Stephen Z. Fadem, M. D.

1/16/2005

Core Values

Filed under: — fadem @ 4:53 pm

As you read this your first question is probably why is an article about my core values doing in the technology section? Hopefully, this will be answered.

Core Values are beliefs that an individual, a family, a company and even a community hold. Every action and every decision, among the million we make each day, in some way, through behaviors and actions, reflects upon our values and our belief system. These ideals are inextricably linked, and flow seamlessly into one another. They are often bidirectional, that is - what one can expect to receive he should also expect to give.

We all have core values that drive us, but it takes introspection to realize what they are and categorize them. After doing this discipline, I am ready to display mine. They are the values I live by, teach my children, and run my life.

1. Knowledge - Each day is different for billions of inhabitants of this planet. As our continents drift together and apart, physically and metaphorically, news, as well as weather is created. Man is gifted with the cognitive ability to explore, to learn and to use knowledge to make the earth better or worse.

Yet, the world and our lives are far from perfect, and only improve through a process. This process begins with knowledge, therefore so do my core values. Knowledge is a prerequisite to understanding.

One does not need to use imagination to understand why nephron.com is comprised of a very powerful news aggregating engine. It is fundamental to my being to pursue knowledge, and a core essential to my ability to progress and make a difference as a doctor and as a citizen of this planet.

2. Understanding - To understand and be understood is the prerequisite for every action that we take toward our visions, objectives and goals. Understanding people is a requisite for relating. It requires perception and is clouded by misperception. It necessitates communication, but regrettably ceases with emotion. Being able to look at an issue from all sides and derive a substantive conclusion is most healthy for every relationship, and on every level.

Understanding is also being able to assemble knowledge, moving from the vast data that pours into our lives constantly and parsing it for that which will lead to our betterment.

3. Integrity - Integrity makes all else possible or impossible. It must be the cornerstone of how we live our lives. To be able to trust and be trusted is a matter of survival with respect to any relationship, business dealing, or pursuit. But honesty must be taken a step further. Honesty with oneself is a prerequisite for using knowledge and understanding. One who cannot face a hard truth cannot ever move beyond it. Integrity emcompasses accountability, taking responsibility so that one can ultimately achieve a sense of accomplishment.

4. Respect - This is the culmination and benefit of our core values, and yet is intertwined. To give respect means that one values colleagues, and is practically the only true way to work together. Respect is a feeling one has for others, and it the natural consequence of respect is providing good service. Service excellence results when a company values its customers or clients, and when doctors values their patients. It is bidirectional, and directly leads to team fulfillment. To get respect means that the system is working and that we are able to progress.

Respecting people occurs with understanding and integrity, and getting respect from patients is necessary if one is going to make a positive difference in their lives.

5. Contributing - This is what it is about - being able to combine the other values above and create the opportunity to make a positive difference in the lives of my family, my children, my patients and my colleagues is a value I will always cherish. Honesty, it keeps me alive. Contributing is sharing wisdom in a way that leads to the betterment of others. It is often a challenge, and requires innovation and ingenuity. It leads to the thrill that a physician achieves when a patient does well.

6. Accomplishment - As one contributes and makes a difference, one is able to derive a sense of accomplishment. Achievement is not a solitary act, and is the culmination of a team effort, so the associated feelings should be shared with the team that made it possible.

7. Joy - There are many rewards one can earn, but none surpass the internal joy of seeing a job well done, a child achieve, a patient recover, or a person one loves very much happy. These joys renew our vigor and recycle our energy.

Well, these are my basic core values, and they drive my behavior and my activities. You are witness to one of them, nephron.com - so maybe now you understand what this is all about.

1/12/2005

How to indroduce CKD to primary care physicians

Filed under: — fadem @ 4:53 pm

What does a busy doctor want to know about kidney disease?
1. Definition and classification?
a) The intrinsics of kidney disease
b) Why the incidence changed - NHANES III meets MDRD
c) Why “kidney”
d) What happened to the creatinine clearance?
2. What the trends in care are?
a) prevention through blood pressure, diabetes and ARB
b) Drugs which harm the kidney
c) Drugs which harm the body in kidney disease
d) Lifestyle changes - exercise, BMI, diet
e) Inflammation - CRP
f) vitamin D - emerging
3. What is the evidence?
a) MDRD
b) HOPE, MICROHOPE, MRFIT
c) ALLHAT, AASK
d) ABCD, DCCT, Collaborative Study Group, RENAAL, IRMA
e) SysEUR, REIN,
4. What are the guidelines?
a) NKF KDOQI
b) JNC VII
c) ADA, AHA,
4. Why refer patients to disease management?
a) Structured to provide patient support
b) Implementation of knowledge the biggest challenge
c) Primary physician role is expanded as patient motivation increases
d) Nephrologist as coach to primary physician who coaches patient
e) Nurse specialists, dietitians, PAs, RNs as trainers
f) Continued reinforcement crucial to any lifestyle change

