Summer Recipes

By Stephanie of Infinite Life Fitness

As the summer time is slowly creeping by, more and more people are starting to instill healthier eating habits and a new fitness routine to their busy schedules. Becoming healthy is a full lifestyle change. It is not just a fad you can stick with for a few weeks to see the results that you are wanting. It takes WEEKS of dedication and hard work insides and outside of the gym. The biggest part of getting healthier is eating healthier. Today I am sharing with you some easy, yummy, and not too hard recipes of some great meals you can try this summer!

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Rolled Lasagna

Prep: 25 mins

Cook: 35 mins

Makes: 4 servings

INGREDIENTS


• 8lasagna noodles
• 3tablespoons olive oil
• 1clove garlic, minced
• 112 ounce can crushed tomatoes
• 2ounces goat cheese
• 1/2cup chopped sweet onion
• 1large leek, white part only, chopped
• 1 3/4cups sliced cremini mushrooms
• 1bunch asparagus, cut into 1/2-inch pieces
• 2ounces low-fat mozzarella, grated
• 1/8teaspoon ground nutmeg
• 1/4teaspoon salt
• 1/4teaspoon freshly ground black pepper
• 1/2cup chopped fresh mint
• 1/2cup chopped fresh basil
• 1/4cup grated Parmesan

DIRECTIONS

1. Preheat the oven to 350 degrees. Cook the lasagna noodles according to package directions. Drain, rinse and set aside. Reserve 1 tablespoon pasta water.
2. Heat 1 tablespoon of the oil in a medium pot over medium-low heat. Add the garlic; cook 2 minutes. Add the tomatoes; cook 15 minutes. Whisk in 1 tablespoon of the goat cheese until combined. Set aside.
3. Meanwhile, heat 2 tablespoons oil in a 12-inch skillet over medium heat. Add the onion; saute 3 minutes. Add the leek; cook 3 minutes. Add the mushrooms; cook 10 minutes. Add the asparagus; cook 3 minutes.
4. Turn heat off; add 1 1/2 tablespoons goat cheese and the mozzarella, reserved pasta water, nutmeg, salt and black pepper. Add the mint and basil, reserving 1 teaspoon of each.
5. Spread 1/2 cup tomato sauce on the bottom of a baking dish. Spoon 1/2 cup vegetable mixture onto each noodle, roll up and place seam side down in baking dish. Drizzle with remaining tomato sauce; crumble remaining goat cheese on top. Bake 15 minutes. Remove from oven, sprinkle with the Parmesan and reserved mint and basil; serve.

Nutritonal Informaiton:
Amount Per Serving:
Calories426
Protein(gm)17
Carbohydrate(gm)51
Fat, total(gm)18
Saturated fat(gm)6
Dietary Fiber, total(gm)6

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Lemon Basil Pasta With Summer Squash

INGREDIENTS


• 2ounces (2/3 cup) dry whole-wheat penne
• 1/2cup chopped zucchini
• 1/2cup chopped yellow squash
• 1/2cup canned white beans, rinsed and drained
• 1lemon, juiced
• 1/4cup chopped fresh basil
• 1tablespoon Parmesan cheese
• 1tablespoon olive oil

DIRECTIONS
Make it:
Boil pasta and drain. Toss with remaining ingredients.

Nutritional Information:
Amount Per Serving
Calories497
Protein(gm)21
Carbohydrate(gm)74
Fat, total(gm)16
Saturated fat(gm)3
Dietary Fiber, total(gm)8

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Spinach-Mushroom Pizza

Prep: 20 mins

Cook: 15 mins 425°F

Makes: 6 servings

INGREDIENTS


• 112 ounce whole-wheat pizza crust, such as Boboli
• 1/4cup pizza sauce
• 1/2cup frozen spinach, thawed and drained well
• 1/4small red onion, thinly sliced
• 1cup shredded part-skim mozzarella
• 6medium cremini mushrooms, sliced
• 1/4cup part-skim ricotta
• 2tablespoons grated Parmesan
• 1tablespoon extra-virgin olive oil
• 2teaspoons balsamic vinegar

