DOCSLIB.ORG

Special Care Units for People with Alzheimer's and Other Dementias: Consumer Education, Research, Regulatory, and Reimbursement Issues

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Special Care Units for People with Alzheimer's and Other Dementias: Consumer Education, Research, Regulatory, and Reimbursement Issues Special Care Units for People With Alzheimer's and Other Dementias: Consumer Education, Research, Regulatory, and Reimbursement Issues August 1992 OTA-H-543 NTIS order #PB92-228444 Recommended Citation: U.S. Congress, Office of Technology Assessment, Special Care Units for People With Alzheimer’s and Other Dementias: Conwmer Education, Research, Regulatory, and Reimbursement Issues, OTA-H-543 (Washington, DC: U.S. Governrnent Printing Office, August 1992). Foreword Several million Americans have Alzheimer’s disease or another disease or condition that causes dementia. As our population ages, the number of people with these devastating diseases and conditions will increase relentlessly. Families take care of individuals with dementia at home for as long as possible, but most individuals with dementia are likely to spend sometime in a nursing home in the often long course of their illness. Until recently, little attention has been paid to the special needs of nursing home residents with dementia. In many nursing homes, they have received and continue to receive inappropriate care that exacerbates their cognitive impairments and behavioral symptoms and further reduces their quality of life. There has been a pervasive feeling that nothing positive can be done for nursing home residents with dementia. More often than nondemented residents, they have been overmedicated and physically restrained. As awareness of Alzheimer’s and other dementing diseases has increased, innovative approaches to caring for people with dementia have been developed. Some experts have recommended that nursing homes establish special units for their residents with dementia. OTA estimates that by 1991, 10 percent of all U.S. nursing homes had established at least one such unit. Special care units promise to provide better care for individuals with dementia than these individuals would receive in nonspecialized nursing home units. On the other hand, existing special care units vary greatly, and many people believe that some special care units are established only for marketing purposes and actually provide nothing special for their residents. This OTA report analyzes the available information about special care units for people with dementia. It discusses ways in which the Federal Government could encourage and support what is positive about special care units and at the same time protect vulnerable patients and their families from special care units that actually provide nothing special for their residents. This is OTA’s third report on Alzheimer’s-related public policy issues. Two previous OTA reports, Losing a Million Minds: Confronting the Tragedy of Alzheimer’s Disease and Other Dementias and Confused Minds, Burdened Families: Finding Help for People With Alzheimer’s and Other Dementias, have focused on biomedical and health services research and other components of the care needed by individuals with dementia. OTA hopes that these reports help to define and clarify the problems raised by Alzheimer’s and other dementias and identify ways in which the Federal Government can assist in solving them. OTA was aided in the preparation of this report by members and staff of the Alzheimer’s Association, staff of the National Institute on Aging, special care unit researchers, State officials, and others. OTA wishes to thank all these individuals. OTA particularly wishes to thank Nancy Mace for her valuable contributions to this and OTA’s two previous reports on Alzheimer’s and other dementias. As with all OTA reports, the content of this report is the sole responsibility of the agency and does not necessarily reflect the views of these individuals or the members of the Technology Assessment Board. AA7# -. /j/ JOHN H. GIBBONS Director Ill. Special Care Units for People With Alzheimer’s and Other Dementias: Consumer Education, Research, Regulatory, and Reimbursement Issues OTA Project Staff Roger C. Herdman, Assistant Director, Health and Life Sciences Division Clyde J. Behney, Health Program Manager Project Staff Katie Maslow, Senior Analyst Kerry Kemp, Division Editor Support Staff Marian Grochowski, Office Administrator Eileen Murphy, P.C. Specialist Kim Holmlund, Word Processing Specialist Kelly Faulks, Secretary Contractors Joan Hyde, University of Massachusetts at Boston Nancy Mace, Pacific Presbyterian Medical Center Contents Page Chapter 1: Overview and Policy Implications . 