Friday, 12 April 2019

Myths about using Suboxone to treat opiate addiction

It used to be that prostate cancer screening was routine for men over the age of 50. Positive results on the prostate-specific antigen (PSA) test would trigger a biopsy, and findings of cancer would lead almost inevitably to treatment.

But recently, the rate of PSA screening in the United States has fallen sharply — and the number of new cases of prostate cancer has dropped, too. That’s according to a pair of studies published together this past November in The Journal of the American Medical Association. The studies couldn’t prove that these two trends are causally related; however, the authors speculate that they are. That is, the drop in the number of new cases likely reflects declines in screening, rather than a drop in the number of men who actually have prostate cancer.

Like some other cancer screening tests, such as mammography for breast cancer, the PSA test has come under growing scrutiny. Experts say that it flags too many low-risk tumors that might never become harmful during a man’s lifetime. Treating those cancers can expose men to a needless risk of impotence, incontinence, and other side effects.
Why the numbers are dropping

In 2008, the United States Preventative Services Task Force (USPSTF), an influential volunteer panel of medical experts, came out against PSA screening in men older than 75. Then in 2012, they issued an updated recommendation against screening for all men, regardless of age, race, or family history. These recommendations are controversial. Even though many experts acknowledge the PSA test’s limitations, they worry that abandoning the PSA test altogether will boost diagnoses of late-stage tumors that may no longer be curable.

One of the newly published studies reviewed national PSA screening data collected between 2000 and 2013. Results showed that screening rates started falling in 2010, but only among men younger than 75, and especially within the 50-54 and 60-64 year age groups. The overall screening rate (for all men combined) fell from 36% to 31%.

The second study detected a similar drop in PSA screening rates — from 37.8% to 30.8% — as well as a 22% drop in new prostate cancer diagnoses. The authors of this study reviewed data maintained by the National Cancer Institute and found the number of diagnoses per 100,000 men ages 50 and older had fallen from 540.8 cases in 2008 to 416.2 cases in 2012. The biggest declines came after the USPSTF released a preliminary draft of its updated screening recommendations in October 2011.

“These are the first national, population-based data showing what appears to be an effect on prostate screening and diagnoses from the Task Force recommendations,” said Ahmedin Jemal, DVM, Ph.D., vice president of surveillance and health services research at the American Cancer Society, and a key author of the first study.
Don’t write off PSA screening just yet

In an accompanying editorial, Dr. David F. Penson, the chairman of urologic surgery at Vanderbilt University Medical Center, cautioned that the “pendulum” of popular opinion might be swinging too far away from screening. But rather than stopping screening altogether, Penson called for smarter, more targeted screening approaches directed mainly at men considered at high risk of developing prostate cancer.

“These new findings are an expected consequence of the Task Force’s conclusion that PSA testing probably causes more harm than good,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. However, Dr. Garnick also called for better screening tests, acknowledging that the number of men presenting with more advanced prostate cancer is now likely to rise. “We also need studies that offer focused screening to those at potentially high risk of more aggressive forms of prostate cancer,” he said. “The research should test whether early treatment saves lives or decreases the rates of prostate cancer mortality. Until we have those data, the true effect of decreasing screening rates will remain unknown, and the debates about PSA testing will continue, with no clear answers in sight.” Traveling with your children can be a great way to explore new places, spend time together as a family, and visit with those friends and family members who don’t live nearby. To have the safest and healthiest trip possible, keep in mind these travel tips.
Bring the important things from your medicine cabinet

    Pack any prescription medicines your child takes. Check to be sure you have enough for the whole trip.
    Bring commonly used over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), antibiotic ointment, cold medications (as recommended by your doctor), and diphenhydramine (Benadryl).
    Carry a thermometer and a few Band-Aids on every trip; they can come in very handy. Consider a pair of tweezers, too, if your child gets splinters often.

Kids need car seats

    Make sure you have the proper seat for your child’s age and weight, and that it’s correctly installed in the vehicle you are traveling in. The website of the American Academy of Pediatrics offers tips on choosing and installing car safety seats.
    If you are traveling by plane, the Federal Aviation Administration strongly recommends bringing car seats for infants and toddlers and fastening them to an airplane seat. Remember that you will have to purchase a separate ticket for the child in order to use the seat. Check with the airline to see if discounts are available. The car seat must be less than 16 inches wide to fit; be sure to measure before you go! Booster seats are not allowed on planes.

Be aware of common travel health problems

    If your child easily gets carsick, make sure she is high enough in the car to see out the window, as this can help. Keep a window cracked open for a breeze, and have some light snacks such as pretzels available; both can help nausea go away. If your child has particularly bad carsickness (for example, she vomits every trip), talk to your doctor about medications she might take.
    Ear pain can be a problem when people fly. Having an infant nurse or take a bottle during take-off and landing is a good idea, as swallowing helps combat ear pain. For older children, try having them drink, chew gum (sugarless, of course!), or play a yawning game to prevent their ears from blocking up.
    Since schedules and what you eat when traveling are often different than when you’re home, constipation (not having a bowel movement as often as usual) may happen. Give your child plenty of fluids, and make sure there is fiber (fruits, vegetables, whole grains) in his diet.
    Germs can be anywhere when you travel. Carry hand sanitizer with you at all times, to help you bring fewer of them along with you!

Don’t forget about childproofing

    Bring along a childproofing kit with outlet covers, cabinet locks, and whatever else you use at home.
    If staying at someone’s house, you may not be able to childproof the entire place. Ask if there is one room you can completely childproof, so you can relax better while your child is there. Think about the biggest dangers, such as medications, cleaning fluids, knives, and potential choking hazards. Ask if those and any other particularly dangerous things can be moved and/or locked out of reach during your stay.
    For infants and toddlers, a portable crib can serve as both a bed and a safe place to play.
    Consider bringing safety gates with you to block stairs or to help keep your child in a safe room. Your host may appreciate it if you use the kind that open out, as opposed to ones that need to be climbed over.

Do your homework

    Write down your child’s medical information, especially medication allergies (if you forget the name of the antibiotic that gave him the rash, find out before you go!), health problems, and prescription medications. Keep it with you at all times. If your child needs to see a doctor while you are traveling, she’ll need to know these things.
    Bring the names and phone numbers of all doctors your child sees, including specialists, in case you or a doctor you see needs to contact them.
    Ask your doctor about the best hospitals in the area where you are traveling, so you’ll know where to go if necessary.
    Make sure you bring your health insurance cards, and check with your insurance company about coverage out of your area. Most companies will cover emergency care if your child needs it, but you may need to call for approval or go to a particular hospital.

If traveling outside of the country…

    For travel to certain countries, your child may need special vaccines. To find out the latest recommendations, visit the Traveler’s Health section at the U.S. Centers for Disease Control and Prevention (CDC) website. Do this at least six to eight weeks before traveling, as many of the vaccines need to be given at least a month before travel and you may need an appointment at a special travel clinic to get certain vaccines.
    Find out about the particular health risks, such as malaria or dengue, in the country where you will be traveling so that you can talk to your doctor before you go about how to prevent them. The CDC’s website can help with this. It also has lots of useful, practical information about topics such as safe food and water and traveler’s diarrhea.

It sounds like a lot, but mostly it’s just a matter of planning. And it can make a big difference when it comes to making your trip memorable for all the right reasons. In the United States, depression is the top cause of disability, but only 21% of patients diagnosed with major depression get treatment that meets the guidelines of the American Psychiatric Association. Of people seeking depression treatment, those who’d like to be treated with live psychotherapy outnumber those who’d like to be treated with medication three to one, but those who want live therapy often don’t receive it. Access to psychotherapy is limited by the number of professionals in one’s region, cost, and logistics — not to mention stigma. And when people do get therapy, therapists may not provide care that is evidence-based.

One way to get high-quality psychotherapy to people who need it is to automate and computerize the treatment process and deliver it through websites and apps. This could potentially offer guidelines-based treatment to anyone, anywhere, anytime, at a modest cost. Stand-alone computerized cognitive behavioral therapy (CCBT) has been found to be effective for the treatment of depression, and is already available from a few entities. But it’s still not known how much, if at all, CCBT would improve treatment of depression in primary care, so a group of researchers in the United Kingdom recently tested the advantages of adding CCBT to standard treatment. They randomly assigned 691 people with depression into three different groups. One group received standard care, and the others received standard care plus one of two online CCBT programs.
Comparing CCBT with standard care for depression

As it turns out, standard depression treatment in UK primary care centers is quite good. Citizens are routinely offered antidepressant medications, psychotherapy, and access to community mental health teams, psychologists, psychiatrists, and counselors — a range of resources seldom available in US primary care practices.

There was a lot of crossover between the study groups. In the “standard care” group, 19% ended up using CCBT even though they weren’t specifically assigned to that treatment. Between 77% and 84% of all three groups used medication to treat their depression, and “live” mental health specialists were seen by 17% of one and 24% of the other CCBT group.