DIRECTIONS
Makes:

1. 6 servings
2. Preheat the oven to 450 degrees. Place a large heavy baking sheet on the bottom of the oven. Lay the pizza crust on a work surface.
3. Spread the crust with the sauce, followed by the spinach and onion. Sprinkle with the mozzarella and mushrooms. Dollop the ricotta over the pizza and sprinkle with the Parmesan. Drizzle the olive oil all over.
4. Use a thin cutting board or the back of a second baking sheet to carefully transfer the pizza to the preheated baking sheet on the bottom of the oven. Bake until the crust is puffed and beginning to color at the edges and the cheese is melted, 10 minutes. Take the sheet out of the oven and preheat the broiler.
5. Broil the pizza, watching carefully, until the cheese is browned and bubbling, about 2 minutes. Let pizza cool on the sheet for 5 minutes. Sprinkle with the balsamic vinegar, slice into wedges, and serve.

Nutritional information:
Amount Per Serving
Calories252
Protein(gm)15
Carbohydrate(gm)30
Fat, total(gm)10
Saturated fat(gm)4
Dietary Fiber, total(gm)5

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Mushroom and Asparagus Fettuccine

Prep: 25 mins

Makes: 4 servings

INGREDIENTS


• 8ounces dried fettuccine or linguine
• 8ounces asparagus, trimmed and cut into 1-1/2-inch pieces
• 3cups sliced fresh shiitake or crimini mushrooms
• 1medium leek, thinly sliced, or 1/2 cup chopped onion
• 3cloves garlic, minced
• 1tablespoon olive oil
• 1/3cup mushroom broth or vegetable broth
• 1/4cup half-and-half or light cream
• 1/4teaspoon salt
• 1/8teaspoon black pepper
• 1cup chopped plum tomatoes
• 1tablespoon finely shredded fresh basil
• 1tablespoon finely shredded fresh oregano
• 1/4cup pine nuts, toasted
• Finely shredded Parmesan cheese(optional)

DIRECTIONS

1. Cook fettuccine or linguine according to package directions, adding asparagus the last 1 to 2 minutes of cooking; drain. Return pasta mixture to saucepan; cover and keep warm.
2. Meanwhile, in a large skillet cook mushrooms, leek, and garlic in hot oil over medium-high heat for 4 to 5 minutes or until most of the liquid is evaporated. Stir in broth, half-and-half, salt, and black pepper. Bring to boiling. Boil gently, uncovered, for 4 to 5 minutes or until mixture is slightly thickened. Stir in tomatoes, basil, and oregano; heat through.
3. Spoon the mushroom mixture over pasta mixture; toss gently to coat. Divide among 4 bowls or dinner plates. Sprinkle with pine nuts and, if desired, Parmesan cheese. Serve immediately.

Nutritional Information:
Amount Per Serving
Calories416
Protein(gm)15
Carbohydrate(gm)69
Fat, total(gm)12
Cholesterol(mg)6
Saturated fat(gm)3
Monosaturated fat(gm)5
Polyunsaturated fat(gm)3
Dietary Fiber, total(gm)6
Sugar, total(gm)5
Vitamin A(IU)777
Vitamin C(mg)19
Thiamin(mg)1
Riboflavin(mg)1
Niacin(mg)6
Pyridoxine (Vit. B6)(mg)0
Folate(µg)230
Cobalamin (Vit. B12)(µg)0
Sodium(mg)193
Potassium(mg)503
Calcium(DV %)71
Iron(DV %)5
Vegetables()2
Starch()4
Fat()2

I hope that the few recipes I just shared you will try! And remember…you can always add/subtract/or substitute ingredients for things that you want!

This is Stephanie from Infinite Life Fitness. Please feel free to check out my website at infinitelifefitness.com for more health and fitness tips!

University of Virginia, GE settle $47M suit over EMR implementation

The following Keystone Kops story of healthcare IT dysfunction brings to life (like the old GE slogan) the types of mismanagement I've written about at my site "Common Examples of Healthcare IT Difficulties":

From 1982 GE commercial - "We Bring Good Things to Life"

Clown pun not intentional - but perhaps apropos, not just with reference to GE but to U. Va's health IT leadership team as well.  It seems both parties might have had a role in this debacle (see additional links in the article below).