3 Chapter 2: Nursing Home Residents With Dementia: Characteristics and Problems . 57 Chapter 3: Special Care Units for People With Dementia: Findings From Descriptive Studies . 83 Chapter 4: Special Care Units for People With Dementia: Findings From Evaluative Studies . 111 Chapter 5: Regulations and Guidelines for Special Care Units . 133 Chapter 6: Regulations and Interpretations of Regulations That Interfere With the Design and Operation of Special Care Units . 159 Appendix A: Diseases and Conditions That Cause Dementia . 173 Appendix B: Conceptual and Methodological Issues in Research on Special Care Units . 174 Appendix C: Acknowledgments . 176 References . 178 Chapter 1 Overview and Policy Implications Contents Page INTRODUCTION . 3 Congressional Requests . .. 4 Policy Context . 4 Organization of the Report . 9 NURSING HOMES AND DEMENTIA . 9 The Clinical Syndrome of Dementia . 9 The Prevalence of Dementia . * . 9 Nursing Home Use by Individuals With Dementia . 10 Characteristics of Nursing Home Residents With Dementia . 10 Problems in the Care Provided for Nursing Home Residents With Dementia . 12 Negative Consequences for Nursing Home Residents With Dementia, Their Families, Nursing Home Staff Members, and Nondemented Nursing Home Residents . 14 SPECIAL CARE UNITS . .15 Six Theoretical Concepts of Specialized Dementia Care and Their Implications for Staff Composition and Training and the Individualization of Care . 16 Ideas About Special Care Units From Other Countries . 23 Findings From Research on Special Care Units . 24 THE REGULATORY ENVIRONMENT FOR SPECIAL CARE UNITS . 32 The Nursing Home Reform Provisions of OBRA-87 . 33 Existing State Regulations for Special Care Units . 34 POLICY IMPLICATIONS . .35 Implications for Consumer Education About Special Care Units . 35 Implications for Research on Special Care Units . 37 Implications for Government Regulation of Special Care Units . 39 Implications for Reimbursement for Special Care Units . 42 LEGAL AND ETHICAL ISSUES IN SPECIAL CARE UNITS . ..43 Issues With Respect to Locked Units . 44 Issues With Respect to Admission and Discharge . 44 Issues With Respect to Consent for Research Participation . 45 OTHER ISSUES OF IMPORTANCE TO NURSING HOME RESIDENTS WITH DEMENTIA . 47 The Availability of Physicians’ Services . .47 The Availability of Mental Health Services . 48 The Use of Psychotropic Medications . .49 ALTERNATES TO SPECIAL CARE UNITS . .49 Initiatives To Reduce The Use of Physical Restraints for All Nursing Home Residents. 50 Dementia Training Programs for Nursing Home Staff Members . 50 Specialized Programs for Residents With Dementia in Nonspecialized Nursing Home Units . 51 Specialized Living Arrangements Outside Nursing Homes . 51 CONCLUSION . 52 Boxes BOX Page l-A. A Special Care Unit in Lynden, Washington . 5 l-B. The Development of Excess Disability in a Nursing Home Resident With Dementia. 14 l-C. The Use of Behavioral Interventions With a Nursing Home Resident With Dementia. 18 Chapter 1 Overview and Policy Implications INTRODUCTION prised researchers and others because they were much higher than any previous estimates. Two At least half of all nursing home residents in the studies conducted since then indicate that the true United States have dementia. As awareness of number and proportion of nursing homes with a Alzheimer’s disease and other diseases that cause special care unit are probably somewhat lower dementia has increased in recent years, so have (194,247). On the basis of these studies, OTA complaints and concerns about the quality and estimates that 10 percent of all U.S. nursing homes appropriateness of the care provided for individuals had at least one special care unit in 1991.1 Regard- with dementia by most nursing homes. In response less of the precise figures, however, it is clear that the to these complaints and concerns, some nursing number and proportion of nursing homes with a homes have established a special care unit-that is, special care unit are growing rapidly. a physically separate unit in the nursing home that provides, or claims to provide, care that meets the The proliferation of special care units creates both special needs of individuals with dementia. Such problems and opportunities for individuals with units are referred to generically as special care units, dementia, their families, and many other people and dedicated care units, Alzheimer’s units, or dementia organizations that have an interest in the quality and units. OTA uses the term special care units in this appropriateness of nursing home care for individuals report. with dementia. These other interested parties in- clude: nursing home administrators and staff mem- The number of special care units for individuals bers who provide care for individuals with dementia with dementia has increased rapidly over the past both in and out of special care units; physicians, few years. No comprehensive data are available on nurses, social workers, hospital discharge planners, the number of special care units before 1987, but community agencies, Alzheimer’s Association chap- information from several studies indicates that the ters,
