Category Archives: Critical Care

Prof. Lucien Abenhaim: There is an incredible challenge for the sustainability of health systems across the world

Prof. Lucien Abenhaim

LONDON, Dec-3-2017 — /EuropaWire/ — On December 5-6, 2017, 200 high-level experts from government, academia, biopharmaceutical developers and patient organisations convene in London (UK) to address the mounting challenge of accessibility and patient access to high-value, high-cost medical therapies.

The not-for-profit executive forum is organised by the London School of Hygiene and Tropical Medicine and analytica|LASER, a global research consultancy, to investigate topical questions around drug policy, global health systems sustainability and innovation funding through a combination of case studies, panel sessions, and roundtables. Delegations are registered from over 70 public and private organisations, including the World Health Organization, as well as health systems representatives from Belgium, England, Estonia, Croatia, France, Germany, Italy, Norway, Sweden, the United States and Wales. Multiple patient organisations support the meeting to ensure that the patient voice is reflected in all deliberations.

“Access to life-saving drugs is not a new challenge. The paradigm of accessibility was changed completely in the face of the deadly HIV epidemic. This time, however, accessibility concerns almost every domain of medicine such as cancer, auto-immune diseases and rare diseases. We must act now,” says Prof Peter Piot, Director of the London School of Hygiene & Tropical Medicine and former head of UNAIDS.

“There is an incredible challenge for the sustainability of health systems across the world”, says Prof. Lucien Abenhaim, London School of Hygiene & Tropical Medicine and Chairman of Analytica Laser. “It is critical that drug developers and health system engage on actionable proposals that address concerns around value, cost and overall access to innovation for the patients who need it. We are at an inflection point – the paradigms of the 1990’s can no longer guide us,” he adds.

The main plenary on December 6th features scheduled remarks by over a dozen authorities in the field, including Professor Baron Peter Piot (Director, London School of Hygiene & Tropical Medicine and former Head, UNAIDS), Dr. Olivier Brandicourt (Chief Executive Officer, Sanofi), Dr. Sarah Garner (World Health Organization), Prof. Dominique Le Guludec (President, French HAS), Sir Andrew Dillon (Chief Executive, National Institute for Health and Care Excellence UK) and Dr. Harold Paz (Chief Medical Officer, Aetna). The plenary is preceded by a scientific seminar on December 5th which gathers globally renowned academics to explore new frontiers on the methodology for the appraisal and valuation of high-value medicines.

Please contact the organisers for more information on the programming and media access, or refer to www.accessibility-symposium.org

SOURCE: EuropaWire

“Heart Within a Heart” – Surgery Cures 12 Year Old With Rare Congenital Heart Disease

A 12 year old Indian boy successfully underwent open heart surgery for an extremely rare variant of Total Anomalous Pulmonary Venous Connection (TAPVC) at Sri Muthukumaran Medical College and Research Institute, Mangadu, Chennai.

Prabhakaran, a ‘blue baby’ born with a heart birth defect seen in only 1 out of every 500,000 births, had 2 “hearts” inside his chest, one within the other. This complexcongenital heart disease is so rare that it merited selection out of 430+ submissions to be presented at the recently concluded international conference of the Indian Association of Cardiothoracic Surgery (IACTS) at Mumbai in February 2013.

In an intricate open heart operation that lasted 5 hours, the cardiothoracic surgical team including Dr.S.Sivasubramanian, Dr.S.Visvakumar and Dr.Meenakshisundaram successfully repaired the defect.

Unable to afford the high cost of treatment, Prabhakaran’s widowed mother searched desperately for assistance with her son’s surgery. His operation was sponsored by theDr.Mani Children Heart Foundation, a Chennai-based NGO which has funded 100 heart surgeries for under-privileged children with congenital heart disease since its inception in 2003.

In the defect, a rare intracardiac sub-type of TAPVC, all 4 veins returning oxygen-rich blood from the lungs drained into a common chamber (the “pulmonary confluence”) – forming a mini-heart behind the regular heart.

This mini-heart then pumped blood into the atrium through a hole in the heart called an Atrial Septal Defect (ASD), making him a cyanotic ‘blue baby’. Prabhakaran’s surgery was carried out on 16th October 2012. A week later he was discharged from hospital, his lips and fingernails now pink and healthy.