Against this backdrop — with many participants in the CCBT groups also receiving mental health specialty treatment and 19% of the standard-practice group receiving CCBT — no significant difference in depression treatment results was found. However, in the US, the findings may have been very different, considering the limited array of mental health resources in most primary care clinics.

It would be most interesting, and more important, to know the benefit of using CCBT for patients who receive nothing else — no medication and no access to mental health specialists. It’s for these patients that CCBT might be the most beneficial.
Challenges in getting people to use CCBT for depression treatment

Both of the CCBT websites had been tested in previous clinical trials and both had been found to be effective treatments — but they’re only helpful if people use them. Even though the two stand-alone CCBT websites were designed to be used over either 6 or 8 “sessions,” most people only used them once or twice, even though the study provided reminder calls to the participants. People with depression can experience fatigue, impaired concentration, and feelings of hopelessness. Getting them to consistently use CCBT websites on their own schedule is a challenge — even if these programs might be helpful in the end. More structure may be needed to keep people using CCBT.

What’s the take-home? The biggest challenge isn’t building a CCBT program that works; it’s building one that people will use. Just as you need to entertain before you can educate, any CCBT program needs to be extremely engaging to users — and to provide immediate value from the first session. And, although the treatment-anywhere-anytime concept is alluring, relying on people to schedule CCBT themselves on their own time, in their own homes, may lead to high levels of drop-off; after all, you can always get around to it later. When I was growing up, my doctor still made house calls when we were too sick to get to his office. But he stopped visiting people at home long before he retired. Both he and his patients realized they were perhaps better served by going to his clean, well-equipped office for whatever care they needed.

So I was more than a little surprised when a woman representing my health insurance plan called to schedule me for a home visit from either a nurse practitioner or physician. I have a Medicare Advantage plan, and I thought I was being offered this visit because the caller assumed I was frail and house-bound. I assured her I could easily get to my doctor’s office if I needed to. I’d also just had my annual physical, my immunizations and screenings were up to date, and I felt great. Why would I need a home visit?

The only reason she could give was that the clinician would have more time to spend with me than my own doctor did. The home visit would last 45 minutes to an hour and would include a health history, a physical exam, screenings, and health advice. Since I work full-time, I could schedule the visit for a weekend. And she’d even throw in a $25 Walmart gift card if I completed the exam.

I declined, feeling a little creeped out — especially after checking with my doctor and learning that she knew nothing about this. So I did a little research.

I learned that these visits are legitimate — in fact, over a million patients have signed up for them so far. And I learned that the extra exam had reduced hospitalizations, primarily for patients with diabetes, heart failure, or chronic obstructive pulmonary disease. But what still puzzled me was why my insurer would want to incur the extra expense of duplicating the exam and tests I had just gotten from my doctor. I don’t have any serious conditions and my doctor consistently receives top grades from all the ratings systems.
A method to the supposed madness

Dr. Michael McWilliams suggested an answer. As an associate professor of health policy at Harvard Medical School, he understands the arcane regulations that cover how Medicare reimburses my Medicare Advantage plan for the care I get. He told me that each of us covered by these plans is assigned a risk score. As we develop more health problems, our risk score increases. “The home visits conducted by Medicare Advantage plans allow for the capture of more diagnoses, which in turn increases the risk score that adjusts plan payments from Medicare.  Generally speaking, the more diagnoses recorded, the higher the payment,” Dr. Williams says.

He explains that the risk adjustment system was created to ensure that plans don’t enroll only the healthiest patients, who are less likely to run up charges for expensive procedures and hospital stays. To provide an incentive for insurers to cover sicker patients, the plans are paid commensurately more for their care.

I’ve received two more calls since I first declined the home visit, each more persistent than the last. Now I understand why. If the clinician could diagnose me with a serious health condition, the company could raise my risk score and get a higher Medicare reimbursement each time I visit the doctor.
What to consider if you’re offered a home visit

If you or someone you know is offered a home visit from a Medicare Advantage plan, keep the following in mind:

    If you have a serious health condition, the extra care might help you avoid a hospital stay.
    The care they provide isn’t ongoing. This is the only time you will see the clinician who examines you. The results of the exam and tests will be forwarded to your regular clinician for follow-up.
    If you are healthy and the visit results in an increased risk score, you won’t have to pay more for your care. But the higher Medicare reimbursement your insurer receives may contribute to the nation’s rising health care costs.
Read More »

Tuesday, 9 April 2019

How to maintain your health living status

My mother was lucid and alert when she was hospitalized for pneumonia. But by the middle of the first night, she was wondering how she had ended up at a “hotel” that allowed strangers to enter her room at all hours. The second night, she wandered into the corridor, slipped, and fractured a hip. She didn’t leave the hospital alive.
What is up guys it is I cannot hear and we got a very special episode because they I am back with

today’s Tips is why is French So Dan sexy because me personally as an American as someone who learn French I learned it you know little little bit because it has such a reputation for being so

happy. So and it’s funny because a lot of French people are Belgian people like French is not last section. But for us Americans. It really is like a language of this language of love. It’s a language of just just pure unadulterated sexiness heard that so many times when people are telling me all this sounds so sexy.

I mean it’s normal for me is true is cheating because you got a nice voice to you know, maybe to basically how this video is going to work is I’m going to have five sentences that I’m going to say well she’s going to say them in first and French and I’m going to say the English version and you guys can tell me what sounds sexier in the comments below. And then after that we have a little bonus.

So the other five senses is I’m going to be speaking in my other languages and where to be comparing those languages to French. So for example, like Japanese versus or Russian versus French etc. Alright, are you ready for this?

Yeah.

Alright, so the first one the sound sound as sexy as possible, you know, look into the camera do what you gotta do

now in English, your feet need to buy some so

I think French would add like a French sexiness. You know,

we will definitely video editor put that in A Meeting if you fall down 1000 times get back up 1000. I don’t know. I don’t know. What would you feel about that guys? Yeah, yeah, you guys have to tell us like best for every sentence you can put in the comments below. Like, for example, I was sentence number two. You just put like, you know, 1-234-567-8910 and you can say like, either friend or sexier or English or another language that the sexier right so got it done in English. That dude is

can’t even see this anymore. I don’t I don’t know what to do. I feel trapped.

Okay, that dude is so dirty he never wash. I would have to get that to French in French. I don’t know it sounded like you were just talking about it kind of felt like I was giving you some company yeah

Related Post: Best Way to Learn French at Home for Free

yeah was like it was like you know anyone anyone that was speaking English the walks by would be like

instead of you’re like, really? Like it was actually nice to know many languages because you never know if someone is talking shit behind your back. Yeah, happened to me so many times when I was traveling in so many fights, just because people were like talking shit behind me. But they didn’t know it’s being friends. They love to do it to do it. Unfortunately, for me, even though there’s like six languages that I understand. I haven’t actually had the experience. I don’t know why. I don’t think people will really talk shit about why

Next one

is we can Play play play. Oh please. Alright so it’s Can I have some eggs with bacon and cheese and do some little bit better French? I don’t know this is a big no

no, no. Sometimes people like my mom always says like sometimes at soccer like people are like yeah there’s like a recipe recipe boys and I like this and normal Yeah, but in some ways like this normal so you know, it’s

all right. Next one. Let me wait. Was that sexy? way too much. That was that was like I’m fine. The translation was follow me on Instagram I can I take the best photos that’s what’s up and you should her influence Mana Mana mine is I can obey and now we’re getting to the bonus round all right but obviously be sure don’t forget to comment what you thought one every single sentence little battle every single sentence and now we’re going on to sentence number six I am pretty sure I’m going to see some comments from American people home saying own lead different oh don’t do that to her no come on come on okay so it’s going to be Dutch and since it’s a different language I’m gonna say it first so first let me say the English translation you are unbelievable I’m very impressed to indulge it is a bet on hopefully you’ve been air under the intro Wow tell us what you think is in the next one is Chinese

New sure pretty good

not bad phrase I put in Chinese The next one is you know next one is Japanese

I’m really gonna try with this one

Facilitate Why are you taking

up the sexy we’re gonna crank up let’s crank up the the sexiness level that mean that means like from this point on forget about me

that’s become I don’t speak Spanish is my next language. So I got to put a little bit of spice in the Japanese for now. You know will be more. Okay, sure it is. We wait. I gotta be more.

Yeah. Oh

actually I wanted to do another Chinese one. Just

throw it in there again, iTunes, Joshua. Ciao. Ciao.

Basically what I said was love and french fries are basically the same thing.

Give it to give it some some prison one as far

Alright guys so we have come to the final one I hope it has been interesting so far but now it’s time to get serious and sexy to want to go with Russian and

yeah

because when you have to push it really sounds like you know what I said was I wanted tickle your belly but never know you never know when that phrase might you know might come up because like this the way you said it was very late so I will freak out freak out.



