your side. Bend your bottom leg.  Keep the top leg straight.

Lift your leg up towards the ceiling.  Hold for 1-2 seconds at the top, control the lowering.

These exercises are for guidance only.  Discontinue if there is any discomfort with these exercises and contact your physiotherapist for a detailed assessment and alternative exercises.

A hospital is a healthcare facility that provides specialized medical and nursing care as well as medical supplies to patients. The most well-known form of the hospital is the general hospital, which usually carries an emergency department to handle urgent health issues such as fire and accident victims, as well as medical emergencies.

According to the hospital definition, a district hospital is usually the region’s primary healthcare facility, with a large number of intensive-care beds and extra beds for patients who need long-term care. Trauma centers, children’s hospitals, rehabilitation hospitals, hospitals, and seniors’ (geriatric) hospitals for coping with particular medical conditions such as psychiatric care are also examples of specialized hospitals and several other disease categories. When opposed to general hospitals, specialized hospitals can help save money on health care. Based on the source of revenue, hospitals are categorized as general, specialized, or government.

Types by Hospital size

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One of the most obvious categories for comparing types of hospitals is the size of the institution. Hospital size is categorized based on how many beds it contains. The definition of what makes a hospital small, medium or large can vary depending on who you ask, but generally the lines break down into groupings similar to this:

• Small hospitals contain fewer than 100 beds
• Medium hospitals contain between 100 to 499 beds
• Large hospitals contain at least 500 or more beds

Hospital size often corresponds to location. Rural hospitals tend to be much smaller, while larger hospitals generally only exist in urban areas. This shouldn’t come as a surprise—with a higher population density in urban areas, larger facilities are needed to accommodate the needs of the community.

Acute vs. Long-term care hospitals

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Another potential distinction is whether a hospital specializes in long-term care. To be clear, the vast majority of all hospitals provide acute care. This means that they primarily care for patients dealing with illnesses, diseases, injuries, surgeries, surgery recoveries, obstetric care, postnatal care and trauma.

Long-term hospitals (LTCH) are often certified as acute-care hospitals, but also specialize in patients who on average, stay more than 25 days and are usually transferred from the ICU or a critical care unit, according to the Centers for Medicare and Medicaid Services. These patients often have more than one serious condition, and sometimes need to be treated with respiratory therapy, pain management treatments or for trauma to the head. Long-term patients often improve with time and care and are able to return home.

For-Profit vs. Not-For-Profit vs. Government-owned hospitals

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Another potential differentiator between hospitals is the ownership structure. There are three primary options—For-profit, not-for-profit and publicly owned hospitals. Just over 51 percent of all registered hospitals are not-for-profit, according to the American Hospital Association. This means that they are not obligated to shareholders to earn profits—but that doesn’t mean they’re running a charity, either, as they need to remain financially viable. The biggest distinction is that excess funds typically remain in the hospital and can be invested in new technology, staff or research.

For-profit hospitals, on the other hand, are similar to other private businesses in that they are beholden to investors. Stakeholders demand a return on their investment, which can influence hospital operations. This means that there’s an increased pressure for for-profit hospitals to focus on efficiency in order lower costs. Some may concentrate on particularly profitable procedures and services in order to maximize profitability.

Publicly owned government hospitals are taxpayer-funded. In the U.S., these facilities are often associated with medical schools and do not have investors and quarterly profit projections to meet. That doesn’t mean budgets go out the window—there can still be challenges if public funding levels don’t keep up with patient demand and the needs of a facility.

Rural vs. urban hospitals

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As mentioned in the size section, rural hospitals tend to be smaller and often fewer than 100 beds. Even more limited are “critical access” hospitals, containing fewer than 25 beds and are located 35 or more miles from the nearest hospital. These small hospitals depend heavily on Medicaid and Medicare funding to remain viable.

Urban hospitals are generally larger and have more competition as they are in densely populated areas with multiple hospitals for patients to choose from. Because of this competition, many urban hospitals specialize, either offering more versatility in treatment options and patient-experience perks.