The department of cardiothoracic surgery and cardiology at Sri Muthukumaran Medical College and Research Institute, Mangadu, Chennai has successfully carried out more than 75 operations on patients with valve, coronary and congenital heart diseases in the short period since its inception.

Congenital heart disease (CHD) is rare, with an estimated incidence of 7 to 8 in 1,000 live births. Surgery is often risky and expensive, yet serious complications can arise if treatment is delayed.

For more information about congenital heart defects (CHD), visit the Dr.Mani Children Heart Foundation website at http://www.CHDinfo.com

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Clinical Trial Studies New Treatment For High-Risk Heart Patients

A clinical trial under way at the East Carolina Heart Institute is testing the benefit of a new medical device designed to help high-risk people suffering from leaky heart valves.

Dr. W. Randolph Chitwood Jr., director of the Heart Institute and professor of cardiovascular surgery at the Brody School of Medicine at East Carolina University, secured the clinical trial for the MitraClip System for the treatment of mitral valve regurgitation (MR). A serious heart condition, MR can lead to arrhythmias and congestive heart failure if left untreated.

Dr. Curtis Anderson, a cardiothoracic surgeon and assistant professor of cardiovascular sciences, and Dr. Ramesh Daggubati, a cardiologist and clinical professor at Brody, collaborated to perform mitral valve repairs on two patients at Pitt County Memorial Hospital without making the traditional incision in the center of the chest to access the heart. Chitwood joined Drs. Rajasekhar Nekkanti and John Cahill, ECU cardiologists, to assist in the procedure.

In each case, the multidisciplinary team of cardiologists and surgeons placed a thin catheter in the patient’s groin vessel, guided a tiny clip through the heart’s septum and placed the clip between the leaflets of the valve to stop the leak.

“With mitral insufficiency, we normally use the heart/lung machine to either repair or replace the valve,” Chitwood said. “This new procedure is catheter-based, and can be used in high-risk patients who wouldn’t do well on the heart/lung machine. These patients have severe symptoms stemming from the leaky valve and can’t be operated on safely any other way.”

Chitwood said this new procedure “gives the East Carolina Heart Institute an entirely new set of tools for mitral valve repairs in high-risk patients. It is the least invasive way that we can fix a valve. Centers selected to perform these procedures have demonstrated expertise in applying new medical technology under FDA (Food and Drug Administration) guidelines.”

With the clip, patients leave the hospital the next day and within two or three days return to normal activities – or, in many cases, better-than-normal activities.

“Most of the patients are very sick,” said Daggubati, a clinical associate professor of cardiovascular sciences. “Medical management is the only option for them because surgeons consider the risk too high and the patients inoperable.”

Anderson said patient selection is the key to a successful outcome.

“I think a lot of patients with heart failure will be attractive candidates for this device,” he said, adding that collaboration among physicians is vital. “We want patients to have the confidence of knowing that cardiologists and cardiac surgeons are working side by side to give them the best possible outcomes.”

The mitral valve is a one-way valve that connects the left atrium to the left ventricle of the heart. With mitral valve regurgitation, the valve does not seal completely, and blood leaks back into the left atrium. This reversed flow can cause heart and lung damage, as well as death. Symptoms may include an audible heart murmur, shortness of breath and heart palpitations.

About the East Carolina Heart Institute
The East Carolina Heart Institute is a unique partnership that includes University Health Systems Pitt County Memorial Hospital and East Carolina University, along with cardiovascular experts in private practice, academic medicine and research. The East Carolina Heart Institute is the first in North Carolina devoted exclusively to education, research, treatment and prevention of cardiovascular diseases.

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GoodToBeAlive.Com Launches National Retail Outlet For Defibrillators Exclusively For Home Users

Good To Be Alive launches its primary retail channel, www.GoodToBeAlive.com and toll-free number 1-888-OWN-1-AED (1-888-696-1233), which is a one-of-a-kind retail outlet – the nation’s first exclusive-for-home seller of defibrillators (automated external defibrillators or AEDs) suitable for personal use. Good To Be Alive offers Personal-AEDs or automated external defibrillators, (sometimes referred to as a Portable AED) which are self-contained laptop-sized devices that are used to revive a person suffering from sudden cardiac arrest by delivering a controlled electrical shock that can reset the heart to normal function. For witnessed sudden cardiac arrest, if used immediately, AEDs are up to 90% successful at resuscitation (whereas without an AED readily available, survival rates are 1% – 5%). Until recently, these devices were only safe when used by a trained professional. Now, due to recent technological advances, Personal-AEDs are safe and easy for layperson use. No other consumer device has empowered individuals for such dramatic results – resuscitation of a sudden cardiac arrest victim – basically bringing someone back to life!

