Hvad er en diætist og hvordan du vælger den rigtige for dig

discuss-with-dieticianDiætister er medicinske fagfolk, der designer og formulere kost baseret på en persons særlige behov. Diætister er ansat af hospitaler, samfund sundhedsfaciliteter, private klinikker, fødevarevirksomheder og fitness klubber, selvom nogle af dem kan være engageret i privat praksis.

Diætister har mange opgaver og ansvar, herunder:

* Koordinering med læger og kirurger til at foretage en nærende og passende kost for en patient  raspberry ketones.
* Koordinering med hospitalets personale til at give mad til trange patienter, som ikke er i kritisk tilstand.
* At formulere, programmering, og designe måltider og mad mønstre for patienter med særlige kostbehov ligesom overvægtige, anorexics og bulimics.
* Bestem den ernæringsmæssige værdi af produkter, der sælges i en restaurant eller gemme at kontrollere, om portioner er sund, og vil ikke medføre sundhedsproblemer for kunder og lånere.
* Observere og foretage ændringer i en persons kost plan om nødvendigt.
* Forskning Conduct for universiteter og regeringen til at skabe anbefalinger for alle at komme på en sund kost og spise nærende mad.

Omkostninger og forsikring

De fleste hospitaler har en in-house diætist, der er betalt af hospitalets lønningsliste. Hvis du har brug for at have en privat diætist, kan du ønsker at tjekke omkostninger til honorarer. Nogle forsikringer kan også tilbyde muligheder for dig at oplade en diætist honorar til dine eksisterende forsikringspræmier, så du kan få brug for at rådføre sig med dit forsikringsselskab først. En tommelfingerregel at huske er, at afhængigt af længden af ​​kost program, en diætist afgifter mindre end en læge eller en læge.

Licensed Diætister

Når du vælger en diætist, sørge for, at han eller hun er licenseret. Diætister næsten altid har en medicinsk grad eller specialiseret uddannelse i videnskaben om spise og ernæring. Se altid efter diætist akkreditering og anden relevant dokumentation om hans eller hendes erhvervserfaring inden du foretager dit valg. Du ønsker ikke at risikere yderligere helbredsproblemer, fordi din diætist ikke er licenseret.


Ernæringseksperter har en mindre specialiseret baggrund end diætister, selv om deres råd er værdifuldt, især hvis du er til alternative diæter. Ernæringseksperter anbefaler ofte en kost plan baseret på deres egne erfaringer, eller hvis de støtter en bestemt kost regime. Du er nødt til at rådføre sig med en læge først, hvis din sygehistorie er enig i en bestemt diæt planen. Husk, at ikke alle kostvaner er egnet for folk, fordi en person kan få allergiske eller bivirkninger til en bestemt gruppe af fødevarer.

At vælge en diætist eller en ernæringsekspert hjælper dig tage et skridt frem til et godt helbred, så du kan nyde et godt liv. Med disse tips, kan vælge en diætist hjælpe dig med at træffe bedre beslutninger for din egen sundhed og velvære.

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Sorry, Congress Needs to do Something About Data Blocking

Now it’s clear. On Thursday, the Office for Civil Rights, responsible for HIPAA enforcement and protecting the public, published a new guidance to interpret HIPAA with respect to data blocking. The limits of the current law are now evident. In the interest of affordable health care, the Precision Medicine Initiative, and common sense, it’s time for Congress update HIPAA. Believe it or not, HIPAA still allows hospitals and other electronic health record (EHR) systems to require paper forms before they release data under patient direction. Along with an allowed 30-day delay in access to electronic health records, this data blocking makes second opinions and price comparisons practically inaccessible. Over $30B in stimulus funds have been spent on EHRs and now it is still up to Congress to give to patients full digital access to digital data.

Data blocking is the result of deliberate barriers designed into current EHRs that prevent patients being able to use their own data in efficient and innovative ways. It is practiced by both EHR vendors and healthcare institutions to avoid competition by favoring the services they control. As hospitals consolidate into massive “integrated delivery networks”, the business logic for data blocking becomes clear and irrefutable. Data blocking ensures the largest health delivery networks will get larger and control pricing. The bigger they are, the more data they have about each patient and the more money each patient’s data is worth to outside interests like pharmaceutical companies and data brokers. The results are ruinous healthcare costs and hidden discrimination in insurance, credit, employment, and other key life opportunities.

