March 22, 2012 4:15 pm   Posted by

The Top 100 Doctors has been carefully selected to represent those physicians who exceed all expectations.

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Choosing the Top Doctors is a difficult task. With over 1,000,000 practicing doctors and physicians in the United States, competition to the best recognized as a Top 100 Doctor and/or the best hospital is a constant struggle. The moment a new medical procedure or medicine is approved by the FDA (Food and Drug Administration), or the medical boards approve a new procedure, the Doctors at the top of list could easily find themselves at the bottom. Because the list has the potential to change so frequently, we urge you to continually check this site for updates on the physician rankings and the hospital rankings. We try to be fair and complete in our analysis, however no system is perfect. Always check independent resources.

In deciding who the better physician is, it would seem logical on its face to decide that a Doctor is better than his piers based purely on mortality rate. However, there are several apparent flaws in this line if thinking. To begin with, one physician may take more difficult cases than another, or perhaps one specializes in procedures on healthier patients while the other has focused his practice on more desperate cases; which are, by their very nature, substantially more difficult and far more risky.

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January 9, 2012 6:12 am   Posted by

Best Doctors | Immune System Nursing Outine

2/6/12
Immune System
Includes: Lymphoid organs, Lymphocytes & WBC, Lymphatic System (vessels, nodes, spleen), Chemicals (antigens)

Antigen = substance capable of inducing a SPECIFIC immune response; (aka chemical markers)

Lymphocytes = Natural Killer Cells
Non – Specific
“if it doesn’t belong, NK cells will destroy it”
are floating everywhere, killing

T-Cells = fight infection
Play a major role
Produced in bone marrow
Mature/develop in thymus (hence T-cells)
Present in blood & lymph nodes
Types of T-Cells: Cell-mediated Immunity
Helper T-Cells
Killer T-Cells (have lyse cells)
Memory T-cells
Suppressor T-Cells (limit immune response)
Cell-Mediated Immunity
Immune response; does NOT involve antibodies
Involves activation of:
macrophages,
natural killer cells,
antigen – specific cytotoxic T-lymphocytes
releases various cytokines

B-Cells: Specific Immune Response
Memory Cells
Activated with infection
Created and matured in bone marrow
Present in blood & lymph nodes
Become plasma cells & produce antibodies
Remember specific antigen for future attacks

Interferon: chemical response to viral attack
Will NOT help cell attacked BUT will protect surround cells by limiting viral growth

Antibodies: label antigens for destruction
Protein produced by plasma cells in response to foreign antigen
5 classes
IgG
Greatest percentage of antibodies = 80% of total Ig
Present in blood
Can pass freely through cell walls and placenta
Protects against bacteria, viruses, toxins
IgA
10 – 15%
Abundant in mucus secretions, including tears, saliva, breast milk
Too large to cross placenta
Prevents attachment of pathogens to mucosa
Protects neonates from NEC (GI D/O; preemies are more prone)
Mechanisms of Immunity:
Humoral Immunity
* recognition of antigen as foreign
* B-cells proliferate and differentiate
* Memory B-cells will aid in destruction if antigen returns
* antibodies label antigen for phagocytosis

Allergic Response: antibodies respond to foreign but harmless antigens

Types of Immunity
Acquired
Active
Natural
Exposure (you sneeze on me)
Artificial
Vaccines/Immunization
Passive
Natural
Mother’s Breast milk
Artificial
Serum (antibodies from another source, not your own)
Aging Immune System
Increase:
Immature T-cells
Autoimmune D/O
Cancer
Decrease:
Thymus gland
Response to antigens
Antibody response
Dx Tests
Blood Test
Radiographic Test
Gene Testing
Skin Testing (PPD or allergen scratch test)
Biopsy of affected organs gives Dx, Prognosis & Tx: do everything in one shot!