SUDDEN CARDIAC ARREST BACKGROUND:

Knowing the facts reveals the need for personal AEDs in homes: Sudden cardiac arrest is the leading cause of death in the United States. More than 300,000 US deaths annually, across all demographics, are attributed to sudden cardiac arrest (more than breast cancer, prostate cancer, house fires, hand guns, traffic accidents, and AIDS combined). Tens of thousands of sudden cardiac arrest deaths could be prevented if an AED were used immediately. AED utilization is the only treatment for sudden cardiac arrest – survival odds decrease 10% every minute without an AED. Few attempts at resuscitation are successful after 10 minutes without an AED. It is crucial to recognize that the majority of sudden cardiac arrest victims are asymptomatic, meaning these victims were not at heightened risk for a heart attack. We are all at risk, including the youngest among us. Sudden cardiac arrest is not limited to the aging population. Approximately 22% of sudden deaths for people between 1 and 21 years of age are due to cardiac arrest. A final relevant statistic– 80% of cardiac arrest occurs at home.

PURPOSE, NON-PROFIT PARTNERSHIP:

Good To Be Alive partners with national non-profit Sudden Cardiac Arrest Foundation (www.sca-aware.org). Initially, the two organizations are presenting survivor stories to the public, offering a referral purchase program (that will result in donations from Good To Be Alive to the SCA Foundation), and looking ahead to developing a public awareness campaign called “Save A Life at Home”, which will follow the successful and ongoing SCA Foundation campaign “Save A life at School.”

“Good To Be Alive is focused on providing defibrillators in the home where they are needed most. We are grateful that Good To Be Alive has chosen to begin supporting our Foundation from the onset, this is a demonstration of their commitment to their mission to save lives,” said Mary Newman, the President of the SCA Foundation.

Mark Adelman is the founding partner of Good To Be Alive. Mr. Adelman and senior partner, Allan Fine, are currently test marketing, as well as honing website and logistical operations. The senior management team expects Good To Be Alive to locally employ 12+ individuals by Fall 2010 in a combination of management and member support positions.

“I’ve always focused on technology serving people – I see that society is far too slowly adopting this life-extending medical advancement. The latest generation of easy-to-use AEDs are a game changer against the nation’s number one cause of death – sudden cardiac arrest. We’re determined to put a Personal-AED in the hands of as many people as possible. Our purpose is to decrease loss of life from sudden cardiac arrest. The American Heart Association estimates that between 50,000 – 100,000 lives could be saved annually if AEDs were widely accessible. That said, in the end, the decision to protect yourself and the people you care about against sudden cardiac arrest is a personal choice, it’s the individual’s right to choose to be prepared,” founding partner Mr. Adelman said.

Senior partner Mr. Fine said, “We applaud the proliferation of public access AEDs. The AEDs we all see in airports, fitness centers, and schools are important for people to have available, however the public should understand that 80% of sudden cardiac arrest occurs in the home. We are placing Personal-AEDs in people’s homes, where they are needed most. Good To Be Alive’s mission to save lives is very personal for me due to the fact that last year I lost my 28 year old brother to sudden cardiac arrest in his home. When Personal-AEDs are widely accessible, similar tragic losses can be avoided for other families.”

Good To Be Alive has established the Good To Be Alive Foundation. The Foundation’s purpose is to give back to the community by supporting the proliferation of AEDs, both Personal-AEDs and public-access AEDs (located at schools, airports, etc.) In fact, the Good To Be Alive Foundation has already donated AED equipment to a local high school and an AED to a county-based EMS group. Additionally, the Good To Be Alive Foundation is partnering with the Sudden Cardiac Arrest Foundation (www.sca-aware.org) to support its efforts for a developing “Save A Life at Home” awareness campaign.