HIPAA ensures that our personal health data leaves EHRs and the health care system in hidden ways, because changes to HIPAA in 2002 eliminated the right to give consent before our health data could be used for routine medical transactions: treatment, payment and healthcare operations. Pretty much all of the data leaves, digitally, out of sight, because of the huge loopholes in HIPAA and the pretense that de-identification works (it doesn’t, data can easily be re-identified by data brokers as allowed under the law). “theDataMap”, a project of the Harvard School of Government, shows just some of the thousands of hidden places our data flows without consent or notice. Businesses we never heard of, like Superscripts and IMS Health Holdings, claim to have longitudinal profiles on 230 and 500 Million people that they add to every day, and then sell this data to thousands of customers.

Data can also leave hospital, pharmacy, or lab with an EHR through the front door. These are the cases where the patient is actually asked for consent or at least allowed to know who will receive their data. Our patient rights with respect to patient-directed data access is what the recent OCR guidance made clear and, under current law, they are still tied to paper and subject to 30-day delays.

Under current HIPAA regulations, data blocking will continue and worsen as more and more personal data moves to millions of hidden databases that are unknown and inaccessible to us. The reason is that our HIPAA right to control electronic data movement through the front door can be blocked by paper requests and 30 day delays. Meanwhile, back door, hidden data access and disclosures occur thousands of times every day in EHR systems. Modern technology that our taxes paid for can make the front door, our right of direct access to our own data, cheaper than the ‘back door’.

There are three ways HIPAA enables EHRs to block data from being shared: (1) The healthcare “providers” EHR are not required to process a patient’s digitally signed electronic requests for access directly by other EHRs; (2) “Providers” are allowed to block direct digital access even when technology clearly limits the risk to the single patient that is providing the direct access authorization; and (3) “Providers” can impose a 30-day delay that makes the information almost useless for second opinions and price comparison.

As Congress contemplates funding of the Precision Medicine Initiative and updates to various aspects of the Affordable Care Act, data blocking under HIPAA should be at the top of the list for accomplishing the purposes those acts were designed to accomplish. Patient Privacy Rights calls for making all patient data easily digitally accessible 24/7 to all patients, and to whoever they designate under paperless personal digital “signatures”.

Adrian Gropper, MD is the CTO of Patient Privacy Rights.

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5 Natural Solutions for a Teething Baby

Now that baby Vienna is almost six months old I’ve had a few months of trying different teething remedies. She started with symptoms around 2.5 months and her first bottom tooth poked through about a week ago. We were pretty excited!! It’s a sharp tooth though — ouch. No more munching on mommy’s finger. Thankfully we’ve had no breastfeeding mishaps.

As a natural mama and holistic nutritionist it is always my goal to seek out natural remedies first. From red cheeks, irritability to drooling to restlessness, pain and even fever — these are all common symptoms that can happen from teething. These are symptoms that can be addressed naturally and effectively. In fact, Vienna felt like she was burning up one night so before I took her to the walk-in-clinic I called “Telehealth” and a nurse rest assured me it will pass and just to keep a close watch on her for any changes. Now of course, you must always be careful with fevers which is why I wasn’t trying to treat it naturally until I had confidence from a nurse that it was not high enough to warrant medication. 

After doing extensive research and testing out different options, these are the 5 best natural solutions for lessening the symptoms associated with teething in this video (links all the products below). I have personally found them to be very effective with my babe.

  1. Chew Bead Necklace: The necklace I’m wearing is awesome because Vienna LOVES chewing on it and the counter-pressure on her gums relieves pain. It’s made of silicone, not plastic. I also find it handy because when she’s nursing, instead of pulling on my hair she grabs the necklace — it’s a good distraction!
  2. Amber Necklace: This has helped to lessen the drooling. These necklaces have some controversy because some people worry they are a choking hazard. However, you take it off at night and don’t leave it on your baby unattended. The length is perfectly thought out because it can’t get tangled on anything as it is pretty short.
  3. Mesh Ice Teething Feeder: If your baby isn’t on solids yet, just pop in some ice. The cold will feel good on her gums and relieve pain. Once your babe is old enough and has tried out different foods you can add frozen fruit.
  4. Camilia: This is an effective homeopathic medicine. It helps with irritability and restlessness. When Vienna’s cheeks get super red and I can tell she’s restless this really helps. I have been using it as a preventative as well.
  5. LOVE! This needs no explanation. Love is a proven endorphin producer which is the best natural pain reliever in the world. When Vienna is a cranky-pants because she is suffering (those cheeks give it away!) I just give her extra hugs and kisses.

I hope you find these tips useful mamas. Please do let me know what you’ve found to be helpful.

