Evidence based practice

Evidence-based practice for best outcome By Leonardo L. Leonidas Philippine Daily Inquirer | October 13, 2013 at 9:15 pm Tweet Facebook Ideally, all physicians should use evidence-based practice to get the best outcome, or less complications, for the prescriptions they give or procedures they administer, or not. The first physician to introduce the concept was Dr. David Sackett, a Canadian, who defined it as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” It means “integrating individual clinical expertise with the best available external clinical evidence from systematic research,” he added. Evidence-based practice basically involves assessing the patient, asking correct questions, acquiring and appraising the evidence, and then applying it for treatment of the patient. The physician’s evaluation of his/her performance with the patient is the concluding stage of the process. But while the ideal is the universal use of evidence-based practice, in reality not even the majority of physicians are into it, for a number of reasons. One reason is their age. If they graduated from medical school more than 25 years ago, I think they are generally less likely to go into evidence-based practice. The concept is, after all, only about 20 years old. When they were in medical school or in a hospital for their training program, evidence-based practice was not yet in the consciousness of their mentors. Not all medical practitioners have the financial resources to attend international or national medical conferences. They cannot afford the expenses of travel, hotel accommodations and registration, or of the latest textbooks, and the loss of income from such activities. Another reason even for recent medical graduates is it takes time to do research for a patient. Their time may be consumed by the many patients they tend to, and besides, medical insurance does not pay for research. Physicians are paid only for their patients’ face-to-face office or hospital visits. Probably only a few conscientious physicians will go out of their way to “burn the midnight oil” and study the difficult problem of one or two patients without compensation. And unfortunately, many physicians are still in the 20th century in terms of office management. They have no desktops, laptops, iPads, or tablets. Or they have no time to learn how to surf the Internet, open an e-mail, or log on to Facebook or Twitter. A few of them may have a technology phobia, like the fear of flying. At this time, there is no way for patients to know who are the physicians administering evidence-based treatment and recommendations. Certification for this mental activity is impossible to do. Most patients choose their physician on the basis of a relative’s or friend’s recommendation, or experience. Some are referred by their personal physician to another for a second opinion. Others just consult the phone directory, or the advertisements in the media. One of my friends found the name of a pulmonologist, or a lung specialist, on the hallway wall of a hospital. Now that many patients have access to the Internet through various gadgets, they can do their own evidence-based research in the comfort of their homes, workplaces, schools, hospitals, doctor’s offices, etc. As a result, medical care will dramatically improve. Here are some tips on how to determine if the website you are visiting is trustworthy. If the URL address of the website ends in .gov, .edu, or .org, it is usually reliable. The website that professionals go to is pubmed.com, which you can also visit for free. However, you need a medical dictionary and some knowledge of statistics to understand the reports in this website. But don’t be intimidated by the medical terminology or complex numbers. The conclusion of each abstract is usually easy to understand. Some of the top health websites that I recommend are: MedlinePlus (http://medlineplus.gov/), NIH SeniorHealth (http://nihseniorhealth.gov/), Centers for Disease Control and Prevention (http://www.cdc.gov/), familydoctor.org (http://familydoctor.org/), healthfinder® (http://www.healthfinder.gov/), Kidshealth® (http://www.kidshealth.org/), MayoClinic (http://www.mayoclinic.com/), NetWellness (http://www.netwellness.org/), and Cancer.gov (http://www.cancer.gov/). You can also determine the reliability of a website when the writers or speakers in its videos are experts in their field. Health websites should have minimum ads, or none at all. Websites peppered with ads should be avoided. Look for websites that are regularly updated and whose privacy policy is easy to find and understand. The need for just-in-time information is extremely important because new information from research is reported or updated monthly. The date of publication and latest revision should be clearly stated and easily found. This is usually at the end of the article or page. The best health website contains reports that are written clearly in simple language that even tenth graders can understand. It should carry facts, and not opinions, that can be verified or supported by other researchers or experts in the field. A website with the HONCode logo is generally reliable. If you have no time to surf sites, MedlinePlus (http://medlineplus.gov/) has both English and Spanish versions that can answer most common questions. Dr. Leonardo L. Leonidas (evidencebasednews@ gmail.com) retired in 2008 as assistant clinical professor in pediatrics from Boston’s Tufts University School of Medicine, where he was recognized with a Distinguished Career Teaching Award in 2009. He is a 1968 graduate of the University of the Philippines College of Medicine and now spends some of his time in the province of Aklan.