That was not bad. Not bad. I’m not sure which one sounds sexy though but obviously

I had to include at least one funny phrase in there otherwise

well yeah that was a little sexiness competition and I think for the most part French came out on top for a lot of different things but maybe one or two of the other languages or maybe even you find English to be sexy but you gotta let us know so definitely let us know in the comments again this is Brendan monitor Instagram right here definitely go follow her you know she’s on the quest to hit that 50 k myself I’m on the quest to hit that 10 k I’m getting close to I think I like 7000 something followers now so it would be dealt if you guys uh. You know show your support and give us a follow that’s my music to me and and she has a music coming soon. So definitely, you know, show your support give us some love and hate that follow one as well as of course subscribe And yeah, guys, thank you so much.

Her story, though extreme, is sadly typical. According to several major studies, about half of people over 65 have episodes of delirium — a sudden change in mental status — during hospital stays, and those who do are at increased risk for falling, requiring nursing home care, and developing cognitive impairment and dementia.

It’s easy to understand why hospitalization can be disorienting. Your daily routine is overturned, you are introduced to a stream of new caregivers, and it’s hard to sleep through the night. Anesthetics or sedative medications can also affect your mental state. But decades ago, Dr. Sharon Inouye, professor of medicine at Harvard Medical School, recognized that delirium in older patients isn’t an inevitable consequence of hospitalization.
HELP during hospitalization

Dr. Inouye and colleagues developed the Hospital Elder Life Program (HELP). Available at 200 hospitals in the United States, HELP involves identifying patients at risk for delirium when they enter the hospital and assigning them to receive special care to minimize six major risk factors associated with delirium — cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration. Studies have found that HELP is associated with significant reductions in the percentage of patients who develop delirium. It is also linked to fewer falls while in the hospital, shorter hospital stays, fewer nursing home admissions, and a lower rate of cognitive and physical decline.
What you can do to avoid delirium

If you or a loved one is scheduled for a hospital stay, ask whether your hospital has HELP or another program for preventing delirium. If not, there are several things you can do as a patient or caregiver.

If you’re going into the hospital:

    Gather your records. Prepare a “medical information sheet” listing all your allergies, the names and phone numbers of your physicians and your usual pharmacy, all your medical conditions, and all the medications — both prescription and nonprescription — you’re currently taking. Have your medical records forwarded to the doctors who will be caring for you.
    Bring the essentials. You’ll need your glasses, hearing aids and fresh batteries, and dentures. Ask if you can bring a few familiar things like family photos, a good book, or an MP3 player with your favorite music or relaxation exercises.
    Set up a support team. Let family and friends know you’re being hospitalized and ask them to visit.

If you’re a caregiver:

    Arrange companionship. Schedule family and friends to visit in shifts — and stay overnight, if possible.
    Work with the nurses. See if they’d like your help in encouraging the person to eat, stay hydrated, and to participate in rehabilitation therapy.
    Be vigilant. If you notice signs of confusion, memory problems, or personality changes, let the nurses or physicians know immediately.
Read More »

Friday, 5 April 2019

Farewell to the fasting cholesterol test

Over the last year, the general public has been inundated with a steady stream of reports about the dangers of opiates — pain medicines like codeine, Percocet, and OxyContin. The harm in terms of ruined lives and death from illicit drugs such as heroin is not news. But what is new, and concerning, are the risks of prescription pain medicines — those doctors prescribe for pain due to a range of causes, including musculoskeletal problems like low back pain.
The history of using opiates for chronic pain

Back pain isn’t a new problem either, but the history of how doctors have treated it is probably new to many. A “cliff notes” version of what changed goes something like this. Studies showed that doctors weren’t adequately treating the pain of people with advanced cancer. Research also showed that pain medicines such as opiates improved quality of life for these terminally ill patients. This realization led to recommendations that doctors monitor pain as they would any other vital sign (like temperature or blood pressure) for all their patients — and that all types of pain receive aggressive treatment, including long-term (chronic) pain, such as low back pain. At the same time, drug companies promoted new formulations of opioid medications with longer duration of activity that made it easier for patients to take on a regular basis.

The problem was that this fundamental change in practice was really devoid of any proof that it would help people better manage pain and minimize its effect on their lives. Prior reviews of the medical literature have documented that there is little evidence supporting the use of opiates for chronic low back pain. The modest benefits seen were with short-term use. The practice of using these medicines for long periods of time has not been carefully evaluated. Few risks were seen in these short-term studies, but tolerance to the effects of the medicine, side effects and dependence/addiction have become clearer with longer use.

A recent study published in JAMA Internal Medicine adds to this knowledge. Dr. Abdel Shaheed and colleagues performed an updated literature review, and their conclusions reinforce that only short-term benefits have been proven and the amount of that benefit is modest. Moreover, they examined the doses of pain medicines used in these studies and found that the pain relief people actually experienced was not that great.
Opiates for chronic low back pain carry big risks with uncertain benefits

This and prior studies clearly show that the leap to widespread use of opiates for non-cancer pain was premature. We didn’t know the long-term benefits and risks. We still don’t know the benefits, but this dramatic increase in use of pain medicines hasn’t helped people return to their previous level of activity, and rates of disability haven’t gone down. What is becoming clear are the risks, specifically rates of addiction, overdoses, and the rise of deaths attributed to prescription opiates. And people who have become addicted to their prescribed pain medicines often switch to heroin, which is cheaper and more readily available.

Now this doesn’t mean that we should stop treating pain. For many, the pain is real, chronic, disabling, and they need help managing it. And it doesn’t mean that everyone prescribed opiates becomes addicted. Nor does it suggest that opiate medicines have no benefits at all. But what it should do is give all of us pause. The bottom line is that simply taking a pill (or a handful of pills) doesn’t fix low back pain — and can lead to a whole lot of trouble.
What you can do for back pain

Fortunately, there is growing evidence for treatments that can help with chronic low-back pain, but they aren’t simple fixes in the form of pills, shots or surgery. Instead, treatments should focus on getting back pain sufferers active again and learning to manage, not cure, the pain. A range of therapies including exercise, education about how to care for your back, yoga, and mind-body techniques have been shown to help control back pain. Over the last year, the general public has been inundated with a steady stream of reports about the dangers of opiates — pain medicines like codeine, Percocet, and OxyContin. The harm in terms of ruined lives and death from illicit drugs such as heroin is not news. But what is new, and concerning, are the risks of prescription pain medicines — those doctors prescribe for pain due to a range of causes, including musculoskeletal problems like low back pain.
The history of using opiates for chronic pain

Back pain isn’t a new problem either, but the history of how doctors have treated it is probably new to many. A “cliff notes” version of what changed goes something like this. Studies showed that doctors weren’t adequately treating the pain of people with advanced cancer. Research also showed that pain medicines such as opiates improved quality of life for these terminally ill patients. This realization led to recommendations that doctors monitor pain as they would any other vital sign (like temperature or blood pressure) for all their patients — and that all types of pain receive aggressive treatment, including long-term (chronic) pain, such as low back pain. At the same time, drug companies promoted new formulations of opioid medications with longer duration of activity that made it easier for patients to take on a regular basis.

The problem was that this fundamental change in practice was really devoid of any proof that it would help people better manage pain and minimize its effect on their lives. Prior reviews of the medical literature have documented that there is little evidence supporting the use of opiates for chronic low back pain. The modest benefits seen were with short-term use. The practice of using these medicines for long periods of time has not been carefully evaluated. Few risks were seen in these short-term studies, but tolerance to the effects of the medicine, side effects and dependence/addiction have become clearer with longer use.

A recent study published in JAMA Internal Medicine adds to this knowledge. Dr. Abdel Shaheed and colleagues performed an updated literature review, and their conclusions reinforce that only short-term benefits have been proven and the amount of that benefit is modest. Moreover, they examined the doses of pain medicines used in these studies and found that the pain relief people actually experienced was not that great.
Opiates for chronic low back pain carry big risks with uncertain benefits

This and prior studies clearly show that the leap to widespread use of opiates for non-cancer pain was premature. We didn’t know the long-term benefits and risks. We still don’t know the benefits, but this dramatic increase in use of pain medicines hasn’t helped people return to their previous level of activity, and rates of disability haven’t gone down. What is becoming clear are the risks, specifically rates of addiction, overdoses, and the rise of deaths attributed to prescription opiates. And people who have become addicted to their prescribed pain medicines often switch to heroin, which is cheaper and more readily available.

Now this doesn’t mean that we should stop treating pain. For many, the pain is real, chronic, disabling, and they need help managing it. And it doesn’t mean that everyone prescribed opiates becomes addicted. Nor does it suggest that opiate medicines have no benefits at all. But what it should do is give all of us pause. The bottom line is that simply taking a pill (or a handful of pills) doesn’t fix low back pain — and can lead to a whole lot of trouble.
What you can do for back pain

Fortunately, there is growing evidence for treatments that can help with chronic low-back pain, but they aren’t simple fixes in the form of pills, shots or surgery. Instead, treatments should focus on getting back pain sufferers active again and learning to manage, not cure, the pain. A range of therapies including exercise, education about how to care for your back, yoga, and mind-body techniques have been shown to help control back pain.