Wishing you joyous health!




Joy McCarthy

Joy McCarthy is the vibrant Holistic Nutritionist behind Joyous Health. Author of JOYOUS HEALTH: Eat & Live Well without Dieting, professional speaker, nutrition expert on Global’s Morning Show, Faculty Member at Institute of Holistic Nutrition and co-creator of Eat Well Feel Well. Read more…



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The Health Care Question We Need to Be Asking the Candidates


Screen Shot 2016-02-28 at 10.09.02 AM

As many of the Republican and Democratic presidential candidates lament the high cost of healthcare and put forth how they aim to make it more cost effective, few have focused on the impact of out-of-pocket costs specifically for cancer patients. They should. One in every two men and one in every three women will get cancer at some point over their lifetime. As the U.S. population and American lifespans increase, this toll will have major financial ramification for everyone.

When fighting against the disease, cancer patients are often at the mercy of the pharmaceutical industry. Given Pfizer’s recent announcement that it plans to merge with Allergan, making it the largest pharmaceutical company in the world, many cancer patients are wondering what this will mean in terms of their cost of care.  Pfizer, a giant in the cancer pharma space, already raised prices on 133 of its brand-name drugs last year, and they are not alone.  Big pharma has raised cancer drug prices up to 5000%. Recently ousted Turing CEO Martin Shkreli justified such hikes explaining, “I could have raised [prices] higher and made more profits for our shareholders, which is my primary duty.” The lack of focus on patients spawned outrage amongst patients, providers and even politicians, but the drug industry seems to be “in denial of the seriousness of its pricing problem.”

Granted, drug production takes years of research and can cost $350 million to get a single drug to market. Considering 95% of the experimental drugs will never see a pharmacy shelf, it might seem reasonable that the cost to patients is on the increase.  But contrary to the pharmaceutical industry’s claims, the cost of innovation is not the driver of drug prices.  A study published in JAMA Oncology found that prices of cancer drugs are not tied to novelty nor to effectiveness, but rather set to what the market can bear. Here within lies the problem: if you’re a patient faced with a cancer diagnosis, wouldn’t you pay whatever the cost, no matter the price?

Indeed, many cancer drugs now cost more than the average household income, and prices of over $100,000 per year are common.  It is no wonder that medical costs remain the leading reason for bankruptcy filings in this country.  But skyrocketing costs don’t just affect patients’ pocketbooks; they also affect their well-being.  In a national study of over 2100 cancer survivors, we found that the financial burden associated with cancer care was the leading factor affecting patients’ quality of life. Survivors who said they had “a lot” of financial difficulties associated with their cancer care were four times more likely to report having a poor quality of life than those who reported no financial issues, controlling for other factors including age, race, education, insurance, family income, and cancer type.

As physicians who aim to improve the quantity and quality of patients’ lives, we have a duty to minimize the financial toxicity our patients face.  Yet our options for doing so often seem limited since we don’t set drug prices.  Some doctors have made use of websites like www.drugabacus.org which help them understand the actual cost and value of any cancer drug, to determine whether to prescribe any one particular drug. Others have made use of generic substitutes, but these cheaper alternatives are not always available.  For example, the $10,000-a-month drug Gleevec (imatinib mesylate) used to treat chronic myeloid leukemia has been around since 2003, but FDA approval of the generic equivalent was just granted.  Still others use noveltests that, while costly themselves, can predict whether toxic (and expensive) medications are truly beneficial.

In his final State of the Union address, President Obama called for a “moon shot” to cure cancer. While most of the efforts of this ambitious project will focus on the biology of the disease, containing the cost to patients must also be part of the agenda. The National Cancer Institute estimates that our annual expenditure on cancer care will rise from $125 billion in 2010 to over $156 billion in 2020.  If we are to contain costs, we as a society must not only depend on expensive high tech and novel therapeutics. Take for example, the long-term data from a randomized controlled trial that found that low fat diet was associated with a 54% reduction in mortality in patients with hormone receptor negative breast cancer (which is often associated with a poor prognosis).  If these data were the result of a new drug, it would be widely prescribed at any cost.  Yet, few physicians write prescriptions for “low fat diet” which yielded these results.

Similarly, when my colleagues and I published the findings of our randomized controlled trial that showed removing a little more tissue during initial surgery could save thousands of breast cancer patients the need for a second operation, a colleague of mine lamented that we could not package this technique and sell it since many companies are developing sophisticated and pricey devices to try to achieve the same results.  As breast cancer experts gathered in San Antonio for our annual meeting last month, I presented data on how we achieved these outcomes without capital equipment and without increasing costs.  True, I won’t get rich. But by helping to bend the ever-increasing cost curve, I may improve the lives of our patients. And isn’t that really why we’re in this business to begin with?