Rethinking Blood transfusion

Rethinking blood transfusion By Leonardo L. Leonidas Philippine Daily Inquirer 9:24 pm | Thursday, September 12th, 2013 23 203 144 Most physicians and hospital administrators are firmly entrenched in the belief that blood loss is an unavoidable part of major surgery and that blood banking and transfusion are the antidote to bleeding. Also, with the advances in blood screening, the public is assured that viral infections are significantly reduced—which is true. However, what both physicians and patients have not realized are the silent complications of blood transfusion that can come in the future. One such bad outcome is the increased risk of surgical infection and possible transmission of infectious prions, or microscopic protein particles that are similar to viruses but with no nucleic acid that can lead to ailments like mad cow disease. Another hidden risk of blood transfusion is higher recurrence rate of colorectal cancer in patients given blood during or after surgery. With this new information, I think it makes sense for us to now consider reducing these silent but significant complications of blood transfusion by adopting new ideas, such as the “patient blood management program.” Known also as “transfusion-free surgery,” the program is now in use in more than 120 hospitals in the United States, and in many more in Europe, Australia, and South Korea. One of these hospitals is Eastern Maine Medical Center in Bangor, of which I was a staff member when we started the program in 2006. A study of patients who had blood transfusion from 1993 to 2009 was conducted at our hospital. In 1993 there were 1,550 patients who were given a blood transfusion. This number increased gradually to peak at 2,643 patients in 2006, when the patient blood management program started. In 2007 the number went down to 2,263, in 2008 to 1,736, and in 2009 to 1,608. Translated in units of packed red cells, in 1993 it was 4,079 units, which gradually went up to 8,070 units in 2006. In 2007 the number of units went down to 5,924, in 2008 to 4,027, and in 2009 down to 3,456. Similar trends also happened in the transfusion of platelets and frozen plasma. In heart surgery, the blood transfusion rate was between 44 percent in 1996 and 61 percent (the highest) in 2002. In 2006, when the patient blood management program was started, it was 48 percent. In 2007 the transfusion rate dropped to 28 percent, and in 2008 down to 16 percent. With these results in heart surgery with less blood transfusion, Eastern Maine Medical Center reduced its cases of perioperative AMI (acute myocardial infarction), new onset of renal failure, perioperative infection, and stroke, as well as length of stay, without a change in number of deaths. The question thus arises: Why not adopt this safer and less expensive practice of blood management in all hospitals in the Philippines? But I see certain barriers to this new change in hospital practice, the biggest of which is how to change the mindset of surgeons and related healthcare professionals. It is extremely difficult to change the culture of hospitals and other institutions. Human nature is not comfortable with sudden change, especially if certain beliefs were learned in medical school and in a training program. Several years before I retired in 2008, a study on the use of cough medicines in treating children found that these did not benefit children and in fact had resulted in some deaths from overdose. It took me a number of months to abandon the practice of prescribing cough medication in spite of the study. This is also true with the use of antibiotics for ear infection. Many studies have concluded that most children with ear infections do not need antibiotics. It took me a couple of years to change my ways, to do away with prescribing amoxicillin and zithromax for ear infection. How can we then take advantage of the proven benefits of less blood transfusion in heart operations and other surgeries? My suggestion is for the Department of Health to study this new practice. I have no doubt that health officials will also conclude that it is indeed safer and less expensive to support transfusion-free surgery programs. Another effective system is for heart and other patients due for operation to ask their surgeon to employ the transfusion-free method, if possible. Actually, transfusion-free surgery was started by Dr. Denton Cooley in Texas in the 1950s because of the request of Jehovah’s Witness patients whose religion prohibits them from accepting blood transfusions. After about 15 years Cooley was able to report on the successful experience of 542 patients who underwent transfusion-free heart surgery. With the advent of the Internet, smartphones, iPads, and other devices, I think that in a few years many surgeons and hospitals will join the more than 120 health organizations in the United States in adopting transfusion-free surgery in our homeland. Dr. Leonardo L. Leonidas (nonieleonidas68@ gmail.com) retired in 2008 as assistant clinical professor in pediatrics from Boston’s Tufts University School of Medicine, where he was recognized with a Distinguished Career Teaching Award in 2009. He is a 1968 graduate of the University of the Philippines College of Medicine and now spends some of his time in the province of Aklan. Read more: http://opinion.inquirer.net/60947/rethinking-blood-transfusion#ixzz2em2W2Ect Follow us: @inquirerdotnet on Twitter | inquirerdotnet on Facebook