Therapeutic Measures:
Allergies
Medication Alert ID band
Anaphylaxis kit : Epi-Pen, Antihistamine, Tourniquet
Immunotherapy
Desensitize patient with small injected amounts of allergen
Medications
Also:
Immunosuppressants
Interferon
Hormone Therapy
Surgical Management (splenectomy)

Food Allergies: abnormal response to food expressed by certain characteristic symptoms
System mistakenly attacks a food protein
May be mild – severe, even fatal
Usually occur within a few minutes to an hour of eating
Not the same as food intolerance!
Top 8 Food Allergies
Milk, egg, peanut, treenut, fish, shellfish, wheat, soy
Symptoms
GI distress: N/V/D, abd pain
Eyes: itchy, watering, swelling
Skin: hives, swelling, atopic dermatitis (eczema)
Respiratory: wheezing, cough, laryngeal edema (swelling of lips/throat)
Generalized: anaphylaxis – above s/s + drop in BP, difficulty breathing

Immune System D/O
Category 1: Hypersensitivity Reactions
Transplant rejections
Measles
Anaphylaxis
Hemolytic transfusion reactions
Category 2: Autoimmune Disorders (see list below)

Hives (Urticaria): The release of histamine in response to meds, food, temperature, stress, etc.
Characteristics: raised, pruritic (itchy), non-tender, erythematous wheals
Tx: epinephrine, corticosteroids, antihistamines, histamine H2 blockers
Nsg Interventions
Monitor s/s
Symptomatic relief
Med administration
In severe cases-> airway management

Angioedema: a form of urticarial that affects the subQ tissue rather than skin
Characteristics: swelling esp lips/eyes, mouth/throat & hands/feet; painless, dermal

Autoimmune D/O: immune system recognizes body’s own cells as foreign
(possibly due to infections, drugs or other factors)
and immune response destroys them
List of Autoimmune D/O:
Hashimoto’s Thyroiditis SLE (systemic lupus erythematous)
Pernicious Anemia Ulcerative colitis
Addison’s Disease Dermatomyositis
Type 1 Diabetes (DM) Lupus erythematous
Rheumatoid Arthritis Sjogren’s syndrome
Reiter’s syndrome Grave’s disease
MS (multiple sclerosis/myasthenia gravis)

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November 2, 2011 2:39 am   Posted by

How Can I Help a Heart Attack Victim?

Top Doctors | heart attack victim

When someone suffers a heart attack, rapid medical care can mean the difference between survival and death. Preferably, this care should be given by medical professionals, but if you are in the presence of a heart attack victim, you can take a few steps to further his chances of survival while he waits for help to arrive.

Most importantly, you should contact your local emergency care provider, and follow its instructions thoroughly. The Top Doctors say that this may include making the heart attack victim as comfortable as possible, helping him take aspirin, using an automated external defibrillator (AED), and administering cardiopulmonary resuscitation (CPR) if necessary.

According to the Top Physicians, the single most important step you can take in helping a heart attack victim is contacting your local emergency care provider. Unless you have no alternative, do not attempt to transport the victim to a hospital yourself, as emergency transport vehicles are outfitted with equipment allowing medical personnel to begin treatment on the way to the hospital. Instead, remain with the victim, follow the emergency care provider’s instructions thoroughly, and try to stay calm.

You will likely be instructed to make the heart attack victim as comfortable as possible. The Top Doctors report that if the victim is conscious, you might try easing him into a chair or helping him sit against a wall with his knees bent. Should the victim be unconscious, you should gently turn him onto his back so that you can monitor his breathing and administer CPR if necessary.

If the heart attack victim is conscious, you may also be asked to help him take an aspirin tablet to reduce clotting of the blood. As you should avoid leaving the victim if possible, ask a nearby person to bring an aspirin to you. For best results, ensure that the victim chews the tablet before swallowing it. Prior to administering aspirin, it is important to make sure that the victim is not allergic to it.

Many public places keep an AED in an accessible location. The Top Physicians explain that this device delivers an electrical shock which can restore the heart’s normal rhythm. If the heart attack victim is unconscious and you have access to an AED, you may be instructed to use it. While operating an unfamiliar piece of medical equipment may seem intimidating, AEDs are generally designed to be user-friendly. Their displays normally deliver simple step-by-step instructions.