University of Virginia, GE settle $47M suit over EMR implementation

FierceEMR.com
July 13, 2012

By Dan Bowman

The University of Virginia this week reportedly has settled a $47 million civil suit against GE Healthcare over what it believes was sloppy--and ultimately incomplete--development and implementation of an electronic medical record system. The case, which originally was filed in 2009, had been set to go to trial this week. When FierceHealthIT checked on Friday, the case had yet to be entered into the circuit court clerk's records. In 1999, UVa hired IDX Systems Corporation to develop an integrated healthcare information management system, according to The Daily Progress. Amendments to the contract in 2002 divided the project into four phases, with the first two focusing on implementation of the records management software, and the last two focusing on billing and logistics. After acquiring IDX in 2006, GE was tasked with hitting the milestones outlined through Phase 2 by June 2008; UVa claims it never did, and in February 2009 asked for a refund of more than $20 million. At that time, UVa also awarded a $60 million contract to Epic to perform the same tasks, according to C-Ville.com [see note 1]. GE swiped back, blaming UVa for the delays in implementation, and saying that by going with Epic, the school "failed to perform its obligations under the agreement, breaching its contract," according to a filing obtained by the Daily Progress. The case isn't too surprising, considering that GE Healthcare has had issues since purchasing IDX. In a KLAS report from August 2010, author Kent Gale said there was a "downward trend in GE's meeting commitments" to its customers. Besides what was undoubtedly a huge waste of money and resources, what is missing from this story is the possible impact of this debacle on patient care.  Not "hitting the milestones" of phase 1 and 2 ("focusing on implementation of the records management software") and peforming "sloppy and incomplete" work can probably be translated as having had "bull in a china shop" effects on records management. Perhaps the morbidity and mortality rates at U. Va during the period of EHR mayhem need to be examined. -- SS Notes: [1] From the link to C-Ville.com:  "According to UVA’s complaint, the deal dates to 1999, when UVA contracted with tech firm IDX to develop an electronic medical record system, or EMR, for its hospital. But problems started early, UVA claimed, with IDX failing to hit milestones on the multi-phase project. When technology company GE took over IDX in 2006, the parties got together to rework the contract. But UVA said the issues continued, and it ultimately pulled the plug, saying GE failed to meet its obligations. GE, meanwhile, claimed it was UVA that broke contract. The two parties had agreed to work together on the complicated project, according to the company’s counterclaim. UVA was to act as a development partner, collecting and processing two decades’ worth of patient data and building and testing the system. But the medical center didn’t hold up its end of the bargain, said GE, making it impossible for the company to stay on schedule."

Healthy Hair on Youtube: MsTanish

I've been watching MsTanish for a few years now, and recently her hair has flourished out of nowhere.  This type 4 natural has managed to retain some serious length in the past year or so.  Do not be fooled by her height (taller than 5'10", I believe).  Her hair is fairly long ... and healthy!  In this particular video she discusses her detangling routine for loose hair that has tangled over the course of a few days.

You can now find HHB on Facebook. Share with your friends:

http://www.facebook.com/healthyhairandbody.

Mixology || Field and Sea Body Scrub

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Are you interested in mixing your own body scrub?  Well perhaps you can try the following recipe. (Recipe Source)

Ingredients
Kelp Powder--3 tbsp
Oatmeal--3 tbsp
Orange Peel, grated--3 tbsp
Sea Salt--3 tbsp
Sunflower Seeds, ground--3 tbsp
Grapefruit--3 drops
Sweet Almond Oil

Instructions
Save Sweet Almond Oil for later. Mix all dried ingredients and Grapefruit essential oil in a jar. Keep jar sealed until use. Blend with almond oil to a desirable consistency just before using.

FOR MORE Recipes: Homemade Body Scrubs, 250 Bath Body Recipes

You can now find HHB on Facebook. Share with your friends:

http://www.facebook.com/healthyhairandbody.

