Medicalpreuneur

         Medicalpreuneur bermakna seseorang tenaga medis mampu mengorganisir kegiatan (bisnis) dan berani menghadapi resiko dan ketidakpastian. Mereka juga harus selalu berpikir kreatif untuk memecahkan segala permasalahan yang muncul. Sebagai contoh seorang dokter, disamping harus mampu membuat diagnosis, seorang dokter juga harus mampu memberikan terapi yang paling tepat buat pasien. Ilmu yang diberikan di bangku kuliah kedokteran, kadang belum cukup untuk menghadapi permasalahn pasien yang semakin berkembang. 
        Saat ini telah berkembang pesat cara-cara diagnosis dan terapi yang beragam. Jika pasien datang dengan keluhan panas badan, maka dokter harus berpikir penyebab panas, apakah dari infeksi atau dehidrasi. Selain diagnosis dan terapi, maka agar diagnosis atau terapinya tepat, perlu kreatifitas, misalnya dalam menggali permasalahan yang dihadapi pasien, dokter harus pandai mengorek keterangan dari pasien, suatu hal yang kadang  tidak bisa didapat dari bangku kuliah. Dalam terapi, dokter juga harus berpikir bagaimana obat yang diberikan dapat diminum dengan mudah oleh pasien. Misalnya dalam bentuk sediaan obat, rasa yang enak, dan harga yang sesuai dengan pasien. Pemikiran-pemikiran itu tidak jarang muncul di lapangan yang notabene tidak didapat dari kuliah.  
       Dokter juga manusia yang punya hobby tertentu yang dapat dikembangkan. Kadang berkutat dengan pasien dapat menimbulkan rasa kebosanan. Untuk itu diperlukan sarana refreshing yang menyenangkan bagi dokter tersebut. Dokter bisa mengembangkan hobby atau bakat yang dimiliki, misalnya dengan bermain musik atau melakukan olahraga kesenangannya. Bisa juga dokter melakukan kegiatan bisnis dengan membuka klinik kebugaran atau klinik kesehatan, yang mana klinik tersebut laris oleh masyarakat yang merasakan keuntungan dengan memeriksa di klinik tersebut. 

  

Medical Entrepreneurship: A New Movement to Accelerate Cures

There is a new social entrepreneurial movement afoot, which seeks to find cures to some of the world's most challenging diseases. Medical entrepreneurship is, in my view, the very best hope we have for accelerating the pace of finding medical cures. A good example and arguably the pioneer of this movement is Michael Milken's Prostate Cancer Foundation. Milken has taken on a decidedly entrepreneurial approach to providing capital and human resources to accelerate the pace of research into cures for cancer, particularly that of the prostate. From 1999 to 2006 we have seen a 25% drop in the death rate for prostrate cancer. There is little doubt that Milken's leadership has been one of the greatest catalysts in this improvement.

Another leader in the movement is Henry McCance, who co-founded the not-for-profit Cure Alzheimer's Fund, which I first wrote about last year. The Cure Alzheimer's Fund is another example of a cure accelerator, an organization using a venture approach towards medical research. Out of full disclosure, I recently joined the Cure Alzheimer's Fund's advisory board. And while I care deeply about diseases such as Alzheimer's, I am mostly fascinated and hopeful that a more maverick VC-like business model applied to the search for medical cures will be a better approach to solving some of the big medical challenges we have.

The medical research model as we know it today is broken. Why? Three words: insufficient, inefficient, and ineffective. This is both the big problem and the big opportunity for medical entrepreneurship. Today's model is insufficient because typically 1% or less of the amount spent each year on diseases goes towards cure research, with the balance going to caring for people with the disease. Alzheimer's, for example, costs our country hundreds of millions of dollars each year, yet we spend just one cent out of every $4.00 available towards a cure. That is an astonishing 400x delta. The story is similar for diabetes and cystic fibrosis. While care is obviously critical, we need more dollars to go to finding the cure — or the country is at great risk of a healthcare-induced bankruptcy. Henry McCance and Professor Bill Sahlman of Harvard Business School recently gave an excellent overview of this at Venture Summit East and I draw on many elements of their talk in this blog post. 

