Guest guest Posted October 16, 2011 Report Share Posted October 16, 2011 History should not repeat it's self. By medical standards a study done in 2003 is many times a new study. In fact many studies guiding treatments are much older then 2003. Why would we look at 12 yr old data based on incorrectly obtained BP measurements if our local VA Hospital is any indication? Hopefully to bring about some changes to improvements VA health care. As this statement says The VA/DOD can choose to not follow JNC-8 guidelines. This VA/DoD guideline for Hypertension update is generally in concordance with most other revised national and international guidelines though some differences remain, where noted. VA is for all that have served not just for war time Vets. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2011 Report Share Posted October 16, 2011 From the VA guidelines. Since the results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest hypertension trial, were announced at the end of 2002, there has been a deluge of revised national guidelines. These include those by the World Health Organization (WHO), American Society of Hypertension (ASH), Canadian Hypertension Education Program (CHEP) European society for hypertension and the National Heart Lung and Blood Institutes' Joint National Committee's Seventh Report (JNC 7). Allhat was a web site might want to look at it. http://allhat.sph.uth.tmc.edu/ > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2011 Report Share Posted October 16, 2011 First, let me assure you that I know who the VA Hosptal serves. My mother and father served in WW II. My brother " fought the war " at the Pentagon and my sister " fought the war " at Fort Walton Beach FL. Dad and I were the only ones in a combat theater! My point was since they did NOT do a controlled study and tell me what the distribution was, I had to make an assumption! It is NOT a study of 2003 data. It took them 4 years to gather and publish the data. Here is the evidence: Arch Intern Med. 2003;163:2705-2711 Methods We abstracted 1999 outpatient chart data including visit type, BP measurements, comorbidities, and medication use for 981 randomly selected hypertensive veterans. We examined overall BP control and control in subgroups with diabetes mellitus and renal disease, and compared results with those of a sample of 800 veterans studied from 1990 to 1995. If the VA/DoD elect to not follow JNC-8 you let me know. Since it is written by a panel of experts and reviewed by their peers they better have a real good reason it ignore! In fact, look at who one of the 17 voting members is: The Eight Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) Expert Panel Memberhip Who Writes and Reviews Clinical Guidelines? Expert Panels Expert panels are formed to write clinical practice guidelines for the National Heart, Lung, and Blood Institute. An expert panel is a committee of unpaid experts appointed by the NHLBI. The chair and members are chosen mainly for their scientific and clinical expertise. C. Cushman, M.D. Veterans Affairs Medical Center Memphis, Tennessee IF THE VA CHOOSE TO IGNORE REVIEWING JNC-8 I WILL PERSONALLY CONTACT DR. CUSHMAN RIGHT BEFORE I CONTACT SENS. LEAHY AND SANDERS! - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with Meds. And DASH. . Current BP(last week ave): 125/73 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2011 Report Share Posted October 16, 2011 Francis, let me congratulate - you have now showed us both ends of the spectrum of studies and reviews, IMHO! ALLHAT is an excellent example of how it should be done! they took a large sample, over 50,000 PTN as I recall, and did a controlled study. They then continued with follow-up that if is not still ongoing has only recently ended. I also appreciate the fact that you told me where to find it with a hyperlink instead of replicating the whole study here! IMHO, this discussion has been healthy and may provide an opportunity for us. How about an area in our files pointing to the various studies/trials that we consider important and relevant? We could even have sub-catagories that coexist with HTN and or PA. Let me give an example (and this is only an example, others will probably have better ones but these are some I am working on today to prepare for PCP appt. tomorrow.) SIGNIFICANT STUDIES AND TRIALS HTN - ALLHAT - ALLHAT was the largest antihypertensive trial and the second largest lipid-lowering trial and included large numbers of patients over age 65, women, African-Americans, and patients with diabetes, treated largely in community practice settings. http://allhat.sph.uth.tmc.edu/ - J-Curve - The J-curve between Blood Pressure and Coronary Artery Disease or Essential Hypertension: Exactly How Essential? Franz H. Messerli, MD; Gurusher S. Panjrath, MD http://www.medscape.com/viewarticle/712113 - Third Study - ..... PA - Dr. Grim's Evo of PA -... Point to it in our files (don't copy) -Lab. Investigation of PA - Stowasser et al(list them) address from our file OR actual actual address like ALLHAT & J-Curve as above (I think this may be best and if author changes we delete or enter new address as appropriate. We will know when a user reports a " Not found " .) I have a few others that I'll just mention, again following the above protocal. (These are a few in preparation for PCP meeting which I need to get working on: -ACCORD Study - Effects of