Medical Errors

MEDICAL ERRORS COMMON. 98,000 deaths PER YEAR from Medical Errors in USA. The Events described below can happen at any Hospital all over the World. Many hospitals in the USA have patient advocates. You should be your own patient advocate or request a relative who is a nurse or physician if there is none in the hospital you will be staying. Is there a section or group of MD and Nurses collecting Errors at your Hospital? Nonie Leonidas, MD (I will be posting below to my e mail and FB groups. If you have suggestions how to Reduce Medical Errors, please e mail me:evidencebasednews@gmail.com) What You Need to Survive a Visit to the Hospital By Bob Irish Sophie Tyler checked into the Birmingham Children's Hospital with a minor problem. She needed a routine procedure to have gallstones removed. She left with a major problem: in a wheelchair, paralyzed from the waist down. An epidural anesthetic, put into her spine to alleviate the pain from the gallstone operation, remained in too long. Despite Sophie's complaints of numbness, the hospital staff failed to remove the epidural until two days after her surgery. By then, the anesthetic had entered her spinal cord and damaged the membrane. The hospital admitted its mistake. But Sophie will never walk again. At least Sophie was able to leave the hospital. Perley Covington checked into Kings County Hospital but never checked out. She died of acute lidocaine toxicity. Lidocaine is a topical anesthetic. But some bozo administered the lidocaine intravenously. Perley had a seizure. Again, this hospital admitted its mistake. But that won't wake up Perley from her dirt nap. Hospital errors happen all the time. According to a study by the Institute of Medicine, preventable hospital mistakes kill as many as 98,000 people each year. That's three times the number of people killed in automobile accidents annually. The Office of the Inspector General of the U.S. Department of Health and Human Services reported that one in seven Medicare patients experienced medical errors during a hospital stay that caused serious harm or death. I think about these stats every time I check into a hospital (twice in the last three months). And they scare the crap out of me. Question: What do you call a medical student who finishes last in his class? Answer: an M.D. You may have a lot of confidence in your surgeon. But what about the supporting cast? Maybe the orderly changing your IV bags was up all night on a meth bender. He doesn't seem to be paying attention. Maybe the nurse delivering your medication just found out her husband has cancer. She seems distracted. The intern filling in for your doctor looks tired. Maybe he's at the end of his 24-hour shift. The problem, of course, is that everyone at the hospital is just doing their job. But you are not their only patient. And you are not the center of their universe. I'd feel better about the whole thing if I had someone in my corner every time I see the doctor or check into the hospital. Somebody to ask the tough questions. And from whom to get real answers not shrouded in medical jargon. Someone to double- and triple-check that the doctor or nurse does every procedure correctly. Somebody who's not afraid to ask the nurse if she's washed her hands. Someone who won't be intimidated. Somebody who cares about only me. I've just described a person called a patient advocate. END Comment: Deaths from medical errors are common. Be extra-careful. This can happen to physicians family also. My wife was mis-diagnosed by two board certified internist, two certified orthopedists, and one certified radiologist in Maine, USA. I will write about this error later. L Leonidas, MD