Load more

Recommended publications
  • Understanding Stress, Immunity, and Sleep Disturbances in Caregivers of Persons with Dementia
    UNDERSTANDING STRESS, IMMUNITY, AND SLEEP DISTURBANCES IN CAREGIVERS OF PERSONS WITH DEMENTIA By BRANDY L. LEHMAN A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2008 1 © 2008 Brandy L. Lehman 2 To my husband, who always provided support for my education with love, Brandy L. Lehman 3 ACKNOWLEDGMENTS This endeavor represents the climax of an “impossible dream” of one who has spent many years in academic pursuits. Many individuals have influenced my development along the way but are too numerous to be listed here. The following warrant special recognition. Foremost among these individuals is my advisor and chairperson, Dr. Meredeth Rowe, RN, PhD. From the onset of my doctoral studies through the completion of this dissertation, she willingly shared her knowledge and experience. Her patience and understanding as well as her interest in my education and professional growth are deeply appreciated. Each member of my graduate committee has contributed to the development, refinement, and completion of this dissertation. Appreciation is expressed to the following committee members: Dr. Shawn Kneipp, RN, PhD; Dr. Deidre Pereira, PhD; and Dr. Susan McMillan, RN, PhD. My committee went well beyond their duty in helping me with this dissertation reading and copiously commenting on the numerous drafts. They also provided encouragement and honest analysis of my work. Their collective insight greatly increased the quality of this dissertation. Special thanks go to Dr. Maureen Groer, RN, PhD for her assistance in data collection, use of the University of South Florida Biobehavioral Nursing Laboratory, and purchasing salivary cortisol and IgA kits.
    [Show full text]
  • Integrated Care for Older People (ICOPE) a Manual for Nurses
    Module 5: Geriatric syndromes Integrated Care for Older People (ICOPE) A manual for nurses Trainee's handbook i Integrated Care for Older People (ICOPE) | A manual for nurses (Trainee’s handbook) ii Module 1: Communication with older people Integrated Care for Older People (ICOPE) A manual for nurses (Trainee’s handbook) i Integrated Care for Older People (ICOPE) | A manual for nurses (Trainee’s handbook) Title: Integrated Care for Older People (ICOPE): A manual for nurses (Trainee’s handbook) ISBN: 978-92-9022-753-3 © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization.
    [Show full text]
  • Vote for YOUR Candidate WE WILL NEVER FORGET in Tuesday’S Primary, September 14, 2010 SEPTEMBER 11, 2001 GOVERNOR
    VOL. 114 - NO. 37 BOSTON, MASSACHUSETTS, SEPTEMBER 10, 2010 $.30 A COPY Vote for YOUR Candidate WE WILL NEVER FORGET in Tuesday’s Primary, September 14, 2010 SEPTEMBER 11, 2001 GOVERNOR Deval L. Charles D. Timothy Jill PATRICK BAKER CAHILL STEIN (Democrat) (Republican) (Independent) (Green/Rainbow) LIEUTENANT GOVERNOR ATTORNEY GENERAL Timothy P. Richard R. Martha James Guy MURRAY TISEI COAKLEY M C KENNA CARBONE (Democrat) (Republican) (Democrat) (Write In) (Write In) SECRETARY OF STATE TREASURER News Briefs by Sal Giarratani Liberal Media AWOL on St. Nicholas? William Francis William C. Steven Stephen J. Karyn E. The growing national furor over a proposed GALVIN CAMPBELL GROSSMAN MURPHY POLITO 13-story mosque two blocks from Ground Zero (Democrat) (Republican) (Democrat) (Democrat) (Republican) has now brought forward the plight of St. Nicho- las Greek Orthodox Church, which was turned AUDITOR STATEWIDE into rubble on September 11, 2001 when one of the Twin Towers fell on it during that attack on America. New York officials all promised to help rebuild that church, but it turns out all they offered were promises. St. Nicholas has experienced nine years of bureaucratic and cultural paralysis. A deal had been report- edly made between the New York Port Author- ity and the Greek Orthodox Archdiocese. Then nine years of nothing. If it wasn’t for the Suzanne M. Guy William Mike Mary Z. Kamal controversy over the mosque, St. Nicholas’ BUMP GLODIS LAKE CONNAUGHTON JAIN plight might have stayed unknown to America (Democrat) (Democrat) (Democrat) (Republican) (Republican) but thanks to small media outlets, bloggers, and the Fox News Network we all now know.
    [Show full text]
  • Special Care Units for People with Alzheimer's and Other Dementias: Consumer Education, Research, Regulatory, and Reimbursement Issues
    Special Care Units for People With Alzheimer's and Other Dementias: Consumer Education, Research, Regulatory, and Reimbursement Issues August 1992 OTA-H-543 NTIS order #PB92-228444 Recommended Citation: U.S. Congress, Office of Technology Assessment, Special Care Units for People With Alzheimer’s and Other Dementias: Conwmer Education, Research, Regulatory, and Reimbursement Issues, OTA-H-543 (Washington, DC: U.S. Governrnent Printing Office, August 1992). Foreword Several million Americans have Alzheimer’s disease or another disease or condition that causes dementia. As our population ages, the number of people with these devastating diseases and conditions will increase relentlessly. Families take care of individuals with dementia at home for as long as possible, but most individuals with dementia are likely to spend sometime in a nursing home in the often long course of their illness. Until recently, little attention has been paid to the special needs of nursing home residents with dementia. In many nursing homes, they have received and continue to receive inappropriate care that exacerbates their cognitive impairments and behavioral symptoms and further reduces their quality of life. There has been a pervasive feeling that nothing positive can be done for nursing home residents with dementia. More often than nondemented residents, they have been overmedicated and physically restrained. As awareness of Alzheimer’s and other dementing diseases has increased, innovative approaches to caring for people with dementia have been developed. Some experts have recommended that nursing homes establish special units for their residents with dementia. OTA estimates that by 1991, 10 percent of all U.S. nursing homes had established at least one such unit.
    [Show full text]
  • A Dictionary of Neurological Signs.Pdf
    A DICTIONARY OF NEUROLOGICAL SIGNS THIRD EDITION A DICTIONARY OF NEUROLOGICAL SIGNS THIRD EDITION A.J. LARNER MA, MD, MRCP (UK), DHMSA Consultant Neurologist Walton Centre for Neurology and Neurosurgery, Liverpool Honorary Lecturer in Neuroscience, University of Liverpool Society of Apothecaries’ Honorary Lecturer in the History of Medicine, University of Liverpool Liverpool, U.K. 123 Andrew J. Larner MA MD MRCP (UK) DHMSA Walton Centre for Neurology & Neurosurgery Lower Lane L9 7LJ Liverpool, UK ISBN 978-1-4419-7094-7 e-ISBN 978-1-4419-7095-4 DOI 10.1007/978-1-4419-7095-4 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2010937226 © Springer Science+Business Media, LLC 2001, 2006, 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.
    [Show full text]
  • Dementia Care Guide Dementia Care Guide Understanding How to Provide Compassionate, Effective Dementia Care 2 / Dementia Care Guide
    1 / Dementia Care Guide Dementia Care Guide Understanding How to Provide Compassionate, Effective Dementia Care 2 / Dementia Care Guide The Go-To Guide for Dementia Caregivers Caring for a loved one with dementia can be both fulfilling and stressful. It’s rewarding to be there for someone you care about but the care required can sometimes seem daunting. No matter what stage in the journey you’re in, we’re here to support you by providing strategies you can use to make day-to-day care easier. Whether it’s learning how to handle a loved one’s changing lucidity, finding new ways to communicate, or addressing the various symptoms of the disease, we’re here to help. If you’re providing support to a loved If your loved one has recently been one with dementia: diagnosed with dementia: Find answers to common questions Take a proactive approach and learn related to dementia care and gives you what you can expect to encounter as the tools you need to meet any situation your loved one’s care needs evolve and head-on. how to stay mindful throughout the dementia journey. If you’re feeling overwhelmed by dementia caregiving: There may be times when you’re unsure of the best way to support your loved one. Learn how to deal with some of the more difficult behaviors that come with the disease and how to promote your own self-care. 3 / Dementia Care Guide Table of Contents Can Dementia Come and Go? 4 Effective Communication in Early-Stage Dementia 9 Effective Communication in Mid-Stage Dementia 12 Effective Communication in Late-Stage Dementia 15 Strategies for Reducing Paranoia 18 Strategies for Dealing with Sundowning 21 How Vision Changes with Dementia 25 4 / Dementia Care Guide Can Dementia Come & Go? By: Rob Wagner and Cheryl Popp Nearly everyone who cares for someone with dementia has a story like this: “Just yesterday, mom spent most of the day sitting quietly and barely said a word.
