A genetic disorder, also called the cerebrohepatorenal syndrome, characterized by the reduction or absence of peroxisomes (cell structures that rid the body of toxic substances) in the cells of the liver, kidneys, and brain. One of a group of disorders called the leukodystrophies, all of which affect the myelin sheath, the fatty covering which acts as an insulator on nerve fibers in the brain.

The most common features of this syndrome include an enlarged liver, high levels of iron and copper in the blood, and vision disturbances. Some affected infants may show prenatal growth failure. Symptoms at birth may include lack of muscle tone and an inability to move. Other symptoms may include unusual facial characteristics, mental retardation, seizures, and an inability to suck and/or swallow. Jaundice and gastrointestinal bleeding may also occur.

There is no cure and there is no standard course of treatment.

medicinenet.com

According to the 2009 CMA (AAMA) salary survey and those that responded percentages of time spent on clinical activities were established.

87% obtain patient history and vital signs
81% assist with patient exams
72% injections
53% EKGs
51% laboratory
47% venipuncture
47% other diagnostic testing
12% x-ray

In terms of administrative activities the most common task performed was scheduling patient appointments and over 56% handle medical records. The task least performed was bookkeeping!

Among managerial duties purchasing of supplies surpassed the others. 18% supervised staff and 11% were involved in hiring, evaluating and terminating employees. Data demonstrates why we teach what we do.

Information obtained from CMA Today Nov-Dec 2009.

1. Ill, Acute Care, Urgent, New Problem Visits: focused on the symtom or concern the patient is concerned about. 10-15 minutes, often same day.
2. Medication Check, Chronic Disease follow up or Health Maintenance Visits: Often 2-4 times annually for adults dealing with a chronic health condition for about 15-20 minutes. Usually used to obtain labs to monitor the condition, and/or update meds.
3. Well Visit, Complete PE, Pap, Preventative Visit: Generally more provider driven deals with recommended health screening, immunizations, and individualized healthy behavior counseling, where the goal is to let patients kinow how their health is overall and how to improve it.
4. Procedure Visit: skin biopsies, mole removals, diagnostic procedures with a certain level of time designated for each varying from 15 minutes to a half hour. A procedure room may be need to be reserved.

Keep in mind insurance coverage differs depending on the plan and what the patient has contracted for. For example a complete physical examination may only be covered annually or every other year. Sometimes patients are responsible to pay a co-pay for their visits.

5. Worker’s Compensation Visit: Work related injuries and problems are handled in which the clinic will on bill the worker’s compensation insurance plan.

1. When to apply: the first day of the month, 4 months prior to the month that your testing period begins.
2. 90 days of eligibility: begins with the testing period start date you select on your application. DO NOT CHOOSE A START DATE ANY EARLIER THAN 30 DAYS BEFORE COMPLETION OF YOUR PROGRAM.
3. Choice of time & place: at a time & location convenient for you.
4. Top security: exam is delivered through the same network used by the US Medical Licensing Exam.
5. Ticket to admission: you will need your scheduling permit and a signed government-issued ID.
6. 195 minutes total: 160 minutes to take the exam, plus a 15-minute tutorial & 20 minutes of optional breaktime.
7. Divide & conquer: 200 multiple choice questions to take divided into segments. Those optional breaks may be taken after each segment.
8. Topics outlined: Use the content outline posted on www.aama-ntl.org to study
9. Instant unofficial results: you’ll receive a pass/fail result upon completion. Official score will be mailed within 10 weeks.
10. Professional recognition: Employers can verify your certification status online

Window of exam eligibility: candidates who graduate on or after 1/1/10 will have 60 months from date of graduation to sit for and pass certification exam. If the candidate does not pass within this timeframe, they are no longer eligible for the credential.

Three attempts: for initial certification. If the candidate does not pass on the third attempt, the candidate is not eligible for the credential.

Reactivation by exam: If it has been longer than 60 months since a CMA(AAMA) has recertified, the credential has expired and cannot be reactivated by continuing education. The exam would have to be taken again! So, keep up with continuing education within the timeframe of recertification you are given.

Bathing patients with an antiseptic and squirting medicated ointment up their noses dramatically cut the rate of dangerous staph infections after surgery. The antiseptic did a better job than the reddish-brown iodine solution that has been used for decades to swab the skin before surgeries. Up to a half million Americans develop surgical-site ninfections, most from staph bacteria, each year. Studies are reported in the New England Journal of Medicine.

American College of Obstetricians and Gynecologists announced that women should start getting cervical cancer screenings at age 21 instead of 18, and that women could wait longer between the screenings — regardless of when a woman starts having sex. ACOG is now just endorsing the three-year interval for HPV negative and Pap negative [women]. Women in their 20s with normal Pap smear results now should get screenings every two years instead of every year, and women in their 30s can wait three years between screenings if previous results were within normal limits.

There is some concern that women will neglect annual checkups with gynecologists. An annual pelvic exam is still encouraged particularly for women on oral contraceptives or hormone replacement therapy.  A risk exists for those women that have never been screened with a pap smear.  Newer methods of pap smear collection also include human papilloma virus screening.

ACOG guidelines point out that only 0.1 percent of cervical cancer occurs in women under 21 years of age in part, doctors believe, because young women’s immune systems are strong enough to fight off HPV before it causes cancer. When dysplasias progress to cancers it’s usually a result of older women missing screenings for years at a time; 50 percent of women diagnosed with cervical cancer each year never had a pap smear before, according to the ACOG statement.

http://www.time.com/time/magazine/article/0,9171,1001951,00.html

Interesting news posing a conflict in current recommendations for mammogram screening.  Who is correct- National Health Institute or American Cancer Society and what will the medical community advise.  Currently 40 year old women should have a screening mammogram and continue them annually.  Women with a positive family history often screen earlier at age 35.  Recommendation is to change first screening to begin at age 50.  Just a few years ago the parameters were to begin at 40 and screen every other year until age 50 and then annually thereafter.  Tune in-

Electronic records help avoid medical mistakes. With EMRs, providers can instantly access patient records, including allergy lists, lab results and prescription histories. The EMR makes it possible to generate a single letter that may explain lab results or mailings to a specifice group of patients. Timely access to patient records can prove valuable in emergency care.

The US has been generally slow in implementing EMRs however it does seem fairly prevalent in the Twin Cities. Only 1.5% among 3,000 hospitals surveyed have comprehensive electronic systems! Only about 28% of US physicians use EMRs. This sluggish growth is no doubt due to the fragmented nature of private health care delivery as well as cost of implementation. Starting in 2011, financial incentives will be offered to Medicare providers using electronic records.

There is a lot of info in this article titled “Incoming transmission Switch to EMRs in sight” in SepOct 2009 CMA Today Magazine. The article was written by Mark Harris.

Metformin, normally used in treatment of diabetes, can also help boost immune system memory (T cells and B cells, which recognize returning pathogens, allowing them to launch a quick defense).

Read more in the SepOct 2009 CMA Today Magazine.