The current research model is highly inefficient because researchers spend too much time writing grants. By our estimates at the Cure Alzheimer's Fund, the very best researchers in the field spend up to 30% of their time writing grants, and should they win the grant they may have to wait months or even a year to get the funding. As well-intended and needed are organizations such as NIH (National Institute of Health), there is an embedded trade-off between the robustness of review and the approval of grants to new and innovative projects. Imagine any venture capitalist going to Netscape or Yahoo to validate funding to Google or expecting an entrepreneur to spend a third of his time writing a business plan and then waiting a year for funding. This is the frustration that many of the best researchers in our country feel.

Finally, the medical research model is ineffective because it is, by design, risk averse with regard to the projects it pursues. Grant proposals that win funding are usually those that seek out small, incremental discoveries — it is the very nature and policy of the grant making bodies to look for ideas that slowly build on existing knowledge. Breakout ideas are not able to happen under an incrementalist research model. Even worse, as we've heard anecdotally from some researchers, some people write grants for questions whose answers are already known.

Pioneers of the medical entrepreneurship movement are taking bigger risks on researchers, asking them to focus their energies on the initiatives that have the largest potential impact as opposed to those that would get traditional grant funding. They are also doing so faster. Milken's Prostate Cancer Foundation, for example, makes awards based on applications that are limited to five pages and has a 90-day turn-around time. FasterCures has become a think tank and resource-sharing center for this new approach.

Focus on the big ideas that can lead to the big goal of curing a disease, eliminate bureaucracy, and give smart people more capital, faster, and you have a formula for change. What proof exists that the change is positive? Thousands of lives have been saved by the advances in prostate cancer understanding by medical innovators in that field. The Cure Alzheimer's Fund was recognized last year by Time Magazine for one of the top ten medical breakthroughs of the year for work that identified over 100 genes associated with the disease. A number of other dynamic organizations, including the Harvard Stem Cell Initiative and the Myelin Foundation are making significant contributions to cures.

Across multiple diseases, researchers have been conditioned to make progress with bond-like returns. While some of this is necessary, it cannot be sufficient. As in any portfolio, we cannot maximize returns if we hold all our eggs in one big conservative basket. We need to invest more behind higher risk initiatives that can yield equity-like returns, and hopefully real cures.

Anthony Tjan is CEO, Managing Partner and Founder of the venture capital firm Cue Balland vice chairman of the advisory firm Parthenon.

Rumah pertama

      Jarak rumah yang kutempati sewaktu bekerja di Puskesmas dulu dengan Puskesmas tempatku bekerja, kira-kira 25 km. Jarak tersebut ditempuh dengan kendaraan bermotor kira-kira dalam waktu 45 menit. Jadi, setiap hari waktuku habis di jalanan kira-kira 1,5jam. Hhufff..cukup melelahkan juga..Terpikir olehku untuk pindah rumah sekaligus memiliki rumah sendiri. Aku tidak mau mencari kontrakan, karena menurutku, uang bayar kontrakan rumah, lebih baik dipakai untuk menyicil sebuah rumah. Maka jadilah aku berburu perumahan terdekat dari tempat kerja. 

       Setelah berkeliling mencari rumah, kutemukan perumahan yang paling dekat dengan Puskesmas tempatku kerja. Perumahan tersebut kira-kira 15 menit perjalanan.  Tidak besar sih..Type yang ditawarkan adalah type 36, 45, dan 60 m2. Aku tanya ke pengembangnya ternyata semua unit sudah laku terjual. pengembang menyarankan menunggu tahap berikutnya. Ya sudah..akupun pulang aja.Sampai di rumah, aku di telpon dari pengembang kalo ada konsumen yang batal. Wah..kalo sudah rejeki memang nggak kemana. 

        Akhirnya jadi deh punya rumah sendiri walaupun kecil dan bayar pake KPR. Rumah itu type 45/105 harganya tahun 1995 cuma 12 juta. Type 45 terdiri dari 2 kamar tidur, 1 kamar mandi, 1 ruang tamu dan 1 ruang keluarga. Di samping, belakang masih tersisa tanah di belakang buat jemuran, di samping buat parkir motor. Yah..cukuplah untuk hidup bujangan. Rumahku dijual lima tahun kemudian laku 100 juta...wuaahh..aku sendiri sampai kaget juga, rumahku laku 100juta.

