Subject: News from Dr. Kevin Fickenscher
From: "The Fickenscher Files" <[email-masked]>
To: <[email-masked]>
Date: Tue, 26 Jul 2016 09:11:35 -0400 (EDT)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001Bm4-t2aLtUZLClxtGsL3ZcuK1nzS4neEMayu9EW4cQEGrC4BmKn7_tnsAZosH6PDYln-Pn0xqR3tZ0hvWKvk7G09C2s2C5F4XgN-BN9sQsOTUN4bHZNdiTawx_-XdMNmqSpPrQ9AXpmcp0D1IuOZrVlY3j24KD6-z9FVSnOIw1reM6JwRyn0BU1P2TTfOk9E&c=fkifrcfmDcq43yhV-qedxeQd8_qwOXBPmAlM2ttcy7VuHziVFsbWYA==&ch=UHHJvnP6RuSbOtmhyt8Jzp8xciLotR4x6k2u1-vf5NO8b48JB_qHyQ==]
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The Fickenscher Files, Vol. 4, Issue 10
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001Bm4-t2aLtUZLClxtGsL3ZcuK1nzS4neEMayu9EW4cQEGrC4BmKn7_nEJzxy9EijNPeKNmcFjWMPCXKB4QlE-OZn6dk-ccOcB_l5Sl2t4QvKb4czkf-b1PbaAgA40aefFsGOwjtAseZU9oc0Ieglz3_B5muqwi1KTQHNu-FXPn5DL_Tke5YRN5P-69Q639G7J-xaK9L3PSRe9Rbke-YPg8OKuHu8ineHYPBB7am2j6zrtC4yj1A4WqUp6fqxu6NZ5cwR-vIo6q8s=&c=fkifrcfmDcq43yhV-qedxeQd8_qwOXBPmAlM2ttcy7VuHziVFsbWYA==&ch=UHHJvnP6RuSbOtmhyt8Jzp8xciLotR4x6k2u1-vf5NO8b48JB_qHyQ==],
MD, CPE, FACPE, FAAFP
@MDKev
A compilation of information, thoughts, and perspectives on the issues of the day
related to healthcare, technology, and beyond - including the latest culinary explorations.
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Quote(s) Of The Week
Perspectives from around the world...
"This has happened far too often...it is up to all of us to make sure we are part
of the solution and not part of the problem...  Only we can prove through words 
and deeds that we can be brought together..."
President Barack Obama in response to yet another shooting of police officers in
 Baton Rouge, Louisiana
"Stop this killing.  Stop this killing!  Stop this killing!!"
From the family of Alton Sterling following the shooting of police in Baton Rouge,
Louisiana
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Consulo Indicium
Information for your Consideration...
If You Are Reading This Blog, Stop And Consider For a Moment - The turmoil that 
is seemingly sweeping the world is disturbing at best.  Every morning seems to bring
yet another shooting, a distressing event overseas or an untoward comment from some
politician someplace.  And, we await the quadrennial political conventions which
 we hold in the USA to coronate our political candidates in their run for President.
 It's probably clear from my prior blogs where I stand politically.  I'm not in 
favor of building walls (NOTE: my friends from Canada have told me that if the USA
builds a wall on our southern border, they intend to build one on our northern border
- and, make us pay for it!).  I believe (strongly) that our nation was founded on
the notion that all men and women can worship as they please without conditions,
 which means that there are no tests or oaths required from anyone because of religious
preference (NOTE: This is coming from a guy who regularly serves as the Assistant
Minister at my church).  I don't have an answer for all of the turmoil but I do 
believe we will resolve these issues only through dialogue with one another.  We
 need to listen rather than sling slogans at one another.  I encourage everyone 
to take some time to consider where we are at, engage in dialogue with friends, 
colleagues and even those with whom we might disagree.  We cannot tolerate the dissolution
of a civil society AND it is our obligation to make sure that a civil society is
 ubiquitous throughout the entire nation, in all places, in all neighborhoods, among
all factions.  We are better than this.  We need to listen to Alton Sterling's family
who said following the Baton Rouge shootings that we need to "...stop the killing!"