GOOD TO BE ALIVE TEAM BACKGROUND:

Founding partner, attorney Mark Adelman is a graduate of the Georgia State College of Law and the University of Georgia, Grady College of Journalism, as well as an experienced healthcare administrator. Prior to becoming a member of the Georgia Bar Association (2000), Mr. Adelman contributed to the development of the CNN brand as a producer in the network’s Marketing and Creative Services division. More recently, he won national video production awards for Georgia Tech as part of their marketing efforts. Mr. Adelman is an American Red Cross certified AED Instructor.

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The Facts About Heart Disease

  • Heart Disease has been the number 1 killer in the US every year since 1900 with the exception of 1918.

  • At least 250,000 Americans die of heart attacks each year before they reach the hospital.

  • Every 34 seconds someone in the US dies from Heart Disease.

  • Heart Disease can be avoided with good nutrition.
If you are as little as 10 pounds overweight you are at risk forHeart Disease.Chronic Diseases cost the US economy 1.3 trillion dollars annually and this could reach 6 trillion by the middle of the century.

Reduce the Risk of Heart Disease for you and your loved ones. Over and over again I hear success stories of how people who have used our science based, nutritional products to lose weight. But not only do they lose weight but they are lowering their cholesterol levels, stabilizing blood pressure and sugar levels and are getting off of medications they have been taking for years. We have had people say they have gotten rid of allergies, migraines, joint pain and more. Good Nutrition allows your body to heal. (individual results vary). You can gain weight, lose weight, or maintain weight with our products. Our products do come with a guarantee.

My mother and father have both had open heart surgery. It is not a fun thing to go through. The thought of having your breast bone broken in half and raised in vertical position for hours is not a pretty picture to me. I do not wish to ever need this surgery and I am here to help you, in hopes that you do not ever need it as well.

Good Nutrition affects everything:

  • health

  • energy

  • organs

  • cells

  • vitality

  • skin

  • quality of life

The American Medical Association has said that 70% of medical conditions are diet related.

Here are a few common diseases that may be prevented with proper diet and or maintaining a healthy weight.

Cancer: breast, uterus, cervix, colon, esophagus, pancreas, kidney and prostrate
Coronary Heart Disease, Diabetes, Dyslipidemia, hypertension
Idiopathic Intacraial hypertension, stroke, cataracts
Osteoarthritis, skin, gout, phlebitis
Gynecologic Abnormalities, abnormal menses,infertility, poly cystic ovarian syndrome
Gall Bladder Disease
Pulmonary Disease
Obstructive Sleep Apnea
Hypo ventilation Syndrome
Severe Pancreatitis
Non Alcoholic Fatty Liver Disease

If you truly want to feel good and enjoy quality of life you need to get started with Core Nutrition. Once you receive your Core Nutrition, I will send you a personalize your program DVD (FREE), I will give you personalized coaching on a regular basis (FREE) to help you achieve your wellness goals, and you will receive a FREE Wellness Evaluation. A Wellness Evaluation will help you learn better dieting habits as well as give you a better understanding about where you are at with your health and wellness. We will be able to determine what your goals are and come up with some recommendations that will help you be able to enjoy a better quality of life.

Once you get started with our Core Nutrition or Weight Loss Program you may find that you are saving money on your prescriptions plus doctor and hospital bills. You may even be earning more money because you are missing work less and are able to work longer hours.

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Nursing Shortfall In The UK, According To Hays, Specialist Recruitment

According to Hays, specialist recruitment, the acute shortage of qualified workers, which continues to plague the nursing sector, is particularly apparent for A&E, critical care (ITU), theatre, intensive care (ICU) and emergency medicine nurses.

hays.com healthcare

The magnitude of the shortage has however now also spilt over into other areas of nursing jobs such as obstetrician, orthopaedic, anaesthetic and gynaecologist nurses are also highly sought after by the health service. Additionally there is currently a shortage of accident and emergency expertise and a growing requirement for nurses from an emergency medicine background.

“Without a doubt, there is a shortage of nurses in the UK. The available talent from abroad throws an important lifeline given the pressing need for skilled nurses. Around 10% of nurses working in the UK have trained abroad and it is important that skills shortages in the healthcare sector continue to be addressed where possible, using labour from overseas where necessary,” added Simon Hudson, the new Director of Hays Global Resourcing.

The UK has been able to benefit from the global mobility of the nursing sector and tap into the worldwide nursing talent pool to fill its vacancies, however, “The shortage of nurses is not just limited to the UK. Demand exceeds supply across the world, which in turn fuels this cyclical international movement of labour in the nursing profession,” continued Simon.