Menolong persalinan

          Setelah selesai pendidikan dokter tahun 1995, aku bertugas di Puskesmas Ngemplak 1 Sleman sebagai dokter ke-3. Di situ ada dokter kepala perempuan,1 dokter umum dan 1 dokter gigi. Wah..banyak juga ya dokternya. Maklumlah, di Puskesmas tersebut melayani rawat inap dan persalinan. Jaman saya dulu belum ada yang namanya internship alias magang setahun setelah lulus menjadi dokter. Yang ada waktu itu adalah peraturan PTT atau pegawai tidak tetap selama 3 tahun, dan mendapatkan gaji berdasarkan lokasi PTT. Puskesmas tempat PTT ku termasuk kriteria biasa, dengan honor 500 ribu/bulan. Lumayanlah honor sebesar itu pada tahun 1995, karena untuk bayar cicilan rumah saja masih 140 ribu/bulan.
          Bekerja di puskesmas rawat inap ternyata menyenangkan juga. Kebetulan juga puskesmas tersebut termasuk Puskesmas percontohan sekabupaten Sleman. seringnya maju lomba, entah lomba paramedis, lomba desa teladan, lomba kepala desa teladan, sampai lomba dokter Puskesmas teladan. Meskipun banyak kegiatan, tetapi rasanya santai aja. Pagi hari apel pagi, maksudnya adalah petemuan pagi membahas kegiatan hari itu dan laporan pasien rawat inap atau permasalahan yang ada. Selesai apel pagi, acara bebas hehe...Beabas sesuai jadwal sih..biasanya ke poloklinik meriksa pasien yang datang. Kalo tidak jadwalnya, maka tugasnya jaga di rawat inap, dengan pasien yang selalu full book.
          Melayani pasien pertama kali kayak belajar naik sepeda. Walaupun sudah lulus dokter, namun rasanya grogi juga nih..Beruntung paramedis di situ sudah senior semua. Mereka malah mengajari cara menghadapi pasien dengan penuh keramahtamahan hihi..Ada pasien yang hampir tiap hari periksa ke poliklinik. Seorang perempuan remaja. Entah keluhan pusing, pegel-pegel, wuah..nggak sembuh-sembuh deh pokoknya. Tapi anehnya, pasien tersebut malah seperti enjoy aja periksa. Kata perawatnya sih, mungkin pingin ketemu dokternya yang masih bujang dan ganteng hehe..maklumlah, baru kali itu ada dokter laki-laki (hehe..GR dikit lah..).
          Tantangan lain bekerja di puskesmas Ngemplak adalah menolong pasien melahirkan. Walaupun bidan di situ sudah senior dan mahir, tapi mereka tetap menghormati dokternya (padahal dokternya juga baru lulus). Para bidan jaga akan selalu meminta tolong pada dokter yang jaga bila ada pasien mau melahirkan. saat itu masih jam 9 pagi, aku bertugas di rawat inap. Ada pasien in partu sudah bukaan 9. wah..sebentar lagi mau melahirkan nih..Bener saja, selang 10 menit pasien sudah mengerang kesakitan. Aku periksa (dengan sedikit grogi, karena baru pertama itu aku menolong persalinan setelah bener-bener jadi dokter) pembukaannya sudah lengkap. Segera saja bidan kupanggil untuk mendampingiku menolong persalinan. Dengan semangat dan profesional yang tinggi, akhirnya bayi lahir dengan selamat, dan ibunya bisa tersenyum puas. Dokternya juga tersenyum puas juga karena persalinan perdana. Hehe..begini to rasanya jadi dokter..

Corticosteroid Injections for Osteoarthritis

Even in a small joint, osteoarthritis can have a big impact on your life if it means you can’t hold a pencil, knit, or engage in other activities that you enjoy or need to do. Having a stiff or sore knee can really impact your quality of life, making it hard to get around. Getting a shot of corticosteroids directly into a sore joint can reduce pain and inflammation quickly and effectively.