Protein secreted by muscles may improve memory, stimulate brain cell growth, study
says NPR (6/23) reports National Institute on Aging scientist Henriette van Praag
and colleagues discovered that increased blood levels of the protein cathepsin B,
which is secreted by muscles during exercise, helped mice perform better on a memory
test. Van Praag's team "also found evidence that, in mice, cathepsin B was causing
the growth of new cells and connections in the hippocampus, an area of the brain
 that is central to memory." According to NPR, the study yielded similar results
 on monkeys and human subjects. While Van Praag acknowledged the study hadn't "fully
explained how exercise improves memory," she said, "I think we've made a significant
step forward." The research was published in Cell Metabolism.

Doing Something Else Positive - I recently learned through my church that the lack
of safe drinking water [http://r20.rs6.net/tn.jsp?f=001Bm4-t2aLtUZLClxtGsL3ZcuK1nzS4neEMayu9EW4cQEGrC4BmKn7_gfmSuLt1XHLUzsKSf6qWthXq8Szqzsp3aHhyE4_B6IftjDJ0vXYmkQ4mnMUshOCjW7PO1w1dZmEpUQGLyqKGycZBK7rLYSjiWYeVvxqjNZzsUfaBNalws7sd9o-3-Po24K8b_9Pel0x2cd9XsBx6IN5z3KN-nyRuw==&c=fkifrcfmDcq43yhV-qedxeQd8_qwOXBPmAlM2ttcy7VuHziVFsbWYA==&ch=UHHJvnP6RuSbOtmhyt8Jzp8xciLotR4x6k2u1-vf5NO8b48JB_qHyQ==]
is a global health crisis. Each year, children lose millions of school days due 
to water-related illness which keeps these young people from attending school.  
In fact, every 20 seconds, a child dies from a water-related illness, and more than
783 million people do not have access to an improved water source.  This is a problem
that can be easily resolved with the right interventions.  We've known the solutions
for hundreds of years.  But, it's not just a problem for the developing world.  
As we know from the recent problems in Flint, Michigan, the problems affects municipal
water systems that are poorly maintained and deliver contaminated water. Check out
the website and contribute what you can...

Data Analytics: What's Needed - McKinsey & Company recently reported on a survey
 of senior-level executives across several different industries (so, not just health
care) on the issue of their challenges related to data and analytics.  Not surprisingly,
the biggest issues were not technical in nature.  The top three issues on the list
of major executive challenges were:

* 25% related to "designing an appropriate organizational structure to support analytics
activities",
* 21% for "securing internal leadership for analytics projects"; and,
* 14% for "constructing a strategy to prioritize investment in analytics".

The fourth ranked issue was "designing effective data architecture and technology
infrastructure."  So, it's the people issues - not the technical issues - that garner
the greatest anxiety, as they should.  I have been of the firm belief for a long
 time now that the people and process sides of the equation in information management
are the key points of information technology deployment failures.  The technology
is what it is...

Listening To George Halvorson - I recently had the Berkeley Oral History highlighting
the comments of George Halvorson [http://r20.rs6.net/tn.jsp?f=001Bm4-t2aLtUZLClxtGsL3ZcuK1nzS4neEMayu9EW4cQEGrC4BmKn7_gfmSuLt1XHLSdXsMQQ-iww5OLO_tZxEfR-nyo8pK-vNv0BIw8SXRPZJLE5UUsuNOK4Gu72Frj_wUEX5oE1fo6IiTO5OVeClCMgKGa8GAYl2Lt8n7JZqzAGz9_OJc4RtAUsw_nwhS0k92Tz6E5exUqcFqSocHQbABg==&c=fkifrcfmDcq43yhV-qedxeQd8_qwOXBPmAlM2ttcy7VuHziVFsbWYA==&ch=UHHJvnP6RuSbOtmhyt8Jzp8xciLotR4x6k2u1-vf5NO8b48JB_qHyQ==]
sent to me.  He has comments on continuing improvement, tribalism in health care
 and on other topics as well.  It's definitely worth a listen.  It will take about
30 minutes to hear his thoughts from the four video outtakes.  Go for it.  You'll
capture some good thoughts and lessons...