Many UK nurses are leaving to go and work abroad to destinations such as Canada, Australia, the Middle East and the United States. There are several reasons why nurses from the UK are attracted to overseas destinations, but clearly it is more a case of lifestyle and financial reasons rather than an inability to find a job in the UK.

Nursing in the UK not only offers excellent and varied opportunities to learn valuable skills but also enables individuals to make a positive difference to the lives of others. The NHS encourages applications from people with a wide range of academic and vocational qualifications.

“Going on a work placement or volunteering are excellent routes into the nursing sector and a great way to get a feel for the industry,” said John Faraguna, the newly appointed Managing Director of Hays Health and Social Care. Other ways of entering the industry include cadet schemes and apprenticeships, especially for those with previous NHS experience, for example, clinical support workers and healthcare assistants.

According to recent statistics from the Royal College of Nursing (RCN), one in three community nurses are over 50 and over a fifth of practice nurses are over 55, which adds up to around 200,000 nurses who are due to retire over the next decade.

This represents almost 50% of the worker population and this will leave a massive skills shortfall if these problems are not addressed. This is a worrying prospect at a time when the size of the UK’s elderly population looks set to continue to increase over the coming years, meaning the demand for specialist nurses will continue to grow with it.

“The best solution to this issue is a combination of more effective utilisation and retention of skilled nurses, increased emphasis on training new nurses and, in the short term, increased international recruitment” concluded John,

 

About Hays Healthcare:
Hays Healthcare is part of Hays plc, the leading global specialist recruitment group. It is market leader in the UK and Australia, and one of the market leaders in Continental Europe. As at 30 June 2008, the Group employed 8,294 staff operating from 380 offices in 28 countries across 17 specialisms.

For the year ended 30 June 2008:
– the Group had revenues of £2.5 billion, net fees of £786.8 million and operating profit before exceptional items of £253.8 million; 
– the Group placed around 80,000 candidates into permanent jobs and around 300,000 people into temporary assignments; 
– the temporary placement business represented 49% of net fees and the permanent placement business represented 51% of net fees. 

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Officials From East Carolina University And University Health Systems Of Eastern Carolina Dedicated The East Carolina Heart Institute Today

Officials from East Carolina University and University Health Systems of Eastern Carolina dedicated the East Carolina Heart Institute today. Several hundred invited guests joined leaders from the two organizations to celebrate the facility. The Heart Institute puts ECU and Pitt County Memorial Hospital “at the forefront of progress and the cutting edge of the future,” said Dr. W. Randolph Chitwood, director of the East Carolina Heart Institute.

“What we dedicate today is a concept called the East Carolina Heart Institute that encompasses these new facilities, dedicated to the people of this region, and to the physicians, researchers, educators and staff devoted to their care,” said Chitwood, who is cardiothoracic surgery and vascular surgery at the Brody School of Medicine at ECU. He is also senior associate vice chancellor for health sciences at ECU.

The dedication ceremony, held at the East Carolina Heart Institute at ECU, capped more than four years of work to bring a world-class cardiovascular disease institute to eastern North Carolina. In 2004, the General Assembly approved $60 million for a research, education and outpatient care facility at ECU. Pitt County Memorial Hospital secured private funding for a $160 million bed tower. Today, leaders from the two organizations celebrated the end of construction on both facilities.

Many who attended the ceremony also toured the two facilities after the event ended. The crowd included local and state officials, donors and other friends of each organization.

The celebration marked “the most significant collaboration University Health Systems and East Carolina University have ever undertaken,” said UHS CEO Dave McRae. “It’s the biggest step of a journey we started more than 30 years ago, when a small county hospital and a fledgling medical school committed to forming the world-class academic medical center we’re part of today,” McRae said.

ECU and PCMH have been “joined at the hip” for decades, ECU Chancellor Steve Ballard said. “The East Carolina Heart Institute is the latest partnership between us, and it will make a major and lasting impact in eastern North Carolina, the entire state and beyond,” Ballard said.

The new buildings aren’t the only sign of a new approach to heart disease for ECU and PCMH. The two organizations have also redefined their model for treating cardiovascular illnesses. Both have organized their clinical staffs around illnesses and disease processes, rather than following a traditional model based on academic specialties. That new model encourages more information-sharing among doctors and puts new emphasis on patients’ best interests, Chitwood said. “This new model of care delivery is an innovative way to blend the science and art of medicine so that we add value to the patient,” Chitwood said.