Did Toxic Effects of an EHR Kill Rory Staunton?

A stunning story about the death of a young man from sepsis (blood poisoning by infection), missed in an ED, appeared in the New York Times:

An Infection, Unnoticed, Turns Unstoppable

By JIM DWYER
New York Times
Published: July 11, 2012

For a moment, an emergency room doctor stepped away from the scrum of people working on Rory Staunton, 12, and spoke to his parents.

“Your son is seriously ill,” the doctor said.

“How seriously?” Rory’s mother, Orlaith Staunton, asked.

The doctor paused.

“Gravely ill,” he said.

How could that be?

Two days earlier, diving for a basketball at his school gym, Rory had cut his arm. He arrived at his pediatrician’s office the next day, Thursday, March 29, vomiting, feverish and with pain in his leg. He was sent to the emergency room at NYU Langone Medical Center. The doctors agreed: He was suffering from an upset stomach and dehydration. He was given fluids, told to take Tylenol, and sent home.

Partially camouflaged by ordinary childhood woes, Rory’s condition was, in fact, already dire. Bacteria had gotten into his blood, probably through the cut on his arm. He was sliding into a septic crisis, an avalanche of immune responses to infection from which he would not escape. On April 1, three nights after he was sent home from the emergency room, he died in the intensive care unit. The cause was severe septic shock brought on by the infection, hospital records say. 

Rory Staunton, age 12, 5 feet 9 inches tall and 169 pounds, had suffered a cut on his arm.  He presented with a marked fever of 102 F (39 C), pulse markedly elevated at 131, respiratory rate elevated at 22; reported to have hit as high as 36 breaths per minute (in essence, panting).  It was reported by the NYT that before the ED visit his parents said his temperature had reached 104 F (40 C).

That alone should have set off some level of concern.  (It is possible narrative details of his history never made it into the ED chart; ED EHR's are often templated point-and-click affairs that can impair or discourage capture of narrative.)

Per the NYT, the bacteria Streptococcus pyogenes normally dwells in the throat or on the skin, areas where the body is well defended.  Also known as Group A streptococcus, the strain typically causes strep throat or impetigo.  However, if it gets into the blood stream (e.g., via a cut in the skin, as this patient suffered playing ball), the results can be devastating.

The lab results from the first ED visit are particularly stunning:

(From NYT article; click to enlarge)

The white blood cell count is markedly elevated at 14.7, meaning 14,700 cells per microliter of blood (cubic millimeter or 1 mm³).  Further, there is a plain evidence of greatly accelerated new white cell production, in the form of "bands", at 53% of the total (normally 5-15%).  Bands are immature white blood cells that are seen in the blood, being produced as part of the body's response to infection.

Herein is a significant issue.  The NYT noted that:

"Three hours later [i.e., after the ED visit, which reportedly only lasted 2 hours - ed.], Rory’s blood tests came back. High levels of neutrophils and “bands” – immature white blood cells – are evidence of infection. But nobody called the Stauntons, and by the time Rory returned to the hospital the next day, his infection was unstoppable. He died two days later."

Not getting into the issue regarding the patient apparently being discharged before the labs got back (itself an invitation to disaster), and the other abnormalities such as low sodium, low platelets, elevated glucose all pointing to a very sick patient... nobody called the Stantons with white cell results like these?   Nobody entertained the thought of ... antibiotics as a precaution?

It is possible - dare I say likely - that no clinical person in the ED ever saw these results.

EHR's that are poorly designed or implemented can have a toxic effect on care.  For instance, EHR's can cause user confusion if the user interface is complex, data can be lost due to poor relational design.  Data from the wrong patient's data can be presented (misidentification), or data from a lab can come back to the system after a patient has left, and despite being abnormal, just sit there in a silo without being looked at ("out of sight, out of mind"; a "silent silo" syndrome).