Moving Ahead To Solve The Ongoing Opioid Crisis - It seems that the "opioid crisis"
is everywhere - and, nowhere.  In an effort to move some substantive projects along,
US Department of Health and Human Services (DHHS) Secretary Sylvia Burwell recently
announced [http://r20.rs6.net/tn.jsp?f=001Bm4-t2aLtUZLClxtGsL3ZcuK1nzS4neEMayu9EW4cQEGrC4BmKn7_gfmSuLt1XHLx7bdi-9Q4yNGsAWwru89fGLJNtrGPGaOmf5hrqzm3OVuMABtiItXXf9PlQqwbXA5BNdnoQ1G7CCStTypeoZ6PWQ8bBvB6DQ3SnNDHC-w-QC0ZeAWCgdgchnk8B9uWNSkhIVRAOV3ZPEp2MQxDmrc0hsh2CFY8vy0f5QKjFn2R1SKfSGJa0sLGtGgLR6Jza1CkEEDyf7s_3ySfAHOk8od8w==&c=fkifrcfmDcq43yhV-qedxeQd8_qwOXBPmAlM2ttcy7VuHziVFsbWYA==&ch=UHHJvnP6RuSbOtmhyt8Jzp8xciLotR4x6k2u1-vf5NO8b48JB_qHyQ==]
several new initiatives to move forward in combating the nation's opioid epidemic.
Specifically, some of the actions will include: 1) expanding access to buprenorphine,
a medication to treat opioid use disorder, 2) eliminating any potential financial
incentive for doctors to prescribe opioids based on patient experience survey questions;
and, 3) implementing a requirement for Indian Health Service prescribers and pharmacists
to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing
or dispensing opioids for pain. DHHS is also launching more than a dozen new scientific
studies on opioid misuse and pain treatment and soliciting feedback to improve and
expand prescriber education and training programs.