What I am Doing Now in this Part of the World

What I am Doing Now in this Part of the World I give talks at second grade Lezo Integrated School on Brain Anatomy, Neuroscience and How to do easy Math. I give talks at different schools in Kalibo about basic Neuroscience concepts that will help students learn better. Almost every first Sunday of the month, I give a Talk at the Pre-Cana meeting in our Catholic church for couples who want to get married on effect of Stress on Pregnancy and ACE (Adverse Childhood Experiences). I do on-the-spot magic for abut three minutes at many places like Petron gas station, palengke, Groceries for bag carriers, birthdays, weddings, airports, schools, government offices, beauty parlors, facial and massage parlors, etc then followed by a few minutes talk on “Effect Stress During Pregnancy, why NO TV under three, and ACE. If it is a birthday, wedding, fiesta, I add no Lechon, more Vege script in reducing Stroke and Heart Disease. I e mail about 30 Deans of College of Medicine in the Philippines about Medical errors and Research in cognitive psychology. I am active at PHI e mail and Western Visayas State University College of Medicine Facebook forum on Diagnostic Errors and Early Brain Development. I have several more op-Ed columns ready to be submitted to Inquirer or other National Newspapers about How to Improve Teaching and Learning and promote Creativity. I gave “sermons” to priests in parties on “How to Give a Lively Sermon” so their parishioner will be awake. My wife and I are “social innovators” here in Lezo, Aklan. We lend some money to promote jobs like small piggery business (less than 10 pigs). This week we gave a gift to an 82 year old lady a decent house to live in. We expect to finish it before New Year. The old lady was living in hut with dried coconut leaves, bamboo, and cardboard under a mango tree about, ten by eight feet. The roof drips when it rains. The past few nights when storm Quinta passed by Panay she kept herself dry by using a plastic cover on her. Two weeks before Christmas my wife, our house helpers, and I went door to door to deliver Handog Pamasko bags in our barangay. Last year we invited 100 poorest families in our area to our place to get the Handog Pamasko. This Christmas day, we hosted a party of about 250 poor children and parents at our open-living room on top of the hill. The first few dozen lucky children got sleepers and some parents with gifts from our Christmas tree. We did not invite any one with college degree except my wife’s two cousins. To keep my mind alert and stimulated, I do stock stock market trading at about 3 a.m. before the market close in the USA. * “How to Make Good Business Decisions” Junna Corporation with more than 100 employees, Manila Philippines, 1995 * Son: Len, Graduate, Tufts University School of Medicine graduate, 2001 Residency, Albany Medical Center with Albany Medical College Certified in Internal Medicine and Pediatrics Practicing at Albany, New York suburb Wife: Thelma, RN. University of the East, Manila, Class 67 Part Nurse, City of Bangor Office Manager, Primary Care Pediatrics Residence: Mina, Lezo, Aklan and Bangor, Maine, USA END