So what do I tell my patients? For those with chronic back pain who aren’t on opiates, steer clear. For those who are already take them, you can’t go cold turkey. Your body has adjusted to these medicines and stopping them abruptly is a bad idea. With help, people on opiate pain relievers can try to wean themselves off these medicines gradually and replace them with other treatments. This isn’t easy, but for many people it starts a long process of regaining control over the pain that has taken over their lives and can help them avoid the terrible consequences of opiate addiction. At a recent meeting I offered a visitor lunch which she declined with obvious regret. She was hungry, and it was noon. But she was headed to her annual physical, and eating beforehand would mean returning another morning for a fasting cholesterol level. Most of us can relate to her annoyance, but thankfully this may soon be a thing of the past.

Doctors have traditionally ordered cholesterol tests to be drawn after an overnight fast. But this requirement causes a significant burden on both sides of the health care equation. Most people hate to fast. Skipping meals is particularly difficult for active people, people with diabetes, and children. Yet coming back for another visit is even more of a hassle, so many people just don’t bother. And it has been a drain for doctors, too, resulting in repeat test orders, phone calls, and patient visits.

International guidelines published last month in the European Heart Journal became the latest official recommendation against routine fasting for cholesterol tests. These guidelines defend what many health care systems and many doctors (including me) have been practicing for several years already. They should be met with universal acceptance, even if takes a while. There are several scientific reasons supporting this change.
The history behind fasting cholesterol tests

When doctors test for cholesterol, we almost always order a group of tests called a lipid panel (lipids are fat-containing molecules). This panel typically includes four separate measures:

    Total cholesterol concentration.
    Low-density lipoprotein* (LDL) – cholesterol, often called the “bad” cholesterol. The amount of LDL in your blood strongly predicts your risk of cardiovascular disease, as higher levels are associated with development of plaque in the arteries.
    High-density lipoprotein (HDL) – cholesterol, often called “good cholesterol” because higher levels protect against heart disease.
    Triglycerides (a different type of lipid molecule). High levels of triglycerides are also associated with vascular disease, although this relationship isn’t as well defined.

*Lipoproteins are the “packages” that transport cholesterol in the bloodstream.

Lipids have traditionally been drawn after a fast for two main reasons. The first was to minimize variation, since eating can affect some lipid levels. The second was to produce a better calculation of LDL-cholesterol, which is often derived from an equation thought to provide highly distorted results after eating. However, more recent studies have largely negated these concerns.

Scientists now agree that eating has only slight, clinically insignificant effects on three parts of the lipid profile: total cholesterol, and both HDL- and LDL-cholesterol. Food does raise triglyceride levels for several hours, usually to a modest degree. After a high fat meal these increases can be striking. Therefore, a doctor may still order a fasting test of triglycerides if non-fasting values are significantly elevated.

Perhaps more important, large-scale analyses have shown that non-fasting lipids don’t weaken the connection between cholesterol levels and harmful events like heart attack and stroke. In fact, post-meal measures are thought to strengthen the ability of lipid levels to predict cardiovascular risk. This observation may stem from the fact that most people eat several meals plus snacks during the day. That means we spend most of our time in a “fed” state, not a fasting state. So lipid levels after eating may best reflect our normal physiology.
An end to the dreaded overnight fast?

Guidelines for lipid panels have evolved over the past decade, supported by evidence from studies involving hundreds of thousands of people. Most recommendations now support non-fasting cholesterol tests for routine testing. (You can find a summary of these recommendations here.)

Some fasting lipids tests will remain necessary, especially in people with very high triglycerides. And some people will still need to fast for blood sugar levels, although an alternative test for diabetes (hemoglobin A1c) has replaced much of this testing. But for most, including those having routine cholesterol tests to weigh cardiovascular risk and for those taking drug therapy, this news is good news.

So ask your doctor if you really need to skip breakfast before your next blood draw. Traditions die hard, but both science and convenience may ultimately steer this one to its end. This is one change doctors and patients should celebrate together.

So what do I tell my patients? For those with chronic back pain who aren’t on opiates, steer clear. For those who are already take them, you can’t go cold turkey. Your body has adjusted to these medicines and stopping them abruptly is a bad idea. With help, people on opiate pain relievers can try to wean themselves off these medicines gradually and replace them with other treatments. This isn’t easy, but for many people it starts a long process of regaining control over the pain that has taken over their lives and can help them avoid the terrible consequences of opiate addiction.
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Sunday, 17 March 2019

Best Time Management Systems for Students

Hi clicks on this page, you’re probably a hard working student who wants to improve their study skills even further. Or maybe you’re someone who tries really hard or wants to try really hard, but you’re not really seeing that payoff in your numbers. But we’ve come to the right video because today we’re going to go over five ish study techniques to help you improve your study skills. I’m not going to go into the obvious ones, like do a bunch of practice problems. And always pay attention in class and don’t do homework in your bed. You know, make sure your desk is neat and your room is neat. I at least that helps me doing work in a clean environment. I feel a lot less messy.

When I feel less messy. I can be more productive. Write down all your work and make a plan or your notes or whatever works for you. When I say clearly do practice problems, pay attention in class, take notes, do your homework that will make the biggest difference. Honestly,

These are five things that you can do to sharpen your skills even further.

Number one, differentiate your study methods. Now, I’ve always found it really effective, especially in high school to study differently for different subjects. To me, this is a very similar idea to, you know, using different color binders for different subjects, or shooting the same flavor of gum while studying as when you’re taking the actual test.

I think it’s like the same effect. I think it just gets your brain used to different environmental conditions, different sensations when you’re doing a certain activity that allows you to switch between them more quickly and more efficiently. Now, there are an infinite number of study methods and everybody has their favorites. I’m going to quickly go over study methods that I use for different classes, especially when I was in high school. There were many for example, in math.

I always used whiteboards. I loved using whiteboards for math, because you can use different colors to visualize each step not only turns your map into a picture, but also allows you to

You clearly see each step. And you know, the colors make it a little more fun than just doing practice problems over and over again, on pencil on paper, what I would do is in the corner, I would write in small print the date of the test the name of the test, if there was one in beneath it, I would just quickly bullet the content that would be covered on the test. So it was like trig identities or you substitution or integrals or anything like that, I would just quickly bleed on here so I knew exactly what to cover and then I would keep that on there the whole time.

Related Post: Best Time Management Systems for Students

And then over here, I would do practice problems and practice problems over and over and over again history and social sciences in general government politics, all that I would mostly use quickly or Spanish or foreign language I was vocab I would like do piece of paper and fold it in half I’d have English on one side is finished on the other and I flipped through and check in quiz myself easily for economics I inserted picture right here I would do a bigger view on a whiteboard the day of the test just a few periods before my study hall because that’s just what worked well in my schedule in addition to making

My notes into a study guide or actually my notes already were a study guide. More on that in my how to take notes video and for science if it was like a physics or chemistry or something that and although the practice problems obviously I would do a lot of practice problems to study and look at all the questions and all tests and stuff like that but if it was more just like understanding concepts and memorizing material I would often use study song have a few of those on this channel and also listen to other people’s like ASAP science has some and yeah a lot of other people have some all you have to really do is go to the YouTube search bar and look up the topic and type the word song next to it. Something will come up this is YouTube.

Number two should be obvious, but if it’s not, I’m going to reiterate it. Always ask for help. Always ask for help. Always ask for help. Don’t be ashamed of asking for help. I did it all the time. The smartest people do they’re not ashamed to go to a teacher or go to a professor’s office hours or whatever to seek.

further explanation on a concept that’s totally normal is literally the teacher professors job, you’ll need more than just like a five minute conversation or five minute explanation see if your teacher will stay after school and work with you or if they have study sessions or if there is somewhere you can go to get further review or if they recommend reading certain chapters in your textbook doing practice problems or reviewing for a test and you really you’ve come across something you really don’t understand take some sticky notes and make a little note of it so that when you go and see your teacher professor to ask them about it leader you know exactly what to bring up you know exactly what your question will be.

Number three review easily review mindlessly review without straining your brain. This was one of my favorite tactics in high school because it was just so easy, no effort. Really what I’m talking about is just kind of always having information and knowledge and answers around you turn those mundane transitions of everyday life turn those mundane tasks into an opportunity.