Intensive BP Control in T2DM -Inappropriate LVMass in PTN w/PA, Lorenza et al -LVH in Renal Failure, Heidelberg, Germany - Okin et al Regression of Electrocardiographic LVH During Antihypertensive Treatment and the Prediction of Major CV Events. I have 4 or 5 more dealing w/DM and LVH that I won't list today but I think this gives everyone an idea as to what I am thinking. I suggest one person, you Francis, be responsible for updating and removing or archiving as they become obsolete. We may want to consider a 2-step process where an article sits in a holding area for a month to allow for review and on to Permanent if no negatives are reported (Consider letting DR. Grim's recomendations bypass this step!) That's really about as far as I've gotten and I've really got to prepare for PCP Appt. tomorrow. (Study for that annual digital exam!) Comments Everyone? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2011 Report Share Posted October 16, 2011 It would seen the VA choose to do use this study to see how they were doing at DX and treating Hypertension. It seems they as far as the study shows were not doing a very good job with Hypertension. The study was used as a guide to set the guidelines they are now using or what they would expect there providers to be using. If the study is flawed then are the guidelines flawed as well? More likely it isn't the guidelines that are flawed but the providers choose not to follow them. How many of the the following do they do right on you. Based on how they do with me my guess is not many. Any primary care manager/provider (PCM/PCP) can obtain the BP of a patient in any health care setting, (e.g., clinic, doctor's office, emergency room, or hospital). Blood pressure readings may vary depending upon the instrument and technique used, the setting, and patient and provider characteristics. RECOMMENDATION 1. Blood pressure should be measured with a technique using a properly calibrated and validated instrument: & #56256; & #56451; Patient should be seated quietly for 5 minutes with back supported, feet on the floor, and arm bared, unrestricted by clothing, and supported at heart level. Measurement of BP in the standing position may be indicated for patients at risk for postural hypotension or at the discretion of the clinician. & #56256; & #56451; Smoking, exercise, or caffeine ingestion should not have occurred within 30 minutes prior to the BP measurement. & #56256; & #56451; The appropriate blood pressure cuff size should be chosen for the patient. The cuff should be wrapped snugly around the arm with the bladder centered over the brachial artery. The bladder should encircle at least 80% of the arm. For Auscultatory Measurements Only: & #56256; & #56451; Palpated radial pulse obliteration pressure should be used to estimate the systolic BP (SBP). The cuff should then be inflated 20-30 mm Hg above this level for the auscultatory determinations. & #56256; & #56451; Position the stethoscope over the brachial artery and rapidly inflate the cuff. Deflate the cuff at a rate of 2 to 3 mm Hg per second, listening for Phase 1 and Phase 5 Korotkoff sounds. The first appearance of sound (Phase 1) is used to record the SBP. Phase 5, at the disappearance of sound, is the diastolic BP (DBP) in adults. Listen 10 to 20 mm Hg below Phase 5 for any further sound then deflate the cuff completely. & #56256; & #56451; The BP should be recorded in even numbers with the patient's position, arm used, and cuff size documented. & #56256; & #56451; BP readings should be repeated in the same arm and averaged, if different. Two minutes should elapse before repeating the BP measurement. If the readings differ by more than 5 mm Hg, additional measurements should be obtained. 2. Measurements can be taken with a mercury sphygmomanometer, but a recently calibrated aneroid manometer or a validated electronic device is an acceptable alternative. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2011 Report Share Posted October 16, 2011 Thanks for the reference, Francis. I have a copy from the SOP in my folder and it is the first thing I pull out when I explain that we will be using my numbers for BP decisions(noncomplient my ass!) It might be interesting to do a survey to find out how many have clinicians that take BP correctly and the setting and type of person, tech, nuese, MD, PA etc.) > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 FYI the VA has stopped using mercury devices due to the baby with the bathwater approach of reducing mercury in the environment.There is yet no automatic BP device that is better than a trained and certified human (every 6 months) using a stetho and a merucry or other calibrated device (every 6 months). I have seen Hg devices that have been in use over 50 years and are till accurate. They still need to be cleaned every year of so.The VA does us mercury devices in its research projects I am told by Dr.Cushman who I know well.If BP is not done properly all else we are doing for BP is built on an base of sand-you want it on a bed of mercury.CE Grim MDOn Oct 16, 2011, at 9:35 PM, Francis Bill SUSPECTED PA wrote: It would seen the VA choose to do use this study to see how they were doing at DX and treating Hypertension. It seems they as far as the study shows were not doing a very good job with Hypertension. The study was used as a guide to set the guidelines they are now using or what