Abacus at my office

My Innovation in Practice: Why I had an Abacus at my Office. In 1991 I decided to move to a new office in Bangor, Maine. Since we were building the office ground up, I made all of the six room cable ready for internet connection so we can have computers in each room. While we were designing the rooms, I decided to change my practice to an “Education-Based-Pediatric-Practice” (EBPP) and a fun office from a standard “shot” office image. The first physical change is a Winnie-the-pooh decor in the walls of each of the examining rooms. Added to these cartoons on the walls is a message “We want you finish RN, Phd, MD degree when you grow up, then you can have a boy/girl friend.” This same message is also printed at the back of my blue lab coat. Each room has a computer monitor and key board to at one side of the examining table where I strategically placed an abacus. My idea was to balance technology and traditional thinking. To be truly EBPP, I supplemented the standard routine preventive advice with advances in neuroscience research. In my practice I included early brain development instructions as part of the routine visits of infants. At the nursery rounds, usually my first contact with new mothers, I explained what the Amygdala, Hippocampus, Pre-frontal cortex, and Fusiform Face Area are about and why they should know it. During the pre-natal meeting I talk about the importance of talking to the fetus from 25 weeks of gestation. I tell the mother to avoid chronic stress, food with anti-thyroid properties, and peanuts. Take multiple vitamins with folic acid. I specifically recommend DHA tablet to boost the fetal brain development. At one-month visit, I demonstrate to the parent how to count using their fingers. At two months old visit, I demonstrate how to do basic baby sign language like, “More,” “Thank you,” “Please,” and “bird.” At four months old I emphasize the importance of pointing to an object. When the parent is holding any object, they should first say its name three times, then point at it with their left index finger while saying the name of the object. Six months old visit, I demonstrate the “apple and orange” experiment. Ninth month visit, I demonstrate how to improve the memory of their baby. I tell the parent to place their baby in front of a couch. Show a ball and tell her that she will hide the ball behind the couch. Then walk back to the front of the couch and request baby to “Go get the ball.” One year visit, I demonstrate letter/word and object recognition. At the 15 and 18 month old visit, I demonstrate how to add one plus one, and one plus two using my fingers. Education-Based-Pediatric-Practice is my “immunization” against school failure and other chronic mental difficulties. In the future, I hope all Primary Care Physicians will use this practice. Leonardo Leonidas, MD * I was the first pediatrician in Bangor to use a computerized networked medical records system from 1991.

Silent Medical Tsunami

What will you do if one in a hundred plane flights crashes, resulting in injuries? Will you still fly? Or what if one in a hundred bank transactions results in an error in your balance? Will you still trust your bank? In these two instances, the error rate is much less than 1 percent and is fortunately hypothetical. And the chance of these happening is slim because of the technology we have today. Read more: http://opinion.inquirer.net/51421/the-silent-medical-tsunami#ixzz2ThdtApjy Follow us: @inquirerdotnet on Twitter | inquirerdotnet on Facebook

