Stroke Prevention: Choices You Can Make to Help Prevent a Stroke

By Margaret Jazayeri, PA-C

A stroke is a “brain attack” where the oxygenated blood cannot reach your brain cells and they begin to die. Stroke has become a leading cause of death and permanent disability in America -- almost 750,000 people have strokes each year.

The good news is that 80 percent of strokes can be prevented.

There are a lot of choices and lifestyle changes you can do to help prevent a stroke. I've highlighted some of the most important below.

Have regular physicals to check your health

If you check your health regularly, you can more quickly recognize and treat a risk factor for stroke.

For instance, if you have high blood pressure, you should monitor your blood pressure regularly to make sure the values are staying in a normal range. If it is not within norms, you should seek your doctor’s advice immediately.

Keep a healthy weight and know your body mass index (BMI) and your waist circumference

Being overweight or obese can significantly raise your risk factor for not only stroke but many coinciding health problems.

Keeping a healthy weight includes making healthy food choices and getting regular exercise. Always check with your doctor before initiating an exercise plan.

Quit smoking

Smoking is one of the leading causes of stroke. It can raise blood pressure, cause blood vessel changes such as narrowing, and increase your risk for forming blood clots.

Your doctor can assist you in finding programs to quit smoking and discuss smoking cessation medications available to you.

Limit your alcohol intake

Drinking too much can raise your blood pressure and add unnecessary calories to your diet. It is best to limit your alcohol to two drinks daily for men and one drink daily for women.

Stroke Warning Signs

Just following these few healthy choices and lifestyle changes could make a big difference in your life for a better health. Should you choose to not make or are unable to make necessary changes for your health, you can be at risk for a stroke.

Everyone should know what the signs and symptoms of a stroke are so that you can be prepared to get medical attention quickly. The faster medical treatment for stroke is given, the better the outcome for most individuals.

If you notice the following signs and symptoms, call 911 immediately: weakness, numbness, tingling, or loss of feeling on one side of your body, trouble seeing from one or both eyes, slurred speech, trouble talking, or problems with thinking, sudden severe headache, dizziness or feelings of spinning, loss of balance or falling easily, and blackouts.

With stroke, prevention is the best medicine and treatment.

Rotator Cuff Tear

The rotator cuff is made up of four muscles (subscapularis, supraspinatus, infraspinatus, and teres minor) that help move and stabilize the shoulder joint. These muscles and their tendons connect your upper arm bone (humerus) with your shoulder blade (scapula).

When any one these muscles or tendons tears this is considered a rotator cuff tear. Torn rotator cuffs are common rotator cuff injures.

What causes rotator cuff tears?

Torn rotator cuffs can occur from sudden jerking movements, falling on an outstretched hand, or lifting something that is too heavy. Tears can also be a result of other shoulder injuries, such as a dislocated shoulder or a fractured (broken) collarbone.

Rotator cuff tears are also wear-and-tear injuries, resulting from repetitive stress on the shoulder's tendons and muscles. Tendons degenerate from use over time, and are more common as we age. Therefore, individuals over 40 years of age are at risk for torn rotator cuffs.

Individuals who also overuse their shoulder muscles, like weightlifters, and those who do repetitive overhead activities, such as painters and carpenters, are also at risk.

What do rotator cuff tears feel like?

Rotator cuff tears are characterized by:

• Pain when lifting or lowering the affected arm
• Tenderness
• Weakness when lifting or rotating the affected arm
• Instability
• Loss of range of motion in the shoulder
• Discomfort when sleeping on the affected shoulder
• A cracking sensation when moving the affected shoulder in certain positions

How do I know if I have a rotator cuff tear?

A physical examination of the shoulder, with focus on its range of motion and assessment of arm strength, will allow your doctor to determin if you have a torn rotator cuff. Your doctor may also use x-ray or magnetic resonance imaging (MRI) to view the rotator cuff muscles and rule out underlying conditions such as arthritis, pinched nerves, or fracture.