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Readmissions, Observation, and Improving Hospital Care

Ashish JhaReducing Hospital Use

Because hospitals are expensive and often cause harm, there has been a big focus on reducing hospital use.  This focus has been the underpinning for numerous policy interventions, most notable of which is the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for higher than expected readmission rates.  The motivation behind HRRP is simple:  the readmission rate, the proportion of discharged patients who return to the hospital within 30 days, had been more or less flat for years and reducing this rate would save money and potentially improve care.  So it was big news when, as the HRRP penalties kicked in, government officials started reporting that the national readmission rate for Medicare patients was declining.

Rising Use of Observation Status

But during this time, another phenomenon was coming into focus: increasing use of observation status.  When a patient needs hospital services, there are two options: that patient can be admitted for inpatient care or can be “admitted to observation”. When patients are “admitted to observation” they essentially still get inpatient care, but technically, they are outpatients.  For a variety of reasons, we’ve seen a decline in patients admitted to “inpatient” status and a rise in those going to observation status.  These two phenomena – a drop in readmissions and an increase in observation – seemed related.

I – and others – spoke publicly about our concerns that the drop in readmissions was being driven by increasing observation admissions. An analysis by David Himmelstein and Steffie Woolhandler in the Health Affairs blog suggested that most of the drop in readmissions could be accounted for both by increases in observation status and by increases in returns to the emergency department that did not lead to readmission.  Two months later, a piece by Claire Noel-Miller and Keith Lund, also in the Health Affairs blog, found that the hospitals with the biggest drop in readmissions appeared to have big increases in their use of observation status.  It seemed like much of the drop in readmissions was about reclassifying people as “observation” and administratively lowering readmissions without changing care.

New Data

Now comes a terrific, high quality study in the New England Journal of Medicine that takes this topic head on.  The authors examine directly whether the hospitals that lowered their readmission rates were the same ones that increased their observation status – and find no correlation.  None.  If you’re ever looking for a scatter plot of two variables that are completely uncorrelated, look no further than Figure 3 of the paper.  The best reading of the evidence prior to the study did not turn out to be the truth.  It reminds me of the period we were all convinced, based on excellent observational data, that hormone replacement therapy was lifesaving for women with cardiovascular disease.  And that became the standard of care – until someoneconducted a randomized trial, and found that HRT provided little benefit to these patients.  That’s why we do research – it moves our knowledge forward.


Where are we now?

So where does this leave us?  Is the ACA’s readmissions policy a home run?  Here’s what we know:  the HRRP has, most likely (we have no controls) led to fewer patients being readmitted to the hospital. Second, the HRRP does not seem responsible for the increase in observation stays.

Here’s what we don’t know: is a drop in readmissions a good thing for patients? It may seem obvious that it is but if you think about it, you realize that readmission rate is a utilization measure, not a patient outcome.  It’s a measure of how often patients use inpatient services within 30 days of discharge. Utilization measures, unto themselves, don’t tell you whether care is good or bad. So the real question is — has the HRRP improved the underlying quality of care? It might be that we have improved on care coordination, communications between hospitals and primary care providers, and ensuring good follow-up. That likely happened in some places. Alternatively, it might be that we have just made it much harder for that older, frail woman with heart failure sitting in the emergency room to get admitted if she was discharged in the last 30 days. That too has likely happened in some places. But how much of it is the former versus the latter? Until we can answer that question, we won’t know whether care is better or not.

Beyond understanding why readmissions have fallen, we also don’t know how HRRP has affected the other things that hospitals ought to focus on, such as mortality and infection rates. If your parent was admitted to the hospital with pneumonia, what would be your top priority? Most people would say that they would like their parent not to die. The second might be to avoid serious complications like a healthcare associated infection or a fall that leads to a hip fracture. Another might be to be treated with dignity and respect. Yes, avoiding being readmitted would be nice – but for me at least, it pales in comparison to avoiding death and disability.  We know little about the potential spillover effects of the readmission penalties on the things that matter the most.

So here we are – a good news study that says readmissions are down because fewer people are being readmitted to the hospital, not because people are being admitted to observation status. That’s important.  But the real challenge is in figuring out whether patients are better off.  Are they more likely to be alive after hospitalization? Do they have fewer functional limitations? Less pain and suffering? Until we answer those questions, it’ll be hard to know whether this policy is making the kind of difference we want. And that’s the point of science – using data to answer those questions. Because we all can have our opinions – but ultimately, it’s the data that counts.