To deeper you to further engage yourself intellectually listen to a podcast. When you’re in the car when that is relevant to what you’re learning or is related to something that you’re interested in, you can play sideshow Crash Course physics girl, very task to be sauce any educational content creators videos while you’re in the shower getting ready in the morning going to bed just having information constantly being read to you and explain to you in the background of your life I think is really helpful You don’t have to be focused in on what they’re saying but just having it there I think kind of shapes your mind to listen more as well as just learn more because you won’t pick up on all the information because you’re not in a situation where that’s your main focus but but you might learn something new or use it as an opportunity to review something that’s on coming test other methods you can employ that fall under this umbrella of number three is reading you can read I encourage you to read articles, books, even Twitter threads on topics that you’re interested about. I think that counts.

You can if you’re studying and you just want to always have the information around you again but physically you can take sticky notes and you can just put concepts and reminders of certain pieces of information all over your room all over your house so that you see them in your everyday life



Number four This one’s a big especially if you’re taking a college or AP class know the format of the exam that you’re taking know how many questions are going to be on it know how much time you have know if you need a pencil or pen know if you can bring a calculator know what kind of calculator you can use know how many sections there are no know if there’s going to be a break in between know it’s multiple choice short answer long essay, short essays and anything like that true false because that way you can practice problems like that you’ll feel so much more comfortable because you will have seen that material that style so much before and my fifth tip is to make it fun. This depending on the type of person you are fun means different things.

Like if you really like just bunker down and just silence desk, nothing but a desk light on just working for six straight hours that works for you go for it. You do you boo. I’m not judging you. But for me, especially when it comes to like math and science. I like to have fun while I do it.

I will listen to music if I’m doing those kinds if I’m doing a problem set, or I’ll watch Netflix really like this because I feel like if you have a good time when you’re doing your work, you all associate positive feelings and positive emotions with that work and it will make you enjoy learning more.

Obviously you can’t do that with all things like if you’re reading I definitely can’t watch Netflix. Well, I read but sometimes I listen to classical music and listen to an audio book. I can find that that helps say, Do whatever you need to do to trick yourself into thinking that homework is fun.

focus focus. espresso beans. help you do were like Adderall accepts just happy and not at all please don’t do trophies don’t do at all. Unless you’re subscribed to you. Please don’t. Please don’t don’t. I have never have never will. You won’t either. But we read on this thing. Yeah, that’s pretty much it. For me.

It all comes down really to preparing yourself ahead of time and making your work and you’re studying colorful and fun. Leave a comment down below about your favorite studies strategy or any one of these that you plan on trying out also let me know other content that you guys would maybe want to see.

Let me know if you guys would be down for like fitness and lifestyle videos because I totally be down to make those that hopefully really fun tips coming out in a few days. So stick around for that. Okay. Again, I’m Hannah and thank you so much for reading. I hope this helps. Hello everyone. We are now in 2019. And if you’re already feeling behind on your organization system for 2019, I’m here for you. I believe. And this is a mode of my year that if you want to achieve things in life, you need to start simple. And you need to go back to basics to achieve the perfect balance of what you need to be productive and organized.

This is why we are going to start with the free full organization system that will absolutely help you get your life together have everything seamlessly organized into one ecosystem.

So today we are going to talk of course, about the Google Apps for productivity and organization. Basically, this means that the Google ecosystem includes the calendar file, managing email, managing with productivity tools, text editors, and note taking app regarding the pros and cons of the Google ecosystem. I will start



By saying that it’s free. So as long as you have a compatible device, an internet connection and Google products aren’t blocked in your country, you’re able to access Google Apps. Also,



their synchronization between all the devices you use to access the same account and you have the ability to sign in into your organization system. In any computer or device. There’s also concept backing up of your information, so you’ll never be afraid of losing anything.

So there are simple tools that make your organization system that much easier to use and to manage for cons. We can also take simplicity because it can be a burden for some users who prefer complex tools to organize their lives. And also the digital environment may not be very convenient or the best start for some people.

I myself use a hybrid of an analog and digital system. There are some tests that I prefer to do on papers if that’s your case, and it prefer to all of your organization in paper that’s just fine. Also, you mostly need an internet connection.

If you live in an area where that’s hard to come by, you might have a lot of trouble making the most out of this ecosystem to build a foundation of our organization system.

We’re going to start with Google Keep and I believe that Google Keep is one of the most underrated organization apps out there yes we’ll keep is a very simple app but it’s really powerful because its simplicity ease transported to other types of Google apps like calendar in Gmail, but we will talk about that later.

So for now, what you need to know is that Google Keep acts as a dashboard where you can place post it notes with all kinds of to do’s of notes and reminders.

So in your main dashboard, you can see these little notes that you can color code and then click and drag according to your own priorities, your arrow key and even if you want, you can simply establish blocks of color so you can see how many tasks you have according to the topic you shows for each color. The best way to organize your notes with Google Keep is basically sabotaging a color for each kind of topic you are choosing for each node.

So for instance here I have yellow for every YouTube related task and I have blue for every school related.

Task wise tasks are personal tasks, including things like personal to do’s appointments, financial stuff, and so on. The second thing you can do to really organize your notes is using labels these act as tax so it can simply create a note, assign it a color, and then choose a label according to the topic of the notes.

So you can select the label on the left side of your screen to access all notes labeled with that name. Also, as I said before, you can click and drag every single note so you can have the order of notes that you prefer to get yourself organized. Also, since it’s a Google product. You can also download Google Keep to your phone, so it synchronizes with every

See: Best Study Tools for Medical Students – Top 5 Study Techniques

Everything you do on your computer when you migrate all of your to do’s all of your notes, all of your project notes into Google Keep, you can definitely go to Google Calendar and start managing your time, your appointments and your tasks. My basic tip for Google calendar to work is creating a calendar for each categorized sort of information you’re trying to place your calendar.

So for instance, in my particular case, I use for instance, rav4 family sharing tasks and appointments. I use purple for my history classes, I use orange for any YouTube related stuff. This is a really good way for you to understand which parts of your week are allotted to certain parts of your life, and so on.

The second tip I can give for Google Calendar users is using the upper part of your calendar to schedule daily tasks instead of hourly events. So even if you’re using a calendar blocking technique to manage your time and your digital calendar sometimes



Your events that are occur hourly, but instead they occur on a daily basis. This happens mostly with holidays, birthdays and things like that. So what I do in these cases is creating that event, then assign it to one of those specific color coded calendars and then drag the event up to the top of my calendar where it will be considered a daily event that do not need to assign an hour for the event to be completed are finished possible. calendar has a function of sinking with all of your devices and also inviting it also allows you to invite people to share your calendar This is really good for things like housework, your business, teamwork, or even scheduling meeting hours with the book clubs, work groups, and so on.

The power of your Google ecosystem really shows up here when you access it tools in the right tab in the right side you have these little app lets that you can access to open up different Google apps that can synchronize and can be used with your Google Calendar.



So for instance, we have already set up all of our tasks in Google Keep. And by clicking the respective button on your Google Calendar app, you can access all those tasks so you can better understand by looking at those tasks. Those color coded knows how you need to schedule your time better, what type of to do’s you need to integrate into your calendar, what kind of goals you need to project in your schedule, and so on. Also, if you set reminders, both in your Google Calendar and in your Google Keep apps, you can also get on track with your tasks and with your events by being smart with how establish those alarms go off in your phone.

After that, I think it’s time for you to manage all of your files with Google Drive. If you’ll basically be the only file manager you need in case you have a permanent internet connection. So Google Drive is free until 15 gigs which may definitely not be enough for you to keep all of your files but 100 gigs goes for less than $2.



A month. And if you’re a student, that’s what you’ll need in case you deal with PDF and text documents. Mostly just like any file manager on your computer. Google drive’s allows you to create folders and organize them according to name and color. So you can basically create a full fledged file managing system online.

That way, you never fear losing your files since Google Drive backs up your documents to the cloud. So they’re always there. Even if your computer crashes. There’s nothing really special about Google Drive in itself.

It’s a very simple and powerful tool for you to organize all of your files and being sure that that can be accessed anywhere. If you cannot rely on a specific device to do all of your work.

You also have sharing capabilities with other users. And the good thing is you do not need to share your whole files with your friends and family because you can select the specific folders or files you want to share. Also, the good thing is that when you are storing documents in Google Drive if they are text based



documents, you can quickly open them up in Google Docs and added them on the go. And Google Docs is actually pretty powerful text editor, although is not as powerful as Microsoft Word, but it definitely has all the tools you need, including an commenting interface, as well as sharing capabilities that make it a solid text editor. In case you need something a little bit more structured than Google Keep.

It also has constant cloud backup. So you’ll never worry about losing your files. And although the tools are nothing to elaborate, they will make the job just fine.

Finally, I want to talk about Gmail. And I’m not going to talk about Gmail in itself as a mailing service in comparison to other mailing services. But I want to talk about the organization tools inside Gmail that make it the perfect tool for you to organize your mail if you are into the Google ecosystem. So the first thing I love about Gmail is the ability to call her



code and label my emails effectively, just like I do with my calendars. I have very specific labels in my Gmail, things like answered, not answered sponsorship, inquiry blog post, any school related emails and so on. And every time I get an email, I will automatically label it according to one of those things.