What are rotator cuff tear treatments?

If you have a torn rotator cuff, ignore the pain, and keep using your injured shoulder, you may cause further injury to yourself.

Your Duke Orthopaedics specialist will consider many factors including your general health, age, activity level, and the type of tear you have when tailoring your rotator cuff tear treatment.

Typically, nonsurgical treatment options are offered before considering surgical treatment options. Torn rotator cuff treatment options can relieve pain and improve function in the shoulder:

• Steroid injections and anti-inflammatory medicine: Relieving the pain and inflammation associated with rotator cuff tears
• Activity modification: Avoiding activities that can irritate the injured shoulder
• Rest: Limiting overhead activity and immobilizing the injured shoulder -- perhaps by use of a sling
• Physical therapy: Therapeutic exercise designed to strengthen the shoulder muscles and improve range of movement

Though less invasive treatments can help improve shoulder function, shoulder strength does not usually improve without rotator cuff tear surgery.

At Duke, we typically offer rotator cuff tear surgery as an arthroscopic surgerywhere surgeons inspect and reattach torn tendons in the shoulder's rotator cuff.

Duke Orthopaedics offers rotator cuff treatments at locations convenient to Raleigh, Durham, Cary, and Chapel Hill, North Carolina.

Torn Rotator Cuff Treatment Videos

Rotator Cuff Tears

Watch an educational video about rotator cuff tears and treatment options, including rotator cuff tear surgery, for this condition.

Arthroscopic Rotator Cuff Repair

At Duke Orthopaedics, our doctors often treat torn rotator cuffs with arthroscoptic rotator cuff repair surgery. The following video demonstrates this procedure.

http://www.dukehealth.org/orthopaedics/services/shoulder-treatments/care-guides/rotator-cuff-tear

Alimentos ricos em vitamina D

Autora: Tatiana Zanin (Nutricionista)

A Vitamina D  favorece a absorção do cálcio, sendo importante também para fortalecer os ossos e os dentes, além de evitar o raquitismo.

Os indivíduos com maior propensão a desenvolver doenças relacionadas à falta de vitamina D no organismo são os bebês prematuros, crianças e os idosos, quando não têm uma boa alimentação e não pegam sol com frequência.

Um adulto saudável precisa consumir, em média, 5 microgramas por dia de Vitamina D e garantir uma exposição à luz solar de 20 minutos por dia, sem o uso de protetor solar.

Alimentos ricos em vitamina D

Alimentos ricos em vitamina D	Porção (g)	Quantidade de vitamina D (mcg)
Óleo de fígado de bacalhau	13,5	34
Óleo de salmão	13,5	13,6
Ostras cruas	100	8
Peixes	100	2,2
Leite fortificado	244	2,45
Ovo cozido	50	0,65
Carnes (frango, peru, porco) e vísceras	100	0,3
Manteiga	13	0,2
Carne bovina	100	0,18

Para que serve a vitamina D

A vitamina D serve para aumentar a absorção do cálcio no organismo, diminuindo o risco de doenças, como raquitismo, osteomalácea e osteoporose, por exemplo. Mas, além disso, ela diminui o risco de doenças cardíacas, combate a enxaqueca e a tensão pré-menstrual.

Uma outra função da vitamina D é ajudar no desenvolvimento e na manutenção de dentes fortes e saudáveis.

Vitamina D 25-hidroxi

O exame de sangue chamado vitamina D 25-hidroxi serve para medir a quantidade de vitamina D presente no organismo, podendo ainda ser chamado de exame de 25-OH vitamina D ou de exame de calcidiol 25- hidroxicolecalciferol.

Antes de realizar esse exame, recomenda-se fazer um jejum de 4 horas. Os seus valores de referência são de 30 a 74 mg/mL.

Embora a deficiência de vitamina D não seja comum, ela é mais facilmente encontrada em bebês de raça negra que são somente amamentados e nos idosos que não expõem-se ao sol com frequência, ou que tenham uma má alimentação.