Ashish Jha, MD, MPH (@ashishkjha) is the C. Boyden Gray Associate Professor of Health Policy and Management at the Harvard School of Public Health. He blogs at An Ounce of Evidence where this post originally appeared. He is also the Senior Editor-in-Chief for Healthcare: The Journal of Delivery Science and Innova

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Why Healthcare Costs Rise Faster Than General Inflation Part 4

Over the last few years, the latest buzz in the healthcare industry has been Accountable Care Organizations (ACOs), and the next wave will be the promotion of “value-based contracting”. These are similar approaches, different words.

Generally, an ACO is formed around a physician group or a hospital linked to physicians. The basic concept is for the provider system to be accountable for patients, and the providers are financially motivated to impact their patient population’s overall costs. Makes sense, right?

For the past 25 or so years, physicians have been linked to Independent Practice Associations, Medical Groups, and Management Services Organizations. Many of these provider organizations have had financial incentives tied to performance. Data have been available to assess physician performance. So what’s different now?

Today the Feds are re-emphasizing performance in their physician contracting under the new Medicare Access and CHIP Reauthorization (MACRA), which replaces the current reimbursement formula.

Beginning in 2019, the existing incentive programs now used for Medicare physicians will be replaced by a new performance-based model with four components. Those components are 1) quality, 2) resource use, 3) meaningful use of technology, and 4) clinical practice improvement.

Based on the Medicare physicians’ results, the reimbursements can be decreased by as much as 4% (adjusting to 9% by 2022). The program will have upside incentive for achieving exceptional performance up to 12% in 2019.

As the largest purchaser, Medicare is striving to establish per unit cost consistency in every market. Yet Medicare’s 2014 costs vary from $6,631 to $10,610 across markets. Why? Even if the cost per unit of service is standardized, extremely wide variation exists in how patients are treated for given conditions. When wide variation in care plans exists, some are right and some are wrong, as regular readers of Cracking Health Costs know. Some are better and some are worse. Period.

It’ll be interesting to see if the four new performance measures under MACRA will have a better impact than what’s in place today.

Self-insured employers don’t need to wait four or five years to see the results. They can leverage their purchasing scale with the providers to drive out both inappropriate care and unit price variations. The time to start is now.

Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. Tom Emerick is the President of Emerick Consulting, LLC, and Partner and Chief Strategy Officer with Laurus Strategies, a Chicago-based consulting firm, and co-founder of Edison Health. 

Tom’s latest book, “An Illustrated Guide to Personal Health“, is now available on Amazon.

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Silicon Valley’s Healthcare Problem


Silicon Valley wants to love healthcare. The industry is enormous and full of inefficiency, which is to say, perfect for technology investment. So it comes as no surprise that venture money in healthcare technology startups has quadrupled since 2011 to $4.5BN in 2015. Moreover, the government wants to invite Silicon Valley-style innovation in healthcare. In January, CMS leaders stated that the next wave of EHR policy will focus on promoting startup innovation in healthcare by incentivizing open APIs and interoperability. Everyone agrees—so let’s just get going, right?

Here’s an important truth to recognize on the eve of what some like to call the “disruption of healthcare”: Silicon Valley and healthcare are fundamentally at odds.

In technology we fail fast, launch and iterate, proudly make mistakes and learn from them. In medicine, the first principle is “do no harm.” Entrepreneurs are obsessed with growth–exponential growth, hypergrowth, 10X growth–and the faster the better. Conversely, in healthcare organizations, progress is measured in months and years. My company is currently in Y Combinator, a three-month accelerator program. I have had phone calls with healthcare organizations that took longer than that to schedule.

The philosophies and operations of the two world are at odds in many ways. Too many well-intentioned startups have come up against these tensions and lost steam.

Despite this, healthcare organizations and startups can make perfect partners. I believe more startups should try to serve healthcare organizations, and more healthcare decision-makers should choose to work with startups. Here are some lesser-discussed advantages for both sides.

Healthcare organizations: Why work with startups

Startups care about user experience and will spend time with users to build empathyThe lean startup movement taught entrepreneurs to listen to users religiously. User-centric software design is remarkably absent in healthcare, with nearly half of physicians reporting that patient care has worsened since implementing their electronic health record systems. Unlike large EHR companies, startup founders don’t find user questions and feedback annoying or expensive; we seek it out and value it highly.

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