And I will just label of those unanswered or an open emails with that label. So I know I need to get back to them as soon as I can.

The second thing I enjoy about Gmail is that integration with other Google apps like calendar, Google came and tasks. So basically, you can open that side on the right side of your screen.

And Gmail lets you peek into those apps and use them side by side to interconnect all the information from that same account. This really comes in handy for some instance you’re using a gmail to schedule a meeting and you need to access your calendar instead of having to access the calendar in another tab or even in another device.

If you prefer it that way, you can simply open the Calendar tab inside your Gmail account and see if you have a free slot of time to schedule that meeting and just type your mail right on the go. The third thing I really enjoy about Gmail is the ability to have different in boxes.

So for instance, I have a ton of social emails arriving every single day to my inbox, people who are messaging me on social media emails that are getting to my YouTube account, things related to my Instagram people replying to blog posts on my website and so on. And usually those emails are not a priority for me to answer.

So they’re all filtered into the social inbox so I can get them when I can get to them. Instead of having to constantly see my main inbox being floated with promotional emails with forum responses with social reminders and so on. I want to thank skill share for partnering with me today and being incredible at supporting more than 7 million people in your



learning journey skill share is an online learning community with more than 25,000 classes in dozens of different categories and they can help you build new skills develop new strategies and learn more about anything feel curious about skill shares portfolio includes productivity and business master classes, tutorials on how to work with different types of software language classes are some design courses and so on.

Here you are seeing a class on easy project management with Google which will be pretty useful in case you want to take what you’ve learned from this video further.

Also, premium membership gives you unlimited access to all these incredible classes. So no individual payments required and since skill share costs less than $10 a month for the yearly subscription.

It’s the perfect companion for the learning with us.

Yes. Also if you are one of the first 500 people to click the link in the description box you’ll get your first two months of unlimited classes for free. Don’t forget subscribe to the channel and I’ll see you next week with

More college, university and organization related articles
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How to Learn Amazing Reading Skills

Hey my friend. This is Darnell clock your industry leader in his career gang. Hey the answer man Hey, today’s topic is how to prep for a in person interview in today’s marketplace before I really get started I have something special for you I have a cheat sheet for interviewing is the interviewing cheat sheet is exactly what you need is perfect for anybody who really doesn’t have a good sense of what a interview is how you actually prep for I have a cheat sheet for you will love it. It is packed with information but you had stayed to the end to get it I promise you it is well worth so now how do you actually prep for an in person interview you know I have had opportunity to be on stages of conferences and workshops and seminars to thousands of people I have also done one on one consulting one on one contracting one on one clients that I have that I that I work with them one on one and



All the people that I have come across thousands of people on stage or workshops and seminars, hundreds of people want a little consulting and coaching. I have recognized that about 95% of people don’t really know how to prep for an interview. I asked people all the time, you know, are you ready for an interview as a yes. Well, how much and how long have you prep? Hey, I’ve only prefer to 1520 minutes or I didn’t prep at all. I’m just gonna go just talk off the cuff. Those type of people go to interviews. And don’t prep does not do well my friend so I’m not sure if you know me. See, I’m different than most career coaches. Most career coaches come from HR or recruiter cited off the side of the fence. Not me. I was the back in hiring authority working for IBM urging Yun Jie Coca Cola. I have a computer science degree and an MBA I was the back in hiring.

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These HR people will get with you. You have that discussion. You have to get through them before you get with me. But I was the backend hiring authority in my career. I have interview well over 300 people and I have personally hired over 250 people to work directly for me. I know what a good interview is. I know what a bad one is. I know exactly what I hire managers looking for.

Because I was one of all those many years. So now I’m going to tell you from the hiring managers perspective, what am I looking for? When I asked you certain questions, I’m going to give you the perspective of hiring authorities not HR, see if you can really think how a interview goes interview is really broken down in four stages. And if you can master those four stages, you will always be in a game for the interview those four stages is the stage number one is is is the introduction stage number two is the employer



Questions stays. Number three is the candidates questions and stays. Number four is the closing. And if you can understand those four stages and see what is expected of you, you will be able to have a high probability and high chance to be selected when you do an interview. So I’m going to break down the four stages and tell you exactly what it is how do you prep for it, and what do you need to do to master each stage stage one is in his introduction, the introduction is this is not the decision part where this this date is not where the employer or the interviewer will make a decision to hire you if that’s not that stage yet, but it is the stage if you patch it. If you blow this introduction stage. This is the stage where they will decide



Not to hire you is not the stage will they will they will decide to hire you but it is the stage will they decide not to hire you as a hiring authority I hired for two reasons to reason only one for likability and to fitness I will have to like you somewhere in this process of the interview, I would have to start liking you to see if I’m going to hire you.

I will never hire anybody I don’t like so that first introduction stage is all around into introducing yourself is the stage where the interview will ask you that question that freaks everybody out. Tell me about yourself, right? That’s the question that everybody starts with because we want to know a little bit about you. Now listen to me, my friend. When I asked you the question, tell me about yourself. I am not asking you where you from? What do you like to do? Do how many brothers and sisters you have are not efficient.

Interested in all that? I’m not. Also I’m not interested in hearing your 15 32nd

elevator pitch. You know the elevator pitch is a high level commercial or who you are a 15 2030

seconds high level general elevator pitch know when I asked you the question Tell me about yourself. I am looking for your value proposition. So what the heck is you have a value proposition in a nutshell your value proposition is a clear statement that explains how you will solve a company’s problem here, how you will improve their situation, what the liquid What do you deliver, what value and what strength Do you deliver to that organization as it connects to the job announcement and why should I hire you over someone else is specific. It is not general. Here’s the crust of it. When I asked you the question, why should I hire you?

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You I’m looking for who you are, what are you have your strength, your benefits as it connects to the actual job and mouse. That’s the key. The elevator pitch is general. It’s a general introduction of yourself. The value proposition is not gender specific of who you are, what do you bring to the table as the connects to the actual job? And now that’s the key. So if you have no idea how to craft your value proposition, when somebody asks you the question, tell me about yourself. Go below in the description field. I have created one of my first YouTube videos of how to address and handle Tell me about yourself. Question The title is, tell me, tell me about yourself. It is not a rendition of your resume. So here’s my tell you tell me about yourself that you have proposition. All right, Darnell, tell me about yourself. Hey, I am a lawyer.



Long learner, I take what I have learned in the past and I transition it to what I do now. I learned from my mistakes and my successes and I’m make sure that it I put it in play. So I can always learn from everything I do. I’m a high say, do I say what I do, and I do what I say. And that will make me a great asset to you and your organization. I’m dependable, reliable, and accountable for getting things done. I love to get to work to get things done. Because I believe in results. It is results and execution that I love so much. Most people say I get things done faster than most there’s no substitution for speed I call the speed of business results.

I truly love getting things done on time and within budget. I am a leader and I believe in delegation of authority because that drives individual accountability and at the bottom line, it grows people and make them be able to handle things at this



level and I’m truly excited by the opportunity that this position presents. You hear that? That’s my value proposition. Did you hear anything about my resume? Did you even hear the word resume? I say anything about my resume. I didn’t say anything about my accomplishments. I see say anything about where I worked at. When I asked you the question, tell me about yourself. I am not asking you for rendition of your resume. Because the very next question I will ask you right now, take me your resume. So that’s stage one. Stage one you must be able to address. Tell me about yourself. Why should I hire you? What’s your differentiation? What’s your strengths and your weaknesses and where you see yourself in five years? Right. Those are the introduction questions. Remember, I hire for two reasons likability and fitness. It’s an 8020 split. 20% of my questions is for likeability and then 80%

My question for fitness and then it transitioned from stage one to stage to stage two is employers questions? Yeah, that’s what I asked the question. All right. Not take me through your resume. Now, I need you to understand this. My friend, I need you to understand and know your resume called when I asked you to take me through your resume. The worst thing I can honestly say, that I see people do is that when I say, all right, take me through your resume. They open up their portfolio and they start reading their resume. I need you to script your resume. What the, what the heck does that mean? Yeah, script your resume. I need you to be able to script it you like as a person as an actor or a a, a actress, you know, so when in the movies or sitcoms, whatever they tell you their lives no different I need to script your resume. So how does it work? So

When I sat down to take me through your resume, I say while working for IBM from 2005 to 2017, you know, I was the program manager director. My responsibility was that because people always want to hear numbers and percentages, I was responsible for 25 people. And my budget was about $15 million our disposal for p&l to the organization and I was driving roughly about 100 million dollars to our to our services are from our products and services to our customers and our clients worldwide. Then my responsibilities XYZ, ABC, you see that and then when I finished with that, I say what my next position was, was what what Gee, I was working for GE from this time to this time for this position, my responsibility that I have 45 people reporting up to me, I had a budget of $65 million I responsible for my p&l to the business over 100 to $200 million to the business.