It is usually difficult to ascertain exactly which EHR product is being used at a particular hospital.  I note this medical center actively promoted its EPIC EHR in a June 2011 press release "NYU Langone Medical Center Launches Next Phase of Its Electronic Health Record System", although another system "ICIS"  (for Integrated Clinical Information System, "a state-of-the-art healthcare information management system that connects all NYULMC caregivers involved in patient care") is mentioned here.  The ICIS may also contain the Eclipsys Sunrise Clinical Manager, per this link. (I'd noted some clinically relevant problems with the latter in an FDA report here.)

In any case, magical powers are attributed to the technology that are not strongly or uniformly supported by the literature (link), but strongly pushed by industry marketing memes of deterministic health IT benefits and absolute beneficence:

“... Our electronic health record system is an integral part of our ongoing efforts to leverage technology and enhance our ability to provide patient-centered care and enable the highest level of quality care management,” said Bernard A. Birnbaum, MD, senior vice president and vice dean, chief of hospital operations at NYU Langone. “These front-end and back-end services are an important step in assuring our patient’s experience from beginning to end is a seamless one.”

I've documented examples of situations where EHR's and other IT components of clinical ERP systems (enterprise resource planning and management systems, a term that more accurately describes what exists in many hospitals now than the misleading, file cabinet-evoking term "EHR") contributed to or caused patient harm, such as at "Babies' deaths spotlight safety risks linked to computerized systems" - a computer error caused a central line placement x-ray to have gone unread, leading to death; "The Sweet death that wasn't very sweet" - a missing "difficult intubation" EHR flag led to a middle-aged man suffocating during an intubation attempt; and others.  An Australian researcher thoroughly studied the potential risks of an EHR meant specifically for ED's ("A Study of an Enterprise Health information System", PDF executive summary at this link).

The following passage in the NYT article also offers another clue:

... Two hours later, though, he had three [signs of sepsis]: his temperature had risen to 102, his pulse was 131 and his respiration rate was 22. But by the time those vital signs were recorded, at 9:26 p.m., they had no bearing on his treatment. In fact, the doctor had already decided that Rory was going home. Rory’s “ExitCare” instructions, signed by his father, were printed 12 minutes before those readings. 

Did those readings escape notice due to delayed charting (data entry), a common problem with EHRs in busy clinical environments?

The Institute of Medicine in its 2011 IOM report on health IT safety admitted harms are reported but the magnitude of harms is unknown due to multiple reporting impediments, as did the FDA in its 2010 internal memo on "H-IT Safety Issues" divulged by the Huffington Post Investigative Fund (see here and here).  The National Institute of Standards and Technology (NIST) admits in its 2011 report on HIT usability that EHR usability is often poor and may lead to "use error" (error caused or promoted by poor design, as distinguished from simple user error, see here), magnitude of problem also unknown.

In a startling medical situation such as Rory Stanton's, where crucial labs seem to have evaporated causing or contributing to delayed treatment of a devastating and obvious illness, I believe EHR-related factors need to be examined and ruled out first.

For, quite simply, if the EHR caused or contributed to this tragic debacle, the public could be at risk.


-- SS

Additional thought:  could this be the "cybernetic Libby Zion case" I've written of?

-- SS

July 18, 2012 Addendum:

The Stauntons, who appeared on the NBC Today Show are seeking to create a “Rory’s Law” in New York to ensure that parents have full access to blood and lab tests done on their children as soon as results are available, and that a doctor will be present to assess the findings. Story here.

-- SS

Interview with Aitor Calero of Directo al Paladar

Aitor Calero writes for the popular Spanish cooking and nutrition blog, Directo al Paladar ("straight to the palate").  We did a written interview a while back, and he agreed to let me post the English version on my blog.  The Spanish version is here and here.

Without further ado, here it is:

Read more »

Quantitating the Corruption of Finance Leadership (Who May Overlap with Health Care Leadership)

The bad leadership in health care that we frequently discuss now appears to exist in a context of an increasingly corrupt society.  In particular, we have discussed how the leadership of major health care organizations, such as teaching hospitals, and the universities within which medical schools operate, now frequently interlocks with the leadership of finance.  The ongoing global financial problems have been blamed on bad leadership in finance.

