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A: Albuterol is usually the primary “rescue” or short-term medicine that is used to help acute asthma symptoms, such as coughing or wheezing. When a patient needs to use albuterol to relieve daytime symptoms more than twice per week, however, it usually reflects the need to use daily “controller” or anti-inflammatory medications. Many people are concerned about possible side effects of inhaled steroids, which are the largest group of “controller” medications available. When used in low- to medium-doses, however, inhaled steroids are very safe, even used on a daily basis for years. They are much safer than either multiple courses of oral steroids OR uncontrolled/undertreated asthma symptoms.
Answered by John Carl, MD. Dr. Carl is a pediatric pulmonologist at Cleveland Clinic Children’s who diagnoses and treats pneumonia, asthma, bronchitis, emphysema, and other respiratory problems in infants, children, and adolescents.
Would it help with the mortification to know you’re not alone? About one in four adult women has what’s called stress urinary incontinence, which means that sudden pressure on your bladder — like laughing, coughing, or jumping — can overwhelm your pelvic floor muscles and lead to a few dribbles.
The best solution? Strengthen those muscles with Kegel exercises, says our friend Miriam Graham, a Maryland physical therapist specializing in pelvic floor health. Miriam recommends doing 30 or more Kegels every day. If your pelvic floor muscles are very weak, however, you might have a hard time finding them, let alone squeezing them. In that case, Miriam says, talk to a physical therapist about electric stimulation and biofeedback (both painless), which will help you isolate and strengthen the right muscles. Dr. Joseph Montella, who directs the urogynecology department at Jefferson Medical College in Philadelphia, counsels patience. “It can take eight weeks to see results,” he tells us.
While you’re waiting, drink plenty of water, Miriam says. Skimping on the hydration can lead not only to incontinence-causing bladder infections but also stronger-smelling urine. Also, suggests Joe, you might try inserting a tampon before an activity that caused you to leak before — but place it a little lower than you would during your period. “It’s not to absorb the urine, but to compress the urethra,” he says. And that, sisters, is how to laugh, sneeze, and jump without fear.
Answered by: Dr. Joseph Montella, who directs the urogynecology department at Jefferson Medical College in Philadelphia
Thanks for your question. The organization sponsoring the CME type 2 credits is International Pain Foundation, a 501-C-3 nonprofit. At the end of the conference we will send the providers a letter of verification of participation for their self-claimed documentation for the number of credit hours they earn during the conference for their records based on the classes they attend and document with International Pain Foundation at the International Pain Summit event. This credit is self-claimed and self-documented by physicians and medical professionals in attendance. In the past events we have not every heard of the CME Type 2 hours not being accepted from our similar events, but it’s always worth checking with the regulators of your specific industry. You can earn up to 9 CME Type 2 hours at the International Pain Summit 2019.
A CME Type 2 is self-designated and claimed by individual physicians for participation in activities not certified for CME Type 1 credits that:
- Comply with the AMA definition of CME; and
- Comply with the relevant AMA ethical opinions; at the time of this writing this includes E-8.061 “Gifts to Physicians from Industry”, E-9.011 “Continuing Medical Education” and E-9.0115 “Financial Relationships with Industry in Continuing Medical Education”, and Are not promotional; and A physician finds to be a worthwhile learning experience related to his/her practice.
- Examples of learning activities that might meet the requirements for CME type 2 include, but are not limited to:
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- Teaching residents, medical students or other health professionals
- Unstructured online searching and learning (i.e., not Internet PoC)
- Reading authoritative medical literature
- Consultation with peers and medical experts
- Small group discussions
- Self-assessment activities
- Medical writing
- Preceptorship participation
- Research
- Peer review and quality assurance participation
- A physician must individually assess the educational value for each learning experience in which he or she participates to determine if it is appropriate to claim Type 2 credits.
- Definition of CME: CME consists of educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public or the profession. The content of CME is the body of knowledge and skills generally recognized and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine and the provision of health care to the public.
- How do physicians calculate how much Type 2 Credits should be claimed? As with live activities, physicians should claim credit based on their participation time with 60 minutes of participation equal to one (1) CME Type 2 this credit is claimed in 15 minute or 0.25 credit increments, and physicians must round to the nearest quarter hour.