they would expect there providers to be using. If the study is flawed then are the guidelines flawed as well? More likely it isn't the guidelines that are flawed but the providers choose not to follow them. How many of the the following do they do right on you. Based on how they do with me my guess is not many. Any primary care manager/provider (PCM/PCP) can obtain the BP of a patient in any health care setting, (e.g., clinic, doctor's office, emergency room, or hospital). Blood pressure readings may vary depending upon the instrument and technique used, the setting, and patient and provider characteristics. RECOMMENDATION 1. Blood pressure should be measured with a technique using a properly calibrated and validated instrument: & #56256; & #56451; Patient should be seated quietly for 5 minutes with back supported, feet on the floor, and arm bared, unrestricted by clothing, and supported at heart level. Measurement of BP in the standing position may be indicated for patients at risk for postural hypotension or at the discretion of the clinician. & #56256; & #56451; Smoking, exercise, or caffeine ingestion should not have occurred within 30 minutes prior to the BP measurement. & #56256; & #56451; The appropriate blood pressure cuff size should be chosen for the patient. The cuff should be wrapped snugly around the arm with the bladder centered over the brachial artery. The bladder should encircle at least 80% of the arm. For Auscultatory Measurements Only: & #56256; & #56451; Palpated radial pulse obliteration pressure should be used to estimate the systolic BP (SBP). The cuff should then be inflated 20-30 mm Hg above this level for the auscultatory determinations. & #56256; & #56451; Position the stethoscope over the brachial artery and rapidly inflate the cuff. Deflate the cuff at a rate of 2 to 3 mm Hg per second, listening for Phase 1 and Phase 5 Korotkoff sounds. The first appearance of sound (Phase 1) is used to record the SBP. Phase 5, at the disappearance of sound, is the diastolic BP (DBP) in adults. Listen 10 to 20 mm Hg below Phase 5 for any further sound then deflate the cuff completely. & #56256; & #56451; The BP should be recorded in even numbers with the patient's position, arm used, and cuff size documented. & #56256; & #56451; BP readings should be repeated in the same arm and averaged, if different. Two minutes should elapse before repeating the BP measurement. If the readings differ by more than 5 mm Hg, additional measurements should be obtained. 2. Measurements can be taken with a mercury sphygmomanometer, but a recently calibrated aneroid manometer or a validated electronic device is an acceptable alternative. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE%20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 See our article in our files there are a number of references in it on BP errors. I have a review I am working on. I have asked 100's of Drs if they have EVER had anyone listen to them with a double stethoscope to see if they could hear accurately. Most never have unless they are among the prob 5000 Drs I have taught and listened with.CE Grim MD Thanks for the reference, Francis. I have a copy from the SOP in my folder and it is the first thing I pull out when I explain that we will be using my numbers for BP decisions(noncomplient my ass!) It might be interesting to do a survey to find out how many have clinicians that take BP correctly and the setting and type of person, tech, nuese, MD, PA etc.) > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE%20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 You and I can only base the VA medical system on one medical center. By rights it should be one of top VA Medical centers there are. Being part of the Dartmouth medical system it should have access to many top medical minds. For me I don't think this is the case. A recent posting on the main VA web site showed photos of the top ten centers. Ours isn't one of them. Of course they didn't name any of the centers or even there rating and don't seen to have a list of where any centers are in there rating. One thing seem to to be true our VA isn't doing as they should in the B/P department. I would expect that you are reading the VA guidelines and can judge how well they are being followed. Of course there is statment so provider can say that is what they are doing. In addition, the reader is reminded that this document is intended as a guideline and should not supersede the clinical judgment of the health care provider. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 In the VA list I can give some. Patient should be seated quietly for 5 minutes with back supported, feet on the floor, and arm bared, unrestricted by clothing, and supported at heart level Don't every think they have me set 5 min before taking B/P in fact don't think per Dr nurse thing takes 5 min. only time B/p is taking with arms bared is during summer and I have short sleeve shirt on. Smoking, exercise, or caffeine ingestion should not have occurred within 30 minutes prior to the BP measurement. Don't smoke and mostlikey wouldn't drink caffeine within 30 min. but the exercise part can not be avoided. From parking lot you walk up hill to get to bulding. Many Vets have to stop and rest on the hill. you go to check in and most of the time you are seeing the nurse within 10 min. The appropriate blood pressure cuff size should