    [Show full text]
  • Perspectives of Children and Elders Living with Dementia on Intergenerational Collaboration in a Participatory Music Project
    “A Lot of Stories in My Mind”: Perspectives of Children and Elders Living with Dementia On Intergenerational Collaboration in a Participatory Music Project Cameron Dusman A thesis submitted to the Graduate Faculty of JAMES MADISON UNIVERSITY In Partial Fulfillment of the Requirements for the degree of Master of Music School of Music May 2020 FACULTY COMMITTEE: Committee Chair: Dr. David Stringham Committee Members/ Readers: Dr. Jesse Rathgeber Dr. Erika Sawin Table of Contents List of Tables ....................................................................................................................................................... iii List of Figures ...................................................................................................................................................... iv Abstract .................................................................................................................................................................. vi Chapter One: Introduction ............................................................................................................................ 1 Statement of Problem and Need ................................................................................................................. 6 Procedural Overview and Research Questions ..................................................................................... 9 Chapter Two: Review of Literature .......................................................................................................
    [Show full text]
  • Kazoo Crazy Game Instructions
    Kazoo crazy game instructions Continue The American musical instrument A metal kazoo with a coin of 1 euro for comparison: 23.25 mm (0.92 inches) Examples of kazoos The kazoo is an American musical instrument that adds a buzzing timbre quality to the player's voice when the player voices, buzzes or blows into it. It is a type of myrliton (which in itself is a membranophone), one of the class instruments that changes the voice of its player by vibrating the membrane of the skin goldbeater or material with similar characteristics. Such vibrating and voice-changing instruments have been used in Africa for hundreds of years, often for ceremonial purposes. Playing kazu player buzzes, not punches, in the big and flattened side of the instrument. The oscillating air pressure of the drone causes the membrane to vibrate. As a result, the sound changes in height and volume with the humming of the player. Players can make different sounds by ingesting specific syllables such as doo, 'too', which, rrrrr or brrrr in kazoo. Some people refer to the casu membrane as a cane, believing that it performs the same action in kazoo as it would be a wooden spirit tool, however the cane is made of cane (or synthetic equivalent), while the membrane (most often made of wax paper) is not. The story originated with the Kaminsky International Kazoo quartet, a group of satirical kazoo players who may truly question the veracity of the story, like the very name alabama West. In 1879, Simon Seller received a patent for a toy pipe that worked on the same principle as the kazu: blowing tube A, while humming a kind of head sound, musical vibration is given to paper covering with a c above the diaphragm b, and sound produced pleasant to the ear.