My responsibility was program project management I built a pm or office either Nana Nana, Nana and when I get finished with that I did this position that’s how you script it right? Do not spend a lot of time on your resume I want you to spend no more than two to five minutes maximum on your resume. So your resume got you in the door. The resume got UNIDO. Your resume was submitted for one reason. And one reason to get a call back for the interview. Your resume worked, your resume will not get you higher. The interview will get you high. So don’t spend a lot of time on your resume my friend to the five minutes get through it as fast as you can. If they want more information. They’ll ask their answer the question but get through it. By scripting your resume. Do not commit it to chance that you know what’s on your resume. I freaked people out and doing I was in interviews you know, I will have my friends.



resume it’ll be my portfolio but I would never pulled it out this. All right, Darnell, take me through your resume. And I just scripted and there’ll be looking at the resume while I’m talking. I hit our numbers and is exactly what they need. So stage two stars, where the question is, take me through your resume. Now most interviewers have a standard set questions that they want to ask. Remember, the second part of me, heart is fitness. I am trying to ascertain that you can do the job by because you have done it already. In today’s marketplace. We don’t hire people to train I know the millennials are having issues with that for sure. But I don’t have a budget to train so we don’t train what we want to do is hire you hit the ground running, learn it on a job so on the job training and hit the ground running when you hear that that means we are not training you whatsoever and only way you can hit the ground running because you have done it.



Before so so most employers are most most interview have standard interview questions they are trying to attach that whatever you have done before you have done it again now in these second stage there’s a two part interview process is your traditional interview questions and behavioral interview questions the majority of the marketplace now is going to majority of is going to behavior interview question if you don’t know what behavioral interview questions is all about. I crafted a four part series of how to handle behavioral interview questions go below in the description field and you’ll see a four stage process of handling How do you handle behavior interview question and when you handle behavior. Any question is all about behavior interview question is is a predictor is a predictor of what you did in the



Past is a predictor of what you have can can do in the present interviewer does not want to know what you think you can do the interviewer note wants to know what you actually have done and prove it and the way you do it by using the behavioral interview using the star method st AR s for situation to attach a for action are for results and throw one more in their lessons learned. So when they ask you a question and you will always know a behavior interview question when they started out like this. Tell me about a time when you did x y z show me a time when you did this. How did you did this? How did you handle that? So a one interview question is Tell me about a time when you had a conflict with a co worker at work. How did you handle it you will have to use the star method s you must tell the situation innocent party is it isn’t here to

tardy, tardy it’s Eric Can you say the word out right? You must tell the situation T for task you must tell the task that you had to do a for action what action that you had to do to handle that task and are for result what results came from your actions and what lessons did you learn for that whole thing a normal traditional interview question if you talk in longer than 3545 seconds you’re talking too long but a behavior interview answer could be anywhere from a minute to two minutes, the three minutes the more detail you are the better it is for behavior interview question down below. Go find out how to do because they will ask you the question you know those behavioral interview questions and if you cannot handle it, it would destroy that part. This stage is the stage that it that the interviewer will decide if you are the person



That they want to hire. The first stage gives them the ability to who you are. Now I’m starting to like you. The second stage, which is the second part is a fitness. I am now trying to ascertain that you can do the job because you show me how to do it. That’s the fitness part. Listen, there is a big difference between traditional interview questions and the behavioral interview questions every time you open your mouth to add to answer any question, you must connect what you have done in the past to what the job announcement is. So I asked you the question, my friend when you see a job announcement to you, like how long and how often do you read it? I need you now to understand it is the job announcement that connects to your resume that connects what you do that you what you have done that will get you the job you spend at least 25 to 32 hour on that job description when I look at



job description. I spend roughly about two or three hours I get my markers, I get my pins, I carve it out. I try to find the what the requirements and I tried to get those requirements as it connects to something in my resume accomplishments, the things that I have done in my resume like connect the dots you must connect the dots. As a hiring manager we are looking for somebody that can get the job done you my friend must be in a solving problem business you must be able to solve businesses solve problems I’m hiring you not just because I want to hire you I’m hiring you because I got some problem that needed to get done and you my friend in the interview stage to the interview the employers questions you must connect what you have done in the past to the actual job announcement. So I can see you have done it already. I can’t tell you how many millennials have issues with that because they want training they want mentorship and in the month



marketplace we just don’t do that right now. I’m sorry millennials but we just don’t do that right now. So you will have to understand that whatever you have done in the past is a predictor of what you can do in the future that is stage to employers questions, you must be able to connect what you have done in the past to the actual job announcement. I need you to spin Elisa hour on that job announcement so they can so you can connect the dots so you can see the job announcement and you can see how it connects to the actual job And now’s your resume connected you must connected that stage three tours in of all of the interview. The interviewer will always say, all right, Daniel, I have everything I need by I have everything I need. And so now



Do you have any questions for Me and I can tell you how many times I have interview people remember I have interview over 300 people. I can’t tell you how many times an interview interview will come in. I said, Do you have any questions for me? And they say, No, listen, my friend



at this stage, the interviewer is trying to ascertain what



how do you determine how much interest do you have for this position? See, if you really wanted that position, you will spend some time and craft some interview questions. So when they said do you have some interview questions for me? I want you to say yes, and I want you to pick your portfolio up just like this. I want you to open it



I want you to pull your questions out there looks just like this



right here on in here on my interview questions. I want you to make sure they have the text



is large enough so so they can see that you have crafted up, I want you to put it back on your portfolio. I want you to take your input. And I want you to now read that first question. And the first question is, what kind of person? Are you looking to fill this position? And what is your ideal candidate looks like get ready, my friend, get ready to write down because the interviewer is getting ready to tell you exactly what they are looking for. They might have said it sometime in the interview. They might not. But now they’re getting ready to tell you exactly what they are looking for. You write it down because this is the beginning of your clothes, right? And so always be able to add that is the first question you ask. And then some of the other questions you can ask is on here. And then this last question the second from last question, I want you to always ask this question this guy



licenses. Now that you had a chance to meet and interview me, what reservations would you have for putting me in this position? Yeah, Margaret, you put them on the spot. Yes. You have put them on the spot. Hey, I need you to conquer your fear. Don’t worry about it. See, number question number one. If they say Yeah, well, we’re looking for XYZ, ABC. And then you hear Hey, that’s me. I have either done that before. It is part of my strength package. Never go to an interview. When you know the position is in your weakness package. You only go to interviews that you know as part of your strengths. That’s why you need to know what your strengths are what your weaknesses are. Never ever ever ever go to a interview when you know it’s not part of your strength package. Never go to interview when you know as part of your weaknesses. No, no, no, no,

you can never perform at a high level.

Doing things that you’re not good at, because it’s part of your weaknesses. No, don’t do that. So the first question is, will, hey, we’re looking for this. We’re looking for that. Hey, then you got to hear that. Is that part of me? That’s part of my strength packet. I have done that before. When you hear that, that question,

let’s, you know, you let you think that you are a good fit, you are a good fit for the position that ate that. That’s that question before. The last question is that hey, what



said you had a chance to meet and interview me? What reservation do you have? And put me in this position? Yeah, you put them on the spot. Listen to that. Because if the interview start talking to negative, well, you don’t have this. You don’t have that you don’t have this, hey,



you are not in the game. Wrap that interview up as fast as you can, and get the heck out of there because you are not going to get that job. But if they say, well, Darnell, I don’t have any



any reservations? We’re looking for x, y. z. You had that? Would you describe it? Pretty good. We are still interviewing but I don’t have no reservations. Now you know that they think you are a good fit. Remember, the first question is positive, it lets you know that you are a good fit. Now, that second question lets you know they think you are a good fit, and if it’s a good fit, and if is the position that you will love to do then transition into the fourth stage, which is closing, you ask this last question of what’s the next step? What’s the next step in the timeline, they’ll ask, they’ll tell you the next step. And then if they if you like it, it’s a good fit. Then I want you to transition into the clothing by asking for the job. Yes, my friend.

You ask for the job you have. Not because you ask not what shoot man what a job you do this So you asked what the next step. So you say, all right, Mr. Clark, I got the next step. I appreciate the opportunity this interview, right? I think I did a great job. I wait patiently for the next step. Because you say, in the next couple of weeks, you’ll have an answer. So now let me leave you with this. In closing, this is your clothes. Let me leave you with this.



Yeah, I am very interested what I have learned here today and the opportunity that this position present right I believe I will love working with working here and learning from you as well. Is there anything else you need to know about my background to determine that I go to the next step in the interview process? Because I want this job that strive you just ask for the job. Some people like okay as what a job I’m scared. Listen, I need you to conquer your fear. I need you to to feel the fear and do it. Anyway, conquer your fear. conquer your fear.