Corticosteroids are related to hormones naturally made in your adrenal glands. Corticosteroid injections are often referred to as steroid shots or injections.

Corticosteroid shots relieve inflammation faster and more directly than traditional anti-inflammatory medications taken by mouth. And a single injection doesn’t cause side effects such as stomach upset, which often go along with those drugs. Corticosteroids can also be taken by mouthor intravenously to relieve inflammation throughout the body, but when injected into a joint, their effects -- good and bad -- are mostly limited to that joint.

Getting a Corticosteroid Injection: What to Expect

Most injections into the knee or a smaller joint, like that at the base of the thumb, are simple procedures that can be done in a doctor’s office. When performed by an experienced physician, the injection is only mildly uncomfortable.

First, the doctor cleans the skin in the area with Betadine or other antiseptic. If the joint is puffy and filled with fluid, the doctor may insert a needle into the joint to withdraw the excess fluid and examine it. Removing the fluid rapidly relieves pain also, because it reduces pressure in the joint and may expedite healing. Next, the doctor uses a different needle to inject the corticosteroid into the joint.

People feel almost immediate relief after an injection because the corticosteroid is usually mixed with a local anesthetic. Several hours later, the corticosteroid begins to relieve inflammation. The relief usually lasts from several weeks to several months.

Injecting a large joint, such the hip, is more complicated and may require radiologic imaging to help the doctor guide the needle into the joint. Experienced rheumatologists, orthopedists, anesthesiologists, and radiologists may inject the facet joints of the lower spine.

What are the Risks of Corticosteroid Injections?

Despite their benefits, corticosteroids are associated with a range of potentially dangerous side effects, including increased risk of infection, weight gain, gastrointestinal ulcers and bleeding, osteoporosis, elevated blood pressure and blood glucose levels, and eye problems, including cataracts and glaucoma.

Injecting corticosteroids directly into a joint minimizes or eliminates most of these side effects. However, there are some special, though uncommon, risks of joint injection. They include:

• Injury to the joint tissues, particularly with repeated injections
• Thinning of joint cartilage
• Weakening of the ligaments of the joint
• Increased inflammation in the joint caused by a corticosteroid that has crystallized
• Irritation of the nerves, caused by the needle during an injection or by the medication
• Introduction of infection into the joint
• Whitening of the skin or local thinning of the skin at the injection site

Frequent corticosteroid injections may lead to joint damage. If you have an infection in or around a joint or you’re allergic to one or more of the drugs that are injected, you should not get a joint injection.

WebMD Medical Reference

By Mary Anne Dunkin

Reviewed By Louise Chang, MD

Three Lifesaving Steps If Clothes are Burning

If clothes catch fire they can spread very quickly, engulfing the victim in flames. Certain types of clothing, especially synthetic fabrics, may melt and stick to skin. The best way to reduce injury from the flames is to extinguish the burning fabric as quickly as possible.

To put out burning clothing, take these three steps: Stop Don't run or wave your arms. Movement will fan the flames and cause the burns to be more severe. Drop Get on the ground quickly and cover your face with your hands. Roll Try to smother the flames by rolling over and over. Pay attention to what's burning and focus on putting out that area of your body.

It's helpful to roll up into a rug or thick, nonflammable material (such as tent canvas) to help smother the flames. Don't roll into a thin blanket, sheet or plastic because you may accidentally catch that material on fire also.

Others can help you douse the flames by patting the fire with their hands or other material. Use water or a fire extinguisher to put out the fire if one is available.

As soon as the fire is out, cool the area and treat any burns. Call 911 for any burns that resulted from flaming clothing.