    [Show full text]
  • Sundowners Interior.Indd
    Sundowner’s Syndrome A Caregiver Guide from Sundownerfacts.com Introduction by Liz Barlowe, CMC. Published by iSight Technologies Copyright © 2012 by Sundownerfacts.com All rights reserved. No part of this book may be repro- duced in any form without permission in writing from the publisher, except in the case of brief quotations in critical articles and reviews. iSight Technologies P.O Box 547896 Orlando, Florida, 32854 ISBN: 978-0-9859474-0-8 Library of Congress Control Number: 2012948565 Design and Typesetting by Geoff Benge at Silver Fern Bookworks Printed in the United States Contents Introduction * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 7 1. What is Sundowner’s Syndrome? * * * * * * * * * * * * * * * 9 2. Medication * * * * * * * * * * * * * * * * * * * * * * * * * * * * 19 3. Some Approaches to Try * * * * * * * * * * * * * * * * * * * 43 4. Family Dynamics * * * * * * * * * * * * * * * * * * * * * * * * 55 5. Caregiver Well-Being * * * * * * * * * * * * * * * * * * * * * 71 6. Resources * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 83 7. Pay It Forward * * * * * * * * * * * * * * * * * * * * * * * * * * 93 Appendix. Drug Chart * * * * * * * * * * * * * * * * * * * * * 101 Author Note The subject of this book is variously referred to as Sundown- ing, Sundowners, Sundown Syndrome, Sundowning Syndrome, Sundowner Syndrome, Sundowner’s Syndrome, and Hospital Psy- chosis. For consistency, throughout this book, we use the names Sundowner’s Syndrome and Sundowners, except in quotes from medical research articles
    [Show full text]
  • Hot Topics in Primary Care
    SUPPLEMENT TO This supplement was sponsored by Primary Care Education Consortium and Primary Care Metabolic Group. It was edited and peer reviewed by The Journal of Family Practice. Copyright © 2019 Frontline Medical Communications Inc. ® WWW.PCECONSORTIUM.ORG WWW.PCMG-US.ORG VOL 68, NO 8 | OCTOBER 2019 | MDEDGE.COM/FAMILYMEDICINE A SPECIAL SUPPLEMENT ON Hot Topics in Primary Care S1 Chronic Kidney Disease in S26 Evolving Issues in Statin Selection FREE Type 2 Diabetes: Optimizing 1.0 CME CREDIT Michael Cobble, MD, FNLA Glucose-Lowering Therapy George Bakris, MD S32 Identification and Management FREE 1.0 CME CREDIT of Insomnia in Alzheimer’s Disease S7 A Practical Approach to Managing Heart Thomas Roth, PhD; Stephen Brunton, MD, FAAFP Failure in Type 2 Diabetes Mellitus Javed Butler, MD; Pamela Kushner, MD S39 Making the Diagnosis of Cluster Headache Vince Martin, MD S13 Diabetes Management Update: FREE Individualizing Treatment 1.0 CME CREDIT S43 Patient-Centric Care of FREE Timothy Reid, MD Diarrhea-Predominant Irritable 1.0 CME CREDIT Bowel Syndrome S20 Efficacy and Safety of Naproxen vs Opioids Brian E. Lacy, MD, PhD, FACG for the Treatment of Musculoskeletal Pain Stephen Brunton, MD, FAAFP; Steven M. Weisman, PhD [HOT TOPICS IN PRIMARY CARE] FACULTY: Brian E. Lacy MD, PhD, FACG George Bakris, MD Co-Editor in Chief Professor of Medicine American Journal of Gastroenterology Director, AHA Comprehensive Hypertension Center Senior Associate Consultant The University of Chicago Medicine Mayo Clinic Chicago, IL Jacksonville, FL Javed Butler,
    [Show full text]
  • Μια Athens Voice Τσέπης Για Τις Επόμενες 30 Καυτές Μέρες Του Αυγούστου