Vitamina D pura

O uso do suplemento de vitamina D pura é somente indicado para os casos em que o indivíduo não tem uma boa alimentação ou vive em locais muito frios, onde não é possível expor-se ao sol com frequência.

No continente europeu, é comum que os pediatras recomendem 1 gota diária de vitamina D pura para todos os bebês com menos de 1 ano de idade, assim como para os idosos com mais de 70 anos. É uma forma de prevenção de doenças ósseas.

Dosagem da vitamina D

A dose diária recomendada de vitamina D varia de acordo com a idade e com o local onde se vive, por causa da carência ou não de luz solar durante o ano.

Em média, um adulto precisa consumir 5 microgramas por dia e garantir uma exposição solar, sem o uso de protetor solar, de 20 minutos por dia, no mínimo. Os idosos, em geral, devem consumir 10 mcg por dia de vitamina D.

Indivíduos com a pele mais escura tem uma capacidade reduzida de sintetizar a vitamina D e, por isso, devem se expor ao sol com maior frequência ou por um maior período de tempo, para garantir a produção ideal da vitamina.

Sintomas da baixa concentração de vitamina D

Os sintomas da baixa concentração de vitamina D no organismo são:

• Diminuição do cálcio e do fósforo no sangue;
• Fraqueza muscular;
• Tetania;
• Moleira aberta após o 1º ano do bebê;
• Irritabilidade, inquietação, anorexia e suor excessivo podem surgir nas crianças;
• Osteoporose nos idosos;
• Raquitismo;
• Osteomalácea;
• Pernas tortas.

Consequências do excesso de vitamina D

A consequência do excesso de vitamina D no organismo é a elevação dos níveis de cálcio na corrente sanguínea, que pode levar ao desenvolvimento de pedras nos rins e arritmia cardíaca, por exemplo. Porém a única forma de ter níveis tóxicos de vitamina D no sangue é através de tratamentos de suplementação com vitamina D e não com a ingestão de alimentos ricos em vitamina D.

Links úteis:

• Onde encontrar vitamina D
• Alimentos fontes de cálcio
• Vitamina D

Duke Medicine Completes Implementation of Electronic Health Records Across All Outpatient Facilities and Duke University Hospital

By Duke Medicine News and Communications

Implementation at Duke Regional and Duke Raleigh Hospitals Moved up to March 1, 2014, Due to Success of Project To Date

DURHAM, N.C. – Duke University Health System (DUHS) has become the first provider in the greater Triangle to implement the country's leading electronic health record (EHR) system, with 223 outpatient facilities and Duke University Hospital now utilizing this state-of-the-art system.

Based on the success of the rollout of the system to date, the implementation dates for the EHR at Duke Regional Hospital and Duke Raleigh Hospital have been moved up and will take place on March 1, 2014, at which point the EHR will be used at all DUHS points of care and by all Duke providers.

The new EHR will ultimately create a single electronic health record for each patient that contains comprehensive information from each encounter with a physician or provider at any Duke Medicine facility. The seamless, real-time access to a patient's complete medical record will provide valuable information to Duke clinicians and will advance the already high quality of care provided to patients.

The breadth of functionality offered by the new health record system will also revolutionize the way Duke providers exchange information about a patient's care across all care settings – improving quality, safety, speed and efficiency.

Using the Care Everywhere health information exchange, the new EHR also enables Duke Medicine providers to more effectively communicate about shared patients with non-Duke providers throughout the state and country. Duke's EHR allows the confidential and secure sharing of a patient's health information between more than 180 health care institutions that utilize the same health records system. In August 2013 alone, more than 19,000 queries were sent and received between Duke providers and other organizations nationwide using the Care Everywhere tool.

"The EHR technology is a great advance for patients in that it will facilitate a new level of transparency and information sharing among care teams about an individual's care. We expect this will translate to further enhancements in the quality, safety and effectiveness of care delivered," said Jeffrey Ferranti, M.D., chief information officer for Duke Medicine. "It will also give patients complete access to their own health records through an online portal that also allows patients greater ability to proactively engage in their care."