2010 CPR Guidelines

After a review of the available research published over a 5 year period, the American Heart Association released its 2010 CPR Guidelines. As expected, the focus for CPR is on good quality chest compressions. Here are the differences between the 2005 and the 2010 CPR Guidelines: A-B-C is for babies; now it's C-A-B! It used to be follow your ABC's: airway, breathing and chest compressions. Now, Compressions come first, only then do you focus on Airway and Breathing. The only exception to the rule will be newborn babies, but everyone else -- whether it's infant CPR, child CPR or adult CPR -- will get chest compressions before you worry about the airway. Why did CPR change from A-B-C to C-A-B? No more looking, listening and feeling. The key to saving a cardiac arrest victim is action, not assessment. Call 911 the moment you realize the victim won't wake up and doesn't seem to be breathing right. Trust your gut. If you have to hold your cheek over the victim's mouth and carefully try to detect a puff of air, it's a pretty good bet she's not breathing very well, if at all. I have a secret to share: paramedics have been doing it this way for years. Rarely have I seen an EMT or a paramedic put her ear to a victim's nose and listen for air movement. We just get to work. Push a little harder. How deep you should push on the chest has changed for adult CPR. It was 1 1/2 to 2 inches, but now the Heart Association wants you to push at least 2 inches deep on the chest. Push a little faster. AHA changed the wording here, too. Instead of pushing on the chest at about 100 compressions per minute, AHA wants you to push at least 100 compressions per minute. At that rate, 30 compressions should take you 18 seconds. Besides the changes under the 2010 CPR Guidelines, AHA continues to emphasize some important points: Hands Only CPR. This is technically a change from the 2005 Guidelines, but AHA endorsed this form of CPR in 2008. The Heart Association still wants untrained lay rescuers to do Hands Only CPR on adult victims who collapse in front of them. My biggest problem with this campaign is what's left unsaid. What does AHA want untrained lay rescuers to do with all the other victims? In other words, what do you do with the victims that aren't adults or that didn't collapse right in front of you? AHA doesn't provide an answer, but I have a suggestion: Do Hands Only CPR, because doing something is always better than doing nothing. Recognize sudden cardiac arrest. CPR is the only treatment for sudden cardiac arrest and AHA wants you to notice when it happens. Don't stop pushing. Every interruption in chest compressions interrupts blood flow to the brain, which leads to brain death if the blood flow stops too long. It takes several chest compressions to get blood moving again. AHA wants you to keep pushing as long as you can. Push until the AED is in place and ready to analyze the heart. When it is time to do mouth to mouth, do it quick and get right back on the chest.

Source: Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O’Connor RE, Shuster M, Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL. "Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Circulation. 2010;122(suppl 3):S640–S656.

How can I tell if someone is in anaphylactic shock?

There are two important ways to tell if someone is suffering from anaphylactic shock. First, by identifying the symptoms of anaphylactic shock. Second, by identifying the exposure to an allergen that causes anaphylactic shock.

Symptoms of Anaphylactic Shock Anaphylactic shock is primarily an allergic reaction. To identify anaphylactic shock, first look for symptoms of allergy: Itching Red, raised, blotchy skin (hives) Wheezing Anaphylactic shock happens when the victim shows signs of low blood pressure: Confusion Weakness Pale color Unconsciousness Anaphylaxis or anaphylactic shock often have symptoms of shortness of breath: Unable to speak more than one or two words Sitting straight up or with hands on knees Gasping for breath Pursing lips to breathe Using neck muscles to take breaths Identify the Allergen It's easier to identify anaphylactic shock if there is a known allergen. For instance, those with allergies to bee stings will usually know they've been stung. Sometimes, however, there is no known allergen and the victim is simply developing symptoms of anaphylaxis. Anyone who's had allergic reactions in the past should be aware of any symptoms -- especially if no allergen has been identified. If you don't know what it is that makes you sick, you don't know when you've been exposed. The situation can give you clues to figure out whether this is anaphylaxis. People with food allergies are more likely to have anaphylaxis while eating -- even when they don't think they're eating the food they are allergic to.

Anaphylactic Shock Treatment Once you've identified an allergic reaction, treatment depends on how bad the reaction is. Simple allergic reaction treatment includes preventing the reaction from developing into anaphylaxis by taking Benadryl. On the other hand, treatment for anaphylaxis or anaphylactic shock may require epinephrine. Source: Krohmer, Jon. First Aid Manual. American College of Emergency Physicians. 2002. New York, NY.