    28 IΟΥΛΙΟΥ - 3 ΑΥΓΟΥΣΤΟΥ 2016 . ΤΕΥΧΟΣ 580 . 210 Η ΦΩΝΗ ΤΗΣ ΑΘΗΝΑΣ . WWW.ATHENSVOICE.GR . FREE PRESS KAΘΕ ΠΕΜΠΤΗ ATHENS voice Ειδική έκδοση Μια ATHENS VOICE τσέπης για τις επόμενες 30 καυτές μέρες του Αυγούστου Το Εξώφυλλο μας Αυτή την εβδομάδα το σχεδιάζει ο designer Κωνσταντίνος Βαρβιτσιώτης. Έχει δημι- ουργήσει τη σειρά καλοκαιρινών αξεσουάρ AtoZGreek (www.atozgreek.com) συνδυάζο- ντας τις μεγάλες του αγά- πες: το καλοκαίρι, την Ελ- λάδα και το design. Αν και κατοικεί στη Νέα Υόρκη, έρχεται συχνά στην Ελλά- δα όπου κατασκευάζει όλα τα προϊόντα AtoZGreek. Έμπνευση βρίσκει στα τα- ξίδια του, στην καθημερι- νότητα και στις αναμνήσεις του. Χαρακτηριστικό της δουλειάς του είναι η αισι- οδοξία και η χαρά που δια- κρίνει τις δημιουργίες του, στοιχεία που ταιριάζουν και στην προσωπικότητά του. Το 2014 έκανε την πρώτη ατομική έκθεσή του στη γκαλερί Ζουμπουλάκη με τίτλο «365 the project». ΡΑΝτΕΒου τοΝ σΕπτΕΜΒΡη Μη Μέχρι τότε δεν θα χαθούμε. (www.athensvoice.gr) ΧΑσΕΙσ Δωρεάν εξετάσεις Το site της Α.V. θα σας κρατάει πάντα για Ηπατίτιδα C ενημερωμένους με ειδήσεις και θέματα Γνωρίζατε ότι στη χώρα μας εκτιμάται ότι 130.000 της επικαιρότητας - 160.000 άνθρωποι έχουν ενεργή ηπατίτιδα C, αλλά το 80% δεν το γνωρίζει; Με αποτέλεσμα η λοίμωξη από τον ιό να εξελίσσεται σε χρόνια λοίμωξη με άμεση συνέπεια την εξέλιξη της εκάστοτε ηπατικής βλάβης. Για να το εξηγή- σουμε, η χρόνια λοίμωξη μπορεί να επιφέρει προοδευτικά επιδεινούμενη ηπατική ίνωση που μπορεί να καταλήξει σε κίρρωση του ήπατος και ενδεχόμενη εμφάνιση ηπατοκυτ- ΑποκΑτΑστΑση ταρικού καρκινώματος. Το παρόν δημοσίευμα λαμβάνει χώρα προς αποκατά- Ο Σύλλογος Ασθενών Ήπατος Ελλάδος «Προμηθέας» ανα- σταση της αλήθειας και συγκεκριμένα αναφορικά με γνωρίζει ότι το όπλο απέναντι στην έλλειψη γνώσης είναι η το δημοσίευμα του υπ' αρ.
    [Show full text]
  • Hottest 100 List
    10,000 Feet - Wolfmother Alibi - Leader Cheetah 10,000 Horses Can't Be Wrong - Simian Mobile All Babes Are Wolves - Spinnerette Disco All Good - Phrase 1000 Cigarettes - MSTRKRFT All I Know - Karnivool 11th Dimension - Julian Casablancas All I Wanna Know - Tom Ugly 15 To 20 - Phenomenal Handclap Band, The All I Want - Sarah Blasko 1517 - Whitest Boy Alive , The All Is Love - Karen O And The Kids 1901 - Phoenix All Of The Dreamers - Powderfinger 1989 - Rakes, The All The King's Men - Wild Beasts 2 Player Game - Infusion All The Pretty Little Horses - Music Vs Physics 2012 - Gossip, The All We Ask - Grizzly Bear 22 - Lily Allen All Your Wars Are Won - Harlequin League 321 Ready Or Not - Jonathan Boulet Alligator - Tegan And Sara 368 - Jamie T Alright Now Honey - Fearless Vampire Killers 39 Ways To Leave Your Lover - Felicity Groom & Also Frightened - Animal Collective The Black Black Smoke Always More - Autokratz 85 Percent - Curse Ov Dialect Amazing Grace - Cat Power 8th Wonder - Gossip, The Ambling Alp - Yeasayer A Christmas Duel (Ft. Cyndi Lauper) - Hives, The And The Boys - Angus And Julia Stone A Community Service Announcement - Jonathan Angelina - Villains Of Wilhelm Boulet Angelz - Doom A Fight About Money - Powderfinger Animal - Miike Snow A White Demon Love Song - Killers, The AA 24/7 - Dance Area Animal Spirit Guide - Fire! Santa Rosa, Fire! Another Saturday - Stuart Murdoch Abattoir Noir - Regular John Answer Is Zero - Dappled Cities About Face - Grizzly Bear Absolute Truth - Shady Lane Antique Limb - Aleks And The Ramps Anxiety
    [Show full text]