The prevalence of cardiovascular disease in North Carolina justifies the massive investment in treating and researching heart and vascular illnesses. Cardiovascular disease is the second-leading cause of death in the state, and nearly a quarter of N.C. residents suffer from cardiovascular ailments.

Planning for the East Carolina Heart Institute dates to early 2003. ECU and PCMH held a groundbreaking for the Heart Institute in March 2006. In addition to the six-story 375,000-square-foot bed tower, the Heart Institute at Pitt County Memorial Hospitalspawned a pair of companion projects: construction of a massive central utility plant to power the new building and the relocation of Moye Boulevard.

The Heart Institute at Pitt County Memorial Hospital has 120 cardiovascular beds, six operating rooms, seven interventional laboratories, three electrophysiology labs and a heart-healthy cafeteria, all designed to create the optimal patient care environment.

The four-story, 206,000-square-foot East Carolina Heart Institute at ECU houses science and clinical research, robotic-surgery training, future space for simulation laboratories, a clinical outpatient facility for cardiovascular diseases, a database center, offices and an auditorium.

The Heart Institute at Pitt County Memorial Hospital will open Jan. 5. ECU physicians have been seeing patients at the East Carolina Heart Institute at ECU since September. For more information please visit www.eastcarolinaheartinstitute.com

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As One Of The Largest Pain Management Facilities In Pinellas County And The Tampa Bay Area For Nearly 25 Years, The Center Continues To Grow By Adding Several New Specialty Medical Treatment Options

As one of Clearwater’s first Pain Management clinics nearly 25 years ago, Dr Jayam Krishna-Iyer open the doors to patients with chronic back & neck pain, spine injuries, arthritis and many other debilitating painfull illnesses.

Since then, residents from Belleair, Largo, Seminole, Indian Rocks, Redington Beach, Palm Harbor, Safety Harbor, Pinellas Park, St. Petersburg & Clearwater Beach have sought out her pain management expertise. Where previous medical treatment had failed, leaving patients frustrated and with little options, this Board Certified Anesthesiologist could now offer much needed pain relief and hope. Competently treating a multitude of spine issues like bulging or herniated discs, degenerative disc disease, arthritis, migraine headaches, hip & knee joint pain.

For the more serious cases, surgery is not always a necessary treatment. Less invasive pain relieving injections can be given using the facility’s fluoroscope for complete accuracy. Steroid epidural nerve blocks, Radio frequency, Stellate ganglion blocks, lumbar sympathetic blocks & trigger point injections can give lasting relief from spine, hip & leg pain.

As The Creative Health Center continues to meet the needs of its pain management patients, the website offers detailed descriptions of numerous other treatment options. One of the latest new injectable drugs called Euflexxa has been getting remarkable results in their orthopaedic patients being treated for a variety of hip & knee joint pain including osteoarthritis. Where past attempts had failed or surgery had been reccommended, there is now a promising new option that gives instant relief in most candidates.

With the addition of health care staff, the center is excited about the ability to now treat patients with the latest in weight loss technology. Using several options for the treatment of cellulite and unwanted fat pockets along with the physicians diet plan, patients are able to lose weight in a safe and healthy environment. Diet plans may include certain dietary suppliments & vitamins along with continuous medical evaluations.

The facility is also offering cosmetic improvement treatments. With the use of Botox and lumpless Dermal fillers injected directly into facial creases and muscles that cause severe frown lines and wrinkles, significant improvement is seen after just a few short days. This non-surgical, affordable treatment of Botox can last up to 4 months. Dermal filler treatments can last up to a full year.

The center now houses its own family practice with the recent addition of 2 General Practice Physicians. Dr Felicia Spuza and Dr. Michael Spuza are now providing everday basic health care to the public. With all of these specialty services, The Creative Health Center now has the ability to treat a wide range of diverse patients. Everything is done in the one location which flaunts its own fluoroscopy machine, sterile procedure & recovery rooms, along with an educated competent medical staff that is keeping up with the constant changes and improvements in the medical field.

The website offers informative, detailed descriptions of available services, staff and office information. Now accepting new patients. Call for an appointment 727-443-4242

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