And if you conquer your fear, you’ll be the captain of your ship and a master your destiny. conquer your fear and ask that question and ask for the job. You ask for the job. Listen, listen. Listen. Listen. Listen. Listen.If you don’t hear me, listen now.

I have interviewed over 300 people and only one person at all those people ever asked for the job. And he’s the only one I hired on the spot. Those other over 250 people I hired I still took him through the whole process in made him an offer, but he’s the only one I interview and he asked for the job. He’s the only one I hired on the spot. I can’t tell you how many times I have used that since he did it to me. He did it to me early in my career. So cool. I start in doing it myself. Now. I told you on one side of the fence. I was a higher authority working

for IBM at Ernst young a GE and Coca Cola hire people but early in my career I got my computer science degree in an MBA and all these it certification and I became a perpetual job hopper I noticed right now the marketplace doesn’t mind that you job haha we have become a nation of job hoppers from the Bureau of Labor Statistics says for the first time in our nation’s history more people have quit their jobs thing got laid off. The average life cycle of a job is only five years every three to five years. My friend you’re going to be looking for we can be looking for a job but we are nation the job I don’t call them job hoppers. I call it free agent we are a free agent nation unbounded, untethered to one organization taken our talents to the whole marketplace instead of one boss in one one company. That’s what we do now. Right? But I was doing it before this was cool. I was going from job to job every 24 months every 18 to 24 months I would job hopping because I was trying to go get that K.

Every job opportunity came up to get more money. I left one company and went to another why I was in a job search mode.

Other side of the fence I submitted over 5000 resumes. What a dark, you know, up to 5000 resume because I keep track of everything I know who I submitted it to when I submitted to what information I got from it. What company I submitted you I know everything from those 5000 resume. I have had over 200 interviews. Yeah. Does that mean every interview possible that you know that it had a Skype interview in person interview a phone interview interview with HR interview as a group interview as a panel, I have interview all of it and mastered all of them. And early in my career. I recognize the ability to ask for the job. I can’t tell you how many times I’ve used it.

And it worked for me. You know, as a director, senior director over the past 1015 years in the marketplace, I was always interviewing when I go to an interview the person was interviewing me was either general managers, vice presidents, CIOs, CEOs, or see in a minute medium or small medium companies. They were big baller shot callers and I have used the each and every time Excuse me,

I can’t tell you how many people stopped and say, Wow, Darnell, you just asked me for the job. Outstanding Young man. I’m a man a vice president. She was so impressed that I asked for a job. She hired me on the spot. Yes, yes. Yes, sir. So I always use it. Now when you ask somebody for the job. One or two things are going to happen either they can like wow, I’m so impressed. That’s what a job or you’re going to have somebody like man is do just as before the job How dare he have enough.

goon is encouraged as for the job now I’m not giving you for a job when you come across those people who are put up because you asked for the job listen you don’t want to work for those type of people anyway they’re scared you have enough courage and fortitude to ask for what you want and they’re scared to hire you because you think you’re going to take their job you got all right I’m gonna take your job if you think that I’m going to be scared to not ask for the job and you’re not going to give it to cuz cuz you got scared that I’ve had enough fortitude and confident as for you better believe I’m going to ask I’m going to take your position Oh buster, it Hey, but don’t worry about it. So you ask for the job. And then I want you to give them your personal guarantee. Listen, my friend, I can’t tell you how many people scared to put them cell phone line. You give me a personal guarantee. And you say after you say I want this job. Listen, Mr. Clark.



If you hire me I give you my personal guarantee that if you select me

You will not be sorry or disappointed. You hired me. So when you go in the back and you start talking to your team, and you decide who is the best person for the job. Think of me. Mr. Clark. When you go on your team and say, who can hit the ground running because they’ve done it before, and they don’t need little to no supervision. Think of me. Best o’clock. Hi, my name is the clock because I want this job. That’s right. And you shut up and let them talk. Listen, my friend, that is your differentiation.

That right there will put you over the top with anybody. I’m telling you right here right now. My friend. nobody’s doing this. No one is going to be asking for the job because they told freaking scared but not you. You raise up your courage and boldness and you come before us for the job. I want that job if you hire me, Mr. Clark. I guarantee you won’t be sorry or unhappy that you hired me I promise you so there you go for it.

So let me recap. let me recap. There’s four stages of interview. The first day is introduction. This is where you must be able to answer the question. Tell me about yourself. Stage Two is the employers questions. Employers question will give you traditional interview questions and behavioral interview question you must be able to handle both. And stage three is the candidates question.

You always come with questions and you always ask the question what they’re looking for and you capture it. You always ask the question now you had a chance to interview me what reservation we have put me in this position. You always ask that question. And then the final question you always ask for next steps. And then you transition right into the closing by asking for the job which is days for my friend. So then you go, I told you in the beginning, I have something special for you. I have an interview cheat sheet. The interviewing cheat sheet is everything I talked about here. Plus

Much much more it tells you how you supposed to dress in today’s marketplace before in a bit and back in the day it was always suit and tie knot in more my friend you must understand the culture of the organization would tell you how you dress for interview it tells you about how to address and handle the question to tell me about yourself. It talks about the the ability to handle behavior interview questions, it gives you the top 20 most common asked questions in an interview and it gives you the answers to it gives you everything right. It also gives you the ability to understand that your salary it tells you how to find your salary. Never, ever ever go to an interview and you don’t know what the salary is for this position. Down below my friend. I made a video of how to address salary question is down there too. Now lastly,

I can’t tell you how. How many people that I know go to an interview it doesn’t go well any questions them this in my friend, you are not responsible to go to the interview to make somebody like you know what they’re going to do you don’t know why they’re going to hire you.

Why not you are not responsible to find out if they like you are not you are not responsible if they give you the job offer not your responsibility is my friend is to come to the interview and deliver the package What the heck is the package everything I taught you how to prep how to prep and prepare for an interview.

That’s the package your responsibility is to prep and practice everything I showed you here come to the interview and the liver what you practice that’s it you’re not responsible for if they like you. You’re not responsible for if they made your offer. That’s not what you’re supposed to do. Your responsibility is to get to that to the interview.

delivered a package if you get the offer great if you don’t so what is not your responsibility listen no man can open a door to anything any door closes and no man could close any door God opens in that position is for you is for you and there’s nothing they could do about it it will be for you my friend. So if you don’t get it, learn from it, go to another interview and keep learning and you keep doing it until you get hired my friend so there you go.

So if you like this video, click on the like button I truly love when you click on the like button and share with four or five friends I need you to share this with five friends this is how I get my content out I I do it. The way I get my content out is when you share it with five friends so I asking you to share with all five friends and more but minimum five friends in in the comment field. Give me a comment or your feedback or any questions you have.

Have because I’m Darnell clock the answer man there’s no question that you can ask me that I will not have an answer for and I answer every comment every feedback and every question down there I personally answer it and as always if you haven’t subscribed to my YouTube channel subscribe to my channel on the side is that bill click on that bail my friend so you can be notified every time I come out with fresh new content so there you go my friend this is how you prep for in person interview you spend hours so if the interview is four or five days out I want you to spend one hour a day prepping it will serve you well when you get into that interview. So this is Darnell Clark you your your your industry leader, your career coach say hey there’s one thing I recognized for sure that is whatever you want in life. You got to go get it now go get that interview because I showed you how to do it. I see you later. Today we’ve cooked up a video where we teach you know less than 50 wicked football skills and while you might have seen a few of them before you can still use the video as your personal skills Bible that you can pull out before training or match so sit back dealer number one the fake classical facing the defendant you saw him in by pushing the ball forward then you know quick scooping motion dragon away from it’s a bit like the elastic only done with inside of your step

number two the street running with speed you get ready to take on the defendant. And just before reaching in you slow down only to explode away. Again. Lowering the pace for a moment is key because the defendant will sleep the same

Number three, the fake shot. This is what you would call all school move probably the most effective dribble and football set yourself up for a shot and slide to all you have to do now is to not follow through all around the defense.

Step number four is the stop and go running down the line with the defender in your back. You stop the ball with the outside of your foot. Then do a quick body thing and drag the ball with you in the opposite direction. Great, simple and effective move.

Read also: How to Improve Study Skills and Memory

Number five the rollback. Roll the ball back to the side of your body and wait for the defendant to come rushing in. When the timing is right, quickly drag the fall back again and accelerate the way

number six is the outside touch receiving a pass with a defendant chasing you down. This is the perfect skill to send him for a hot dog. Just before touching the ball. There was more money fame tap the ball with the outside of your first in the opposite direction and seventh place is the stop and shop running with the defender on your side.

Do this step on the ball with one foot into a chop with your other it’s a great way to buy yourself some time number eight the zigzag if you’ve got some speeding you This move is even better. T

ake on the defendant and take a shop touch to one side. Now run a bit past the pool so you can top it again outside of your foot in the opposite direction. Thank You for reading
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