12/27/2004

Facts about calcification

Filed under: — fadem @ 4:53 pm

1. Chordates radiated out and then calcified, telling us two things - that the enzymes are already present in each cell prior to radiation and that there must have been some environmental event that made calcification happen.
2. Those tissues that became precursors to the kidney arise from either mesodermal or ectodermal cells, depending upon whether or not the animal was a chordate. This means that the abity to protect and balance with ones environment was also primitive to the appearance of calcification
3. The appearance of calcification was to paleontology what the papyrus was to history.

12/16/2004

Choosing an Information System

Filed under: — fadem @ 4:54 pm

How to avoid making mistakes

Purchasing an information system for a medical office is a major undertaking. If it is not done with careful planning, it can be a disaster. Yet, a successfully implemented health system can save time, increase productivity and efficiency, and improve the quality of care by making requested information readily available for patient care as well as for strategic planning. Here are a few items to consider when determining what system to purchase. There are several online resources -

Start with http://links.nephron.com (There are special sites for administrators and for physicians, and as well there is an entire practice management section).

1. RFI (Request for Information) Determine all the facts about available systems. Interview other clients from provided lists. Below are a series of questions to ask them.
2. RFP (Request for Proposal) This discipline will help you understand your needs, the specifics of your project, expectations and budget. It will also set a straight course regarding setup, training, service, support, responsibilities and upgrades from invididual vendors
3. NPV (It is important to know what your discounted cash inflow and outflow are going to be, and if the outflow is higher than inflow (NPV is negative), you must understand that your investment is not financially sound. Here you and your team should brainstorm to determine all of the ways that the computer will help cut expenses - time, supplies, labor, increase productivity, meet regulatory demands, increase retrievable funds, more accurately show you financial information and clinical information. Also, you must include all costs - capital expense, hardware purchases, network installation, set up, configuration, and software purchases, set up, training of administrator, training of end user, support costs, upgrade costs, supplies costs and computer depreciation (yes, they wear out!!)
4. Survey - It is important after you system is installed and operational that you document carefully how well the vendors met your expectations.
Were setups done in a timely manner?
Was training helpful?
Was training attempted during setup?
Did the vendor train your staff properly on system administration?
Did the vendor attempt to deflect innovation or promote it?
Were they willing to listen to new ideas and enhancements?
How serious was the problem of fingerpointing?
Did the vendors seem to understand hardware, networking and software issues?
Did the program perform as you expected?
Is the program user friendly and easy to use?
Are there obvious bugs?

11/29/2004

Websmart

Filed under: — fadem @ 4:54 pm

1. History - where we have been with information -
Use health care as an example
“The doctor said” to “index Medicus” to BRS
Tie in advances in information technology
Add advances in medical and science tech - keeping up
Consequence: Patients are more informed
Guidelines - clinical trials - v research - anectdotes - v nothing (develop in future chapter)

2. Business example - The Peach
Faires, Guilds,
Sears Roebuck catelog
Train - travel - highways - 1920s
Refrigeration - meat
Television (develop in future chapter)
Direct marketing (develop in future chapter)
Infomercial
Online
e-commerce
3. Advertising - The Media - Daniel Boorstin - The Image
Making news - press releases for new products
Larry King Live and the Talk Circuit
4. Branding and awareness
5. Creating a web product for professionals
6. Creating a web product for e-commerce
7. Creating a web product for patients and consumers
8. Making sure information is authentic -
9. Development - Why Zope
10. Using the product - Why Transparent - levels of use - adminstrator to end user
11. Where do we go from here?

11/6/2004

Computer tips for links.nephron.com and other sites

Filed under: — fadem @ 4:54 pm

1. desktop.google.com
2. define= (google)
3. hubmed - reference managers
4. MDRD GFR
5. ez capture - images
6. Mozilla - tabs
7. Yahoo - spyware and popup blocker
8. Yahoo - beeper reminders
9. Airport - quick connect wireless
10. 3M mousepad
11. colorpic
12. ppt-wav-gif exporter
13. autofilter
14. ppt viewer
15. thumb drive
16. scintila and textpad
17. pdf - digital signature
18. verisign - digital signature
19. background images
20. shortcuts - toolbar
21. keyhole.com (NASA)
22. JPEG2000 - freeware
23. Touchgraph
24. Webdevelopment tools - Mozilla