A Survey of Finance Leaders

Now, a survey by a law firm that supports corporate whistleblowers offers some quantitation of the corruption within finance.  The press release for the survey is here, and a summary of results is here.  The survey respondents were 250 US based, and 250 UK based "senior individuals within the financial services industry."

Key results were:

- 24% of those surveyed believed that the rules may have to be broken in order to be successful.

- 25% of UK respondents believed financial services professionals may need to engage in unethical or illegal activity to get ahead; US respondents were only slightly less inclined to engage in wrongdoing at 22%.

- 12% of total respondents believed that it was likely that staff in their company have engaged in unethical or illegal activity in order to be successful.

Perhaps exhibiting ego bias, the senior professionals thought that there competitors were even worse:

39% of total respondents believed it was likely that their competitors have engaged in illegal or unethical activity in order to be successful.

A substantial number of respondents admitted that they would be willing to engage in illegal activity were the circumstances favorable:

16% of total respondents were at least fairly likely to engage in insider trading if they could get away with it. Perhaps more troubling, only 55% of all respondents could say definitively that they would not engage in insider trading if they could make $10 million with no risk of getting arrested.

An important fraction thought that the worked within organizations that encouraged unethical and illegal behavior:

- 30% of all financial services professionals reported feeling pressure to compromise ethical standards or violate the law as a result of their compensation or bonus plan.

- In assessing other pressures that may lead to unethical or illegal conduct, 23% of all respondents also reported feeling other pressures to compromise ethical standards or violate the law.

Note that due to social desirability bias, the survey likely understates these problems.

Comment

Also note that at least so far, this survey is not much less anechoic than much of the evidence of corruption in health care that we have discussed. Although it has been briefly noted in the financial blogs and press, like Reuters, BusinessWeek, and also in the New York Daily News and Los Angeles Times, no other main-stream media has commented yet.

One post on a Forbes blog by Peter Cohan made the weary observation:

Business corruption follows a well-worn path. The boss tells you to bend the rules, and knowing that ignoring that request will cost you your job, you do what you’re told. At the end of the year you get a big bonus and promotion.

Then a disgruntled customer or employee leaks the shady activity to the press or a regulator and your company pays a fine and gets a few weeks of bad headlines. Time passes and the cycle restarts.

He concluded in part:

The conditions that make business corruption pay off have not changed despite numerous scandals — recent ones include Enron, WorldCom, Madoff, and Lehman Brothers – all of which reflect the same conditions that prompted me to write Value Leadership a decade ago: Let executives write their own report cards, base bonuses on those numbers and you will get corruption every time.

The solution is as clear to me as it is impossible to implement. First, all corporate financial reporting must be conducted by highly paid government auditors –rather than by auditing firms that are paid by the companies they audit. Second, performance-linked bonuses must be set aside in escrow accounts for a decade until it’s clear whether the true benefits of business strategies exceed their costs.

As long as there is no limit to how much money companies can put into politicians’ pockets, this fix will never be implemented. That’s because money puts big business in control of politicians who — if they were responding to the interests of the majority of Americans — would eliminate the conditions that make the benefits of business corruption exceed its costs.

But business corruption pays for those who finance Washington campaigns so the soil in which it flourishes remains fertile.

The same is likely to be true of unethical practices by and corruption of health care leadership. After all, health care leaders now mainly come from business management backgrounds, and so have been trained in the same way as financial professionals, and exposed to the same culture that they have experienced. As we have noted, the leadership of health care and finance often overlap. For example, see ours posts on the finance influence on the board of Dartmouth College; the role of the former CEO of bankrupt Lehman Brothers on the board of New York-Presbyterian hospital; the role of finance leaders who derided the Occupy Wall Street as "imbeciles," among other things on the boards of miscellaneous health care organizations; the role of finance leaders on the board of Pfizer, etc, etc, etc.

True health care reform may require larger reform in the greater society.  In any case, we need to reform the culture of health care organizations so that leaders put patients' and the public's health first, and self-interest last.  Furthermore, health care organizations should not provide positive incentives merely for exceeding financial or volume benchmarks, and should provide strong negative incentives for unethical behavior.