Preventing Suicide

Preventing Depression and Suicide A University of the Philippines student, Kristel Tejada, in the past couple of week tragically succumbed to an illness that is preventable, suicide. This was followed by an avalanche of finger pointing and politically aimed calls for UP officials who did their duty to give up their office. Opinion articles and op-Ed columns have flooded the newspaper and TV news. Dozens of experts were called to give their opinions. Many, especially politicians, are calling for increased educational funding for the poor. College organizations and fraternities are now starting to fund scholarships for students who might be following the same path as Kristel. In most of the talks and media buzz, I have not seen or heard talks about the possibility that suicide is preventable just like many chronic illnesses. It started in their early childhood or teen years as an inflammatory response of the body from adverse environment like poverty, dysfunctional family, physical and emotional abuse, alcoholic parents, drug addiction, and chronic depression. This is the same body inflammation that is commonly seen in high blood pressure, coronary artery disease, and diabetes. In a recent study by Dr. William Copeland and his colleagues at Duke University Medical Center, they found that depression is also linked to an inflammatory marker in the blood called C-Reactive Protein (CRP). In a large sample of adolescent and young adult volunteers, they tracked the CRP levels from childhood and depressive symptoms or episodes. They found that the number of cumulative depressive events were associated with increased level of CRP. People with heart attacks also have high inflammatory marker CRP. People who choose to push the button “Game Over” like Kristel had been through chronic depression which started several years before. Many of them had their mental condition brewing even during the fetal life. When a mother is depressed during pregnancy or had chronic job stress they have a high risk of delivering a baby who later on in life will have ADHD, language and cognitive delays, and prone to depression. Some researchers are even proposing that Autism might be a result of severe stress during pregnancy. When a pregnant mother is chronically stressed, her cortisol or stress hormone goes up in the blood which then goes to the placenta and ends up in the fetal brain. High cortisol during the first trimester can damage brain cells particularly those in the hippocampus, the memory center. A child might have a happy family to start with, but as they grow up when the family develops financial problems, the parents separate, an alcoholic father, or a drug-addict sibling, a young child exposed to these adversities can easily fall into chronic depression with increasing CRP in the blood just like in diabetes. From the seminal study of Dr. Vincent Felitti and his group of Kaiser Permanante in San Diego, since the 1980s, of more than 75,000 interviews, they found that children exposed to ACE (Adverse Childhood Experiences) like drug and alcohol addiction, depression, and abusive parents, these children are prone to school failures, mental problems, hypertension, and suicide. Knowing these risk factors that can lead to an inflammatory response of the body, just like heart disease and diabetes, we should look at depression and suicide as a preventable illness. When I was in my second year of medical school, because of our poverty, my mother was always borrowing money from our relatives to support my tuition fee at UP College of Medicine, I entertain the thought of hurting myself. Fortunately, I was a frequent visitor of National Book Store and I found Norman Vincent Peale’s “Power of Positive Thinking” which save me from ever thinking of the “Game Over” button. I learned how to cope with the stress of medical studies and residency training by reading Dr. Peale and Dale Carnegie. And during my stressful more than three decades pediatric practice in Maine, USA I continued reading and studying how the brain works. Money or scholarship is not the best solution to suicide reduction and prevention just what many politicians are espousing in the past weeks. Or asking for the resignation of UP officials who are properly doing their jobs. I think the better solution is educating all freshman students in all colleges the new science of Cognitive and Positive Psychology. The most important thing in my life are the things that I did not learn from UP. I learned it myself by self study. Now, I am wondering why are we not teaching proven methods of how to control our time, manage our finances, principles of mastery, and most importantly how to conquer stress. Many studies have shown that vigorous and regular exercise produce more BDNF, Brain Derived Neurotropic Factors, that can stimulate new brain cell growth. With high BDNF the risk of depression and suicide is reduced. Meditation has been practices in India and many other countries for several centuries. Now it has been proven to help reduce depression, hypertension, chronic pain, and heart diseases. Many successful CEO in Fortune 500 companies are now including meditation in their corporate environment. Health Insurance giant AETNA’s CEO Mr. Mark Bertolini has brought YOGA and mindfulness to their work place. Proper diet can also reduce inflammatory responses of the body. By eating more fruits and vegetable and less of meat and processed food, we can alleviate inflammation. Like most chronic mental and physical problems in life, education and application of proven preventive methods are better than money or expensive drug or medical treatments. We should educate all freshman that they can cope and prevent depression and suicide. Leonardo L. Leonidas, MD Assistant Clinical Professor in Pediatrics (retired 2008) Distinguished Career Teaching Award, 2009 Tufts University School of Medicine, Boston, USA Outstanding Alumnus UPMASA, 2010 Overseas Teacher of the year, UPMASA, 2006 Gradaute, 1968, UP College of Medicine