The new online portal, Duke MyChart, allows patients to access test results and other information from the new health records system. Patients also can schedule appointments online, communicate with their physicians electronically, request prescription refills, and more. With the new Duke MyChart iPhone and Android MyChart apps, patients can quickly and easily access and manage their health information.

To date, the implementation of the EHR at Duke has been achieved ahead of schedule and under the projected budget. It is anticipated that the project will be completed ahead of schedule when Duke Regional and Duke Raleigh hospitals are brought online in March 2014.

Duke confirmed with Epic Systems, the company behind the EHR technology, that the implementation represented one of the largest single-day go-live events in the vendor's history. It followed two years of extensive planning and building of the system to Duke's specifications. More than 16,000 Duke faculty and staff were trained prior to implementing the new system.

"It would be impossible to overstate the magnitude of the organizational commitment that made this project possible," said Thomas Owens, M.D., chief medical officer for Duke University Health System. "Thousands of faculty and staff invested countless hours participating in the preparation and implementation of this system on top of all of their many other clinical and administrative duties, and our early data indicate it has been a great success."

Of note, during the implementation of the EHR there were no significant disruptions to patient care or the patient billing process.

The implementation of the EHR began in July 2012 with Duke Primary Care practices and providers, and was subsequently rolled out in waves to outpatient clinics and Duke University Hospital in late 2012 and early 2013.

The numbers associated with the project to date speak to the size and complexity of the project:

•  223 clinics now live on the system.
• More than 50 clinical information systems have been eliminated as a result of the vast capabilities of the EHR. By project's end, a total of 130 separate clinical IT systems will be eliminated.
• 172,937 total hours of training (19.7 years) completed by faculty and staff to date.
• More than 396,000 patients with an active Duke MyChart account.
• 44,000 communications sent from patients to Duke providers through Duke MyChart.

"Managing the implementation of this huge project, while maintaining our historic clinical volume and financial performance, is a testament to the high quality and dedication of our faculty and staff," said Victor J. Dzau, M.D., chancellor for health affairs and CEO of Duke University Health System.

"The system is functioning as we designed it and our task now is to complete the rollout of the system at Duke Regional and Duke Raleigh, plus work with faculty and staff for opportunities to optimize the technology and enhance its effectiveness within the unique Duke environment," Ferranti said.

Anatomia dos Ligamentos do Joelho

Sistema Muscular do braço

Sistema Muscular da Coxa

Sistema muscular Ombro

Sistema Ósseo do pé

Sistema muscular do Pé

Porto Medical Tourism

Porto Medical Tourism 

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24-09-2013 

Hospital da Boavista recebeu a apresentação do projeto Porto Medical Tourism, que resulta de um protocolo entre a Câmara Municipal do Porto, a Associação de Turismo do Porto, a Travel Health Experience.

Ao consultar a plataforma - http://porto-medical-tourism.stepvalue.com/ - o turista que procura cuidados de saúde pode conhecer várias informações sobre o procedimento pretendido, nomeadamente o preço, unidade hospitalar e descrição da intervenção sem qualquer compromisso. Após aprovação da proposta apresentada, é iniciado o plano de viagem, podendo ainda conhecer o médico previamente e receber alguns conselhos clínicos ou pedir informações antes de viajar. Aquando da chegada a Portugal é recebido por um colaborador devidamente credenciado que o levará ao Hospital ou Hotel, mediante plano de viagem.

A gestão e a operacionalização logística de todo o processo relacionado com o circuito do cliente, nomeadamente no que concerne à articulação entre todos os intervenientes e à articulação do setor saúde com o setor do turismo fica a cargo da THE - Travel Health Experience. É, também, da sua responsabilidade providenciar a assistência e os cuidados pré ou pós-hospitalares e promover a manutenção do site oficial através do qual será possível desencadear todo o processo de prestação do serviço pretendido. 

Alegria no trabalho, pois. Mas como?