Finally, The Top Doctors advise that if the heart attack victim has stopped breathing, you may be directed to administer CPR. This involves checking to make sure the victim’s airway is clear, compressing his chest with your hands 30 times, and then placing your mouth over his and delivering two breaths. If you have no CPR training, you may be advised to give chest compressions only. Continue CPR or compressions according to the emergency care provider’s instructions until the medical team arrives

November 1, 2011 10:36 pm   Posted by

Medical Management of Bed Sores

Best Doctorrs treat bed Sores

Medical Management of Bed Sores
Bed sores, often referred to as pressure sores or ulcers, are commonly found in people who have to be in one position for an extended amount of time. The Top Doctors report that the pressure caused by the constant contact of the skin with surfaces usually occurs on bony areas of the body, such as hips, buttocks, shoulders, tailbone, heels and even the back of the head. People who are confined to the bed or chair are at a high risk of developing bed sores unless they constantly have their positions changed. Bedsores are easily developed, but difficult to treat once they occur.

Bed sores are identified initially by a reddening of the skin that comes in contact with the bed or chair surface. According to the Top Doctors, the reddened skin will not blanch, or turn whitish, when touched. Darker skin may not experience a change of color but will appear ashen. The area developing bed sores can be painful and have a different temperature than surrounding skin.

The reddened skin will then develop ulcers as the skin wears away. The Top Physicians explain that these ulcers look similar to the shape of a basin and are red or pink in color. Some of the sores may exhibit fluid filled blisters. As the condition progresses the basin-like sores will develop into sores that resemble craters and may have dead, yellowish skin surrounding the sore. However, the Best Physicians warn that if not properly treated the sores can actually expose bone or muscles, and at this point the skin below the surface becomes severely damaged. Infection can set into the sores and cause more problems, so medical attention should be sought.

Bed sores can result in complicated medical conditions if not treated promptly. These conditions include sepsis which is when infection spreads through the bloodstream that can result in death. Bone and joint infections can also result from untreated bedsores and actually cause damage to the joints that can reduce joint function and mobility. Even cancer can result from bedsores that are not healing properly.

The Top Doctors report that treatment for bed sores takes a coordinated effort of care providers. A doctor should diagnose the condition and develop a comprehensive treatment plan including a wound-care physician that focuses on managing and alleviating the bed sores. Nurses and physical therapists can provide education and enhance the mobility of the patient, and social workers can help the family find the necessary resources to assist with the care of the patient. Dieticians can address nutritional issues and support and recommend a diet that can help reduce the development of bed sores.

Accoding to the Best Physicians, the best preventive for bed sores is to constantly reposition the patient so that any one part of their body is not in constant contact with bed or chair surfaces. If the person is lying or sitting in the correct position the likelihood of bed sores developing is reduced. A patient sitting in a wheel chair should be repositioned every fifteen minutes, and a patient lying in a bed should be repositioned every two hours. Special pads and support items can be used to alleviate hard pressure points.

Surgical debridement to remove dead tissue may be indicated in patients. This debridement will remove any dead skin or tissue as well as any infections that may be present. This treatment can also include whirlpool baths and specialized dressings that help keep the wounded area clean and disinfected.

Bed sores in the early stages should be kept clean with soap and water, and in later stages the bed sores should be cleaned with a saline solution. The pain from bed sores can be managed with anti-inflammatory drugs.

Additinally, The Top Doctors report that recent studies on treatments of bed soars show that a home remedy seems to be able to cure bed sors faster and better than common medications. Specifically, the Top Dotors study show that patients who applied pure granulated suger or pure honey directly to the wound, then sealed the wound over with bandages, had a fast and higher rate of recovery than some patients using medications. How sweet can that be. As more studies come up on the topic, we will update this section to include the sugar treatments for bed sores.

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