A Plea To Increase Public Understanding - Mary Wolley, CEO of Research America received
an award at Academy Health for her lifetime achievement in promoting research.  
She indicated that too many people did not know what "health services research" 
was and what it attempts to evaluate.  She suggested that the nomenclature should
be changed to "health care delivery research" which 81% of the public understands.
 Few understand "health services."  It's something we should consider...
Prices Vary In Health Care: Are We Surprised? - A new report by the Health Care 
Cost Institute (HCCI) noted that "huge variations exist in the prices of some of
 the most common medical procedures across state lines." But, it's likely that the
report will be of little use to consumers for a whole variety of reasons extending
from not knowing what the bill will be until it actually arrives to the fact that
comparing one institution to another can be exceedingly complex.  The report [http://r20.rs6.net/tn.jsp?f=001Bm4-t2aLtUZLClxtGsL3ZcuK1nzS4neEMayu9EW4cQEGrC4BmKn7_gfmSuLt1XHL7YuTJrKozScnruPsC9RNJGRfHZb7rEF8hzA_tnQucfcvukRcw-Mgwd089iVDFL82hULR4jGKLoqUfY1F4DCAgxRAy2d1Y8Y9ZPmj3xs4ysn1r-62N5-fNpfpd501JAHFIxGJyxOKPouYLzpJHpOFVhVSQqbYnILbczZij0Ck4NOHek2m-mUf90YG1oQqAMFbUC0qOI61j3Z1vgFYmCEOh_SW0KnT58FYbYtzjSwEQHMFXF_iXXzVQPdFFlkutZ-R7JhpyCYk3oF8FaSxEsFAHFZKU8IQ94-iiVNz1KeZTnCG2IhTRLx7oQHmaF1phDuD44Mf68TF8FBlApeW_LE2ETLffN_dPj7wd3m7tE_t4KOzhIASAuUMC-itRMe_bTwPMdqMAOOhdZZThnOJB2y58XVGIey6SB8cjfk083KPD6inPgFKnbXx1G3ci1c3UijePPt6KV579a6auI53EjIdUTP062SerqIlLLNWox-fhBm6KrMAWbLEf3xWh0LZ9M32pXqNMPkUFkKguwIq6ayxaJ7g76wz_Z5OqRgkCN1YPLg5Z75dm8ok3Q6ONZbp9XORCKMed04ZEPYwcm1rq6bE4w==&c=fkifrcfmDcq43yhV-qedxeQd8_qwOXBPmAlM2ttcy7VuHziVFsbWYA==&ch=UHHJvnP6RuSbOtmhyt8Jzp8xciLotR4x6k2u1-vf5NO8b48JB_qHyQ==]
was published in Health Affairs.  The report did receive some media coverage in 
part because certain states seemed to have lower overall costs (e.g. Florida, Arizona,
Tennessee, Maryland and Nevada) that other states (e.g. Wisconsin, North Dakota,
 New Hampshire and Minnesota) which had the highest health care costs. So, I'm not
certain what trends the report provided except that costs varied a lot...
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The Weekly Whisk
Musings from a foodie...
A friend recently visited who had been to Maine a number of times and suggested 
that we try MC Perkins Cove [* * * * ], a newer restaurant developed by James Beard
Award winning Chefs Mark Gaier and Clark Fraiser in Ogunquit, Maine.  The two chefs
pioneered Arrows some 25 years ago to acclaim for the sustainable dining initiative.
If you're interested in a spectacular ocean view, you definitely want to consider
MC Perkins Cove.
For starters, we had the usual fried calamari which was usual.  The yellowfin tuna
carpaccio was served in an Asian style with a candied galangal dressing.  It was
 quite good.  And, the Maine Peekytoe crab cakes with "Mom's cole slaw" was great!
 The rest of the dinner was very good but not outstanding.  My major problem with
the place was the noise.  We had a very difficult time having a conversation without
trying to out shout the table next door - although they were a bit rowdy.  Regardless,
even when that table left - the noise level was still quite high.  So, the food 
was good to very good.  The view was outstanding.  And, the inside ambiance OK. 
 It you're in Ogunquit, it's worthy of consideration but there are other places 
as well. MC Perkins Cove [http://r20.rs6.net/tn.jsp?f=001Bm4-t2aLtUZLClxtGsL3ZcuK1nzS4neEMayu9EW4cQEGrC4BmKn7_gfmSuLt1XHL_hG3b2QQ2l7xryf86DMv9eZcDMd14I0nq8OfbgfguMnR37fOM7D8mVBqeHdxdHhhavTJ73alEk6Df6yHCTvb6EViR8RCds__waFwyWWGHMEnrkwHgT3H15lrgJtO5im7hxjyCMAWlhAXlu08Y7eZyJLb__VRc51BIqCURZX0MO8=&c=fkifrcfmDcq43yhV-qedxeQd8_qwOXBPmAlM2ttcy7VuHziVFsbWYA==&ch=UHHJvnP6RuSbOtmhyt8Jzp8xciLotR4x6k2u1-vf5NO8b48JB_qHyQ==]
- 111 Perkins Cove Road - Ogunquit, Maine 03907 - 207-646-6263.
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The Good, The Bad, And The Ugly
The ongoing saga...
The Good - The Republican and Democrat conventions have come and just about gone.
 Now we can focus on the final campaign.  Hopefully, we'll start to talk about policy
and directions rather than just personalities
The Bad - The ongoing violence that seems to be a more endemic problem throughout
the world - whether led or initiated by the web.
The Ugly - The vitriol...  Let's be more civilized...
The statements in The Fickenscher Files are the personal views of Kevin Fickenscher,
MD and do not reflect the views or policies of any organization with which he is
 affiliated.
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