Teaching vs. non-teaching hospitals

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Teaching hospitals are affiliated with a university, medical schools or nursing schools. Interns, students and fellows work and learn at teaching hospitals while being supervised by qualified physicians, department leaders and other medical staff.

Non-teaching hospitals serve only the local community and don’t partner with any universities or medical schools. Does this make them better than teaching hospitals? Not necessarily. Teaching hospitals tend to treat sicker patients in order to provide more experiences to the students. Often these hospitals conduct academic medical research and have patients that take part in clinical trials designed to determine the effectiveness of new treatments. This can have a skewing effect on patient outcomes—many clinical trial participants seek out these less-proven treatments because their other options may be limited.

A teaching hospital may be a rewarding setting for experienced hospital staffers. Matthew Thomson RN, BSN, CCRN of The RN Mentor, has worked at two academic medical centres and says he loves the culture.

“What I enjoy the most about academic medical centres is the focus on learning,” Thomson says. “Attending physicians know that they are teaching the next generation of doctors. There’s a culture of mutual learning and respect.”

Federal hospitals vs. State and local hospitals

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This classification of government-run public hospitals is based on where the funding comes from.  Federal hospitals are run and funded by the federal government include mostly Veterans’ Administration hospitals and clinics. The Department of Defense and the Department of Health and Human Services also run federally funded hospitals, but these hospitals aren’t commonly found in most communities.

Some hospitals are operated and funded by local state or county governments. These hospitals rely primarily on funding from local governments—though federal money via grants, Medicare and Medicaid payments certainly is part of their budget. These facilities are highly dependent on local funding—so they’ve seen some strain in states facing tough financial times.

Types of hospitals: Independent vs. hospitals in a system

Many hospitals are a part of a system that can include one or multiple hospitals and several clinics and separate specialized facilities. This allows for more comprehensive outpatient care once a patient leaves the hospital or emergency room. Independent hospitals that are not a part of a system are becoming rare as mergers are becoming more common.

Independent hospitals and hospitals in a system can both be a part of a healthcare network— a group of healthcare facilities, physicians, insurers, agencies and others that work together to coordinate services. Though they have separate administration systems, they collaborate for the community’s benefit.

Trauma levels hospitals

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In addition to being classified by funding and function, hospitals are also evaluated based on their readiness to treat trauma resulting from accidents, falls, gunshot wounds or other massive injuries. Though criteria for the trauma categories vary from state to state, there are common denominators. Let’s take a look at the polar ends of the trauma center scale to get a better idea of what these designations mean.

Level I trauma centers can provide total care, from prevention through rehab, for traumatic injuries. They provide 24-hour in-house coverage by general surgeons, and specialists like orthopedic surgeons, neurosurgeons, plastic surgeons, anesthesiologists and other critical-care providers. The hospital has to meet a minimum requirement of seriously injured patients in their care each year. In addition to providing top notch and prompt care, they also provide public education and leadership in prevention while being a referral resource for community members in the area, according to the American Trauma Society.

On the other end of the trauma center spectrum, Level-V centers can provide initial evaluation, stabilization and diagnostic capabilities by one or more trauma nurses and physicians before transferring patients, if needed, to Levels I through III trauma centers that they have agreements with. Level-V centers may be able to provide surgery and critical-care services, but it is not guaranteed.

Specialty hospitals

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Outside of these primary categorizations, there are many other types of hospitals, usually specializing in certain types of care. Here are three common examples of specialty hospitals:

• Children’s hospitals focus on conditions and diseases that affect young patients. The staff at these hospitals are specially trained to work with children and are able to offer psychosocial support for the children who require extended stays.
• Research hospitals are committed to discovering cures for certain conditions while treating various illness and diseases.
• Psychiatric hospitals specialize in mental health needs and illness using medication, psychotherapy and behavioural therapies. Some focus on short-term, emergent treatment, while some guide patients through long-term stabilization.