be chosen for the patient. The cuff should be wrapped snugly around the arm with the bladder centered over the brachial artery. The bladder should encircle at least 80% of the arm. For Auscultatory Measurements Only: I need the big cuff but they try to use the standed cuff. Since the standed cull isn't quite big enough doesn't stay snug and they will put there hand on cuff to help it stay on. The BP should be recorded in even numbers with the patient's position, arm used, and cuff size documented. Position the stethoscope over the brachial artery and rapidly inflate the cuff. Deflate the cuff at a rate of 2 to 3 mm Hg per second, listening for Phase 1 and Phase 5 Korotkoff sounds. The first appearance of sound (Phase 1) is used to record the SBP. Phase 5, at the disappearance of sound, is the diastolic BP (DBP) in adults. Listen 10 to 20 mm Hg below Phase 5 for any further sound then deflate the cuff completely This one most of the time doesn't apply as they use automatic device. By Dr Grim Standards one should never have both numbers be even. BP readings should be repeated in the same arm and averaged, if different. Two minutes should elapse before repeating the BP measurement. If the readings differ by more than 5 mm Hg, additional measurements should be obtained. 2. Measurements can be taken with a mercury sphygmomanometer, but a recently calibrated aneroid manometer or a validated electronic device is an acceptable alternative. Do think they have ever did two readings and averaged them. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification > > to let you know that > > > > > > > > > > > > > > > > > a file has been uploaded to the Files > > area of the hyperaldosteronism > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR > > HYPERTENSION.pdf > > > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for > > your group, please visit: > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 Francis, I had my BP taken correctly exactly once at the VA... Gigi, a nurse on Team 4 did it and Dr. Grim and I awarded her a box of dark chocolate! Dr. Webster loved it but I don't know that it changed any procedures! Have you ever had them take BP with the cuff positioned below your elbow? I did because they " couldn't find a large cuff " ! I fixed that for Team 4 by asking Dr. Webster if I could buy them one! (They had a brand new one the next time I went!) - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with Meds. And DASH. . Current BP(last week ave): 125/73 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification > > > to let you know that > > > > > > > > > > > > > > > > > > a file has been uploaded to the Files > > > area of the hyperaldosteronism > > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR > > > HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for > > > your group, please visit: > > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 Francis, can you point me to the main VA web site? (I want to see those pictures.) The political blood is starting to flow thru my veins and I am going to see if I can make any changes! Thanks. - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with Meds. And DASH. . Current BP(last week ave): 125/73 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 This is the main site http://www.va.gov/ There is the site where the pictures are now. http://www.blogs.va.gov/VAntage/4622/va-medical-centers-make-top-performers-list\ / > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 Not sure what this award is all about but I checked the top 14% in VT, NH, and MA and didn't see any major hospitals. Wonder if it is a Record Keeping/Reporting issue. I'd like to see a ranking of all VA hospitals but don't want to pay for it! (Would rather they use that money cor PTN care! > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2011 Report Share Posted October 17, 2011 Can find out more here http://www.jointcommission.org/ > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 On Oct 17, 2011, at 11:35 AM, Francis Bill SUSPECTED PA wrote: In the VA list I can give some. Patient should be seated quietly for 5 minutes with back supported, feet on the floor, and arm bared, unrestricted by clothing, and supported at heart level Don't every think they have me set 5 min before taking B/P in fact don't think per Dr nurse thing takes 5 min. only time B/p is taking with arms bared is during summer and I have short sleeve shirt on. Smoking, exercise, or caffeine ingestion should not have occurred within 30 minutes prior to the BP measurement.The reason that is given for not having the pt rest is: "WE DONT HAVE ENOUGH TIME". I have yet to be seen within 5 minutes of my BP being measured so there is lots of time before the Dr. gets there. Don't smoke and mostlikey wouldn't drink caffeine within 30 min. but the exercise part can not be avoided. From parking lot you walk up hill to get to bulding. Many Vets have to stop and rest on the hill. you go to check in and most of the time you are seeing the nurse within 10 min. The appropriate blood pressure cuff size should be chosen for the patient. The cuff should be wrapped snugly around the arm with the bladder centered over the brachial artery. The length and width of the bladder in the cuff. bladder should encircle at least 80% of the arm. For Auscultatory Measurements Only: I need the big cuff but they try to use the standed