10/31/2004

How to archive newsdesk pages

Filed under: — fadem @ 4:54 pm

… by Brian Rosenthal

I implemented an “archive” method, which can be called from any DTML Document (or any other object, for that matter, but not for a method).
Let’s say we want to archive the DTML Document “news_dtml”
We call “(Link:http://links.nephron.com/news_dtml/archive)http://links.nephron.com/news_dtml/archive", which does the
following:
A. CREATE A FOLDER “news_dtml_archive” if it does not already exist.
B. CREATE A METHOD inside the folder called “index_html” which lists
all Documents inside the folder.
C. CREATE A DOCUMENT “2004_11_01″ titled “TITLE - 2004-11-01″ (or
equivalent) which contains in its body the result of calling the method.
n that way, any time you call the “archive” method on an object, it
will create a folder to manage the archives and start populating it.
Now, you have to actually hit that page
“(Link: http://links.nephron.com/news_dtml/archive)http://links.nephron.com/news_dtml/archive” to get this to work. It doesn’t make sense to call “archive” from within the document because you wouldn’t know whether the document was finished (not to mention the
loop: document calls archive, which calls document, which calls archive…).
Therefore, to get the archive script to be called regularly, we have to schedule a task to hit the page
“(Link: http://links.nephron.com/news_dtml/archive)http://links.nephron.com/news_dtml/archive” (or whatever you want to archive) on regular basis (probably at 10 PM at night).
Zope does not to my knowledge have a scheduling infrastructure, so we will use the “crontab” infrastructure on the UNIX machine (same as the
auto-execute).
I have set it to auto-execute every evening at 10 PM California Time (midnight CST) for news_dtml and I can add as many as you’d like to that
file.Alternatively, you can take a look at the script that runs. It is located here: /home/brosenth/crontab/nd_nightly.sh

9/4/2004

Salt - What should we do?

Filed under: — fadem @ 4:55 pm

There are 65 million Americans with hypertension, and in many instances, this can be controlled by a reduction in dietary salt intake. However, salt is ubuiquitous in our diets - it is present in the foods that we purchase at the store, as well as what we eat at restaurants (particularly fast food restaurants). Hypertension is one of the two most common causes of kidney failure - a 16 billion dollar/year government expense, and stroke, which costs approximately 128 billion dollars per year.

We pay for the care of salt victims through taxes or insurance. Lowering health care costs is not going to be possible once patients reach the end stages of either kidney or cardiovascular disease, and the only way that we will every make an impact on health care is through prevention.

Where do our personal rights to make unhealthy decisions end? When does the government, often the payor for the consequences of hypertension have the power to somehow intervene in our health decisions? How strong should the intervention be?

The range of intervention stretches from the extremes of controlling the salt content of food to the vast expenses of education. Education is expensive because a popular food chain spends around 1.5 billion dollars per year on marketing.

8/14/2004

Delaying Chronic Kidney Disease

Filed under: — fadem @ 4:55 pm

1. Overview
2. QOL and Morbidity
QOL = energy
anemia
heart failure
Morbidity - vascular events
peripheral vascular
skin ulceration
target organs - heart, brain eyes, kidneys
3. Pathophysiology
Hypertension - tension on tissues - induces fibrocytes - wall thickens
Calcium - Calcification matrix - induces osteoblasts - wall hardens
Sugar - polymerization (AGES) - increased matrix
Inflammation + Cholesterol - macrophage - foam cell - atherosclerotic plaque

What do you want to hear about - re technology?

Filed under: — fadem @ 4:55 pm

Setting up e-mail online to minimize spam
Making your computer run faster
Adding spice to Powerpoint
Photo finish
Newsdesk
Keeping track of information
Using visio to create guidelines
Publishing and storing on the web
Paperless office
Wireless world
History and physicals without pencils

5/9/2004

New Technologies at szf.com

Filed under: — fadem @ 4:56 pm

szf.com is a development page where new technologies for the web are being developed and tested.

Current projects:

Touchmed
Newsdesk
Photos online
links.nephron.com
Kidney Associates File Server

for any questions
contact Stephen Z. Fadem, M.D.
fadem@nephron.com

4/29/2004

What do you want to hear at the NKF Cybernephrology Sessions?

Filed under: — fadem @ 4:56 pm

Hi, My name is Steve Fadem. I will be holding some instructional classes during the NKF CM.04 meeting exhibits in the cyberNephrology section.

I am interested in what you would like me to talk about. I will answer any questions you are having regarding
Powerpoint
Visio
MS Word
MS Excel
The Web
TouchMed
Newsdesk
MDRD calculators
Powerpoint quizzes
Google
Blogs

Please let me know specifically about what you want.

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