Infants can count

Excerpts from my eBook...Baby Math How Infants Perceive Numbers Zoe, 29 Months Old Starts To Count Up To 30 Hi Dr. Leo, By 13 months, Zoecouldsay: Elmo, thank you, mama, dada, milk, drink, uh-oh, ba ba black sheep, no. By 21 months she knows her colors - blue red yellow pink orange green purple black white. She can count up to 10 with a little help and knows portions of the whole alphabet. By 23 months, she knows her alphabet, meaning, saying in a row, from memory, A - O for example. She knows how to count up to 13 for sure and with help 20. She counts often in the day. She knows she is two. She sorts things that are alike all the time, the same size blocks, spoons, covers, etc. and line them up or stack them on top of each other. By 29 months, she knows her shapes: star, heart, circle, square, rectangle, oval, triangle and even hexagon. She also knows her body: eyes, nose, tongue, eye brows, hair, legs, knees, feet, toes, arms, hands, fingers, elbow, thumbs, belly, butt, chest shoulders. Now also she knows the days of the week and months of the year She knows how her name is spelled. She also knows how Cody’s name is spelled. She counts to 20 with no problem and is starting to count to 30. Leah Infants including newborns can perceive differences in shape, color, size, and numbers. In 1980 in Prentice Starkey’s laboratory at the University of Pennsylvania, 72 babies from 16 to 30 weeks old were studied. The babies sat on their mothers’ lap facing a screen on which slides are projected. A video camera focusing on the babies’ eyes recorded its gaze. The cameraman was blind to the exact conditions of the experiment. However, he measured exactly how long each baby looked at the slides. When the baby starts looking elsewhere, a new slide appears on the screen. In the first few slides two large dots arrange horizontally were shown. The babies looked briefly at these repetitive two dots. The slides were then changed without warning to a three horizontally doted slides. Immediately, the baby started to fixate longer at these unexpected images. The looking or fixation time when the two dots were shown was 1.9 seconds. When the three dots appeared, the fixation time jumped to 2.4 seconds. This showed that the babies detected the switch from two to three dots. A few years later Sue Antell and Daniel Keating from the University of Maryland demonstrated that even newborns could detect a change from two to three dots. And in another experiment using three sequences of sounds, then changed to two sequences of sounds, babies also noticed the switched. Very young children pay equal attention to the number of sounds as to the number of objects in their environment. Experiments by Karen Wynn in babies 6 months of age concluded that babies could tell the difference if a puppet took two jumps versus three jumps. Studies done by Starkey, Spelke, and Gelman also concluded that babies can “count” sounds. The study used six, seven and eight-month old babies. The babies were seated in front of two slide projectors. The right projector showed two common objects and the left three common objects. Between the screens is a loudspeaker that plays a sequence of drumbeats. A hidden video is focused on the baby’s eyes, measuring the time the babies spent looking at each slide. Initially the babies looked longer at the three objects. After several trials the bias disappeared. When the drumbeats played two, or three beats, the babies looked longer at the slide with the corresponding number of drumbeats. * Please Click on the links below. Only $2.99 Author: How to Raise A Happy, Smart Child (an eBook) http://www.amazon.com/dp/B005UZGCMA Baby Math http://www.amazon.com/BABY-MATH-ebook/dp/B005WA5ZBM/ Leonardo L. Leonidas, MD Assistant Clinical Professor in Pediatrics (retired 2008) Distinguished Career Teaching Award, 2009 Tufts University School of Medicine, Boston, USA Outstanding Alumnus UPMASA, 2010 Overseas Teacher of the year, UPMASA, 2006 Graduate, 1968, UP College of Medicine END

Title articles of Dr. Leo

Articles I Wrote for Bangor Daily News, 78,000 circulation, a state wide newspaper “Baby’s Brain Stimulated” October 6-7, 2001 (The story of How we stimulated our son’s brain that helped him finished Medical School in May 2001) “Medical Village Reborn” Oct 7, 1996 (Strategy to lower Medical Cost through technology use) “Brain ‘wiring’ can Lead to Errors” May 19, 1996 (How medical errors occur and some solutions) “Open the Golden Window” August 26-27, 1995 (Principles on how to make Children Smarter) “What a Child Needs” April 28, 1993 (About Basic Needs of Children) “Reach your goals, improve your life in an hour a day” September 23, 1992 (Get an extra hour a day to Improve our lives) “To Succeed, people have to Believe in themselves” August 26, 1992 “Using the full Range of the Brain can Prove Rewarding” May 27, 1992 “Seven Rs Of Education” December 12, 1989 (The seven Rs of Education are: reading, ‘riting, ‘rithmetic, research, relearning, relaxation, and ‘reativity.)

This blogspot is a repository of articles of Dr. Nonie Leonidas. UP Manila College of Medicine 1968. The administrator is Mr. Jose L. Leonidas. The goal of this blogspot is to popularize the writings of Dr. Nonie on the subjects he is passionate about.

This blogspot is a repository of articles of Dr. Nonie Leonidas. UP Manila College of Medicine 1968. The administrator is Mr. Jose L. Leonidas. The goal of this blogspot is to popularize the writings of Dr. Nonie on the subjects he is passionate about.