cuff. Since the standed cull isn't quite big enough doesn't stay snug and they will put there hand on cuff to help it stay on. One must measure the arm circumference properly to select the cuff but this is almost never done in the VA except for research studies. This suggests the VA is more interested in research BP being really accurate but dont really care about the vets. This is not unique to the VA however. The BP should be recorded in even numbers with the patient's position, arm used, and cuff size documented. Position the stethoscope over the brachial artery and rapidly inflate the cuff. Deflate the cuff at a rate of 2 to 3 mm Hg per second, listening for Phase 1 and Phase 5 Korotkoff sounds. The first appearance of sound (Phase 1) is used to record the SBP. Phase 5, at the disappearance of sound, is the diastolic BP (DBP) in adults. Listen 10 to 20 mm Hg below Phase 5 for any further sound then deflate the cuff completely This one most of the time doesn't apply as they use automatic device. And if an auto device is used the numbers should end in even numbers 1/2 time. By Dr Grim Standards one should never have both numbers be even. BP readings should be repeated in the same arm and averaged, if different. Two minutes should elapse before repeating the BP measurement. If the readings differ by more than 5 mm Hg, additional measurements should be obtained. 2. Measurements can be taken with a mercury sphygmomanometer, but a recently calibrated aneroid manometer or a validated electronic device is an acceptable alternative.BP should be measured in the arm with the highest BP.I have had patients with a 100 mm Hg difference between their 2 arms. 120 systolic on one side and 220 on the other. The pt could not understand what I was talking about when I told him he had severe HTN. He said but doc sometimes my BP is normal and sometimes very high. Duh! one time they would use L and next time R. Do think they have ever did two readings and averaged them. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification > > to let you know that > > > > > > > > > > > > > > > > > a file has been uploaded to the Files > > area of the hyperaldosteronism > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR > > HYPERTENSION.pdf > > > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE%20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for > > your group, please visit: > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 In fact I have had pts so large that no cuff will fit their arm. This is when I put a cuff on the forearm and do a palpated pressure.Or stick a needle in the artery to measure the BP.CE Grim MD Francis, I had my BP taken correctly exactly once at the VA... Gigi, a nurse on Team 4 did it and Dr. Grim and I awarded her a box of dark chocolate! Dr. Webster loved it but I don't know that it changed any procedures! Have you ever had them take BP with the cuff positioned below your elbow? I did because they "couldn't find a large cuff"! I fixed that for Team 4 by asking Dr. Webster if I could buy them one! (They had a brand new one the next time I went!) - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with Meds. And DASH. . Current BP(last week ave): 125/73 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification > > > to let you know that > > > > > > > > > > > > > > > > > > a file has been uploaded to the Files > > > area of the hyperaldosteronism > > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR > > > HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE%20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for > > > your group, please visit: > > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 I think the VA is very good at tooting its own horn. Not as good at providing the best Medical care they can. Of course I haven't been to impressed with Dartmouth the last few times I have been there. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification to let you know that > > > > > > > > > > > > > > > > > > > > > a file has been uploaded to the Files area of the hyperaldosteronism > > > > > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > Uploaded by : georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for your group, please visit: > > > > > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 I suspect you are doing it the " old fashion way " and using a stethocope so YOU can tell what is going on without relying on a couple Duracells! - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with Meds. And DASH. . Current BP(last week ave): 131/76 HR 60 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a > > notification > > > > > to let you know that > > > > > > > > > > > > > > > > > > > > a file has been uploaded to the > > Files > > > > > area of the hyperaldosteronism > > > > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR > > > > > HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > Uploaded by : georgewbill > > <georgewbill@> > > > > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the > > URL: > > > > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing > > for > > > > > your group, please visit: > > > > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 Do agree none of the problems listed here are unique to the VA. VA just has better data to show how well there are not doing. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification > > > > to let you know that > > > > > > > > > > > > > > > > > > > a file has been uploaded to the > > Files > > > > area of the hyperaldosteronism > > > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR > > > > HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > Uploaded by : georgewbill > > <georgewbill@> > > > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for > > > > your group, please visit: > > > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 I think we have more people " looking over the shoulder " of the VA hence their " dirty laundry " gets aired more frequently. (The government has too many bean counters, IMO) If you compare the local VA to other hospitals you can see major differences. VA - all levels of care from sliver to MI etc. Other - generally critical care. VA - demographics (primarily age) Other - all ages (younger is usually healthier). VA - lab tests are usually approved Other - must be approved practice according to ins. And the list goes on! - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with Meds. And DASH. . Current BP(last week ave): 131/76 HR 60 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This email message is a notification > > > > > to let you know that > > > > > > > > > > > > > > > > > > > > a file has been uploaded to the > > > Files > > > > > area of the hyperaldosteronism > > > > > > > > > > > > > > > > > > > > group. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > File : /VA CLINICAL GUIDELINE FOR > > > > > HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > Uploaded by : georgewbill > > > <georgewbill@> > > > > > > > > > > > > > > > > > > > > Description : > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > You can access this file at the URL: > > > > > > > > > > > > > > > > > > > > http://groups.yahoo.com/group/hyperaldosteronism/files/VA%20CLINICAL%20GUIDELINE\ %20FOR%20HYPERTENSION.pdf > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > To learn more about file sharing for > > > > > your group, please visit: > > > > > > > > > > > > > > > > > > > > http://help.yahoo.com/l/us/yahoo/groups/original/members/web/index.html > > > > > > > > > > > > > > > > > > > > Regards, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > georgewbill <georgewbill@> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2011 Report Share Posted October 18, 2011 And should be able to implement programs that make it better. And see it get better or not. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension Do agree none of the problems listed here are unique to the VA. VA just has better data to show how well there are not doing. > > > > > > > > > > > > First, let me assure you that I know who the VA Hosptal > > serves. > > > > My mother and father served in WW II. My brother "fought the > > war" at > > > > the Pentagon and my sister "fought the war" at Fort Walton Beach > > FL. > > > > Dad and I were the only ones in a combat theater! My point was > > since > > > > they did NOT do a controlled study and tell me what the > > distribution > > > > was, I had to make an assumption! > > > > > > > > > > > > It is NOT a study of 2003 data. It took them 4 years to gather > > > > and publish the data. Here is the evidence: > > > > > > > > > > > > Arch Intern Med. 2003;163:2705-2711 > > > > > > Methods We abstracted 1999 outpatient chart data including > > visit > > > > type, BP measurements, comorbidities, and medication use for 981 > > > > randomly selected hypertensive veterans. We examined overall BP > > > > control and control in subgroups with diabetes mellitus and renal > > > > disease, and compared results with those of a sample of 800 > > veterans > > > > studied from 1990 to 1995. > > > > > > > > > > > > If the VA/DoD elect to not follow JNC-8 you let me know. Since > > > > it is written by a panel of experts and reviewed by their peers > > they > > > > better have a real good reason it ignore! In fact, look at who one > > > > of the 17 voting members is: > > > > > > > > > > > > The Eight Report of the Joint National Committee on > > Prevention, > > > > Detection, Evaluation, and Treatment of High Blood Pressure (JNC > > 8) > > > > > > Expert Panel Memberhip > > > > > > > > > > > > Who Writes and Reviews Clinical Guidelines? > > > > > > Expert Panels > > > > > > Expert panels are formed to write clinical practice guidelines > > > > for the National Heart, Lung, and Blood Institute. An expert panel > > > > is a committee of unpaid experts appointed by the NHLBI. The chair > > > > and members are chosen mainly for their scientific and clinical > > > > expertise. > > > > > > > > > > > > C. Cushman, M.D. > > > > > > Veterans Affairs Medical Center > > > > > > Memphis, Tennessee > > > > > > > > > > > > IF THE VA CHOOSE TO IGNORE REVIEWING JNC-8 I WILL PERSONALLY > > > > CONTACT DR. CUSHMAN RIGHT BEFORE I CONTACT SENS. LEAHY AND > > SANDERS! > > > > > > > > > > > > - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with > > > > previous rt. flank pain. Treating with Meds. And DASH. . Current > > > > BP(last week ave): 125/73 > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, > > > > and PTSD. > > > > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 7.5 MG, Metoprolol > > > > Tartrate 200 MG, 81mg asprin, Metformin 2000MG and > > Spironolactone 50 Quote Link to comment Share on other sites More sharing options...
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