What can we do about death? Reinventing the American medical system

From the 31 May 2011 Eureka News Alert

(Garrison, NY) In a feature article in The New Republic,(subscription only, check your local public library for availability)  Daniel Callahan and Sherwin Nuland propose a radical reinvention of the American medical system requiring new ways of thinking about living, aging, and dying. They argue that a sustainable—and more humane— medical system in the U.S. will have to reprioritize to emphasize public health and prevention for the young, and care not cure for the elderly.

An interesting twist on their argument, which would aim to bring everyone’s life expectancy up to an average age of 80 years but give highest priority for medical treatment to those under 80, is that Callahan and Nuland are themselves 80 years old. Daniel Callahan, Ph.D., is cofounder and president emeritus of The Hastings Center and author most recently of Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Sherwin Nuland, M.D., is a retired Clinical Professor of Surgery at the Yale School of Medicine and author of How We Die and the Art of Aging. He is also a Hastings Center Fellow and Board member.

“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare,” said Callahan and Nuland. “That warfare, however, has come to look like the trench warfare of World War I: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer, heart disease, stroke, and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public must adapt it to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”

The article notes that the Affordable Care Act might ease the financial burden of this system, but not eliminate it. It reports, for example, that the cost of Alzheimer’s disease is projected to rise from $91 billion in 2005 to $189 billion in 2015, and to $1 trillion in 2025 – twice the cost of Medicare expenditures for all diseases now.

“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person,” the authors write. “An old age marked by disability, economic insecurity, and social isolation are also great evils.” They endorse a culture of care, not cure, for the elderly, with a stronger Social Security program and a Medicare program weighted toward primary care that supports preventative measures and independent living.

Callahan and Nuland point the way to a more sustainable path that reprioritizes the entire system. Among their recommendations:

• improve medicine at the level of public health and primary care, while reducing its use for expensive high-tech end-of-life care;
• shift resources for the elderly to greater economic and social security and away from more medical care;
• subsidize the education of physicians, particularly those who go into primary care, and decrease medical subspecialization;
• train physicians better to tell the truth to patients about the way excessively aggressive medicine can increase the likelihood of a poor death;
• shift the emphasis in chronic disease to care rather than cure;
• conduct a top-down, bottom-up, long-range study of the entire American system of health care, including the training of physicians, with a view toward reconstituting it along systematic lines that take science, humanistic concerns, economics, and social issues into account.

Related articles

• Andrew Reinbach: Health Care Could Kill Us: We Don’t Have to Let It (huffingtonpost.com)
• New at Reason: Ronald Bailey on Health Care Reform (reason.com)

Indiana U. study points to health disparities in physical fitness

From a 4 Jun 2011 Eureka news alert

 

An Indiana University study examining disparities in physical fitness levels between older adults who are patients of safety net community health centers (CHC) and those who are members of a medically affiliated fitness center is producing stunning results.

NiCole Keith, associate professor in the Department of Physical Education at Indiana University-Purdue University Indianapolis, said she expected the study to show similar physical fitness levels between the two groups. The findings, however, show that the fitness center participants performed significantly better on each of the measures when compared to the CHC particpants.

The community health centers serve vulnerable populations, including those without health insurance; the medically affiliated fitness centers serve a more affluent population. Otherwise, the age and health literacy of study participants in both groups were the same.

Further, the members of the medically affiliated fitness center were not exercising at the facility every week, much less every day. Generally, these fitness center members had sedentary jobs. Patients at the CHC who were employed spent a lot of time on their feet and moving about….

…

The overriding difference between the two groups of study participants is access to opportunities to exercise, Keith said. For patients at the CHC, there is generally no place for them to exercise. The cost of joining a fitness center is prohibitive for these patients, she added.

What is of great concern, Keith said, is that low levels of physical fitness are strongly related to negative health outcomes, including increased morbidity and mortality. The distinct differences among physical fitness levels between CHC patients and members of the medically affiliated fitness center demonstrate the clear need to identify low-cost and accessible means for vulnerable populations to improve their physical fitness levels, she said….

USC: Active social, spiritual and physical life helps prevent health decline in seniors

Study shows small day-to-day changes can result in measurable improvements in quality of life

From a 7 June 2011 Eureka news alert

Small, healthy lifestyle changes and involvement in meaningful activities—going beyond just diet and exercise—are critical to healthy aging, according to a new USC study.

Guided by lifestyle advisors, seniors participating in the study made small, sustainable changes in their routines (such as visiting a museum with a friend once a week) that led to measurable gains in quality of life, including lower rates of depression and better reported satisfaction with life.

The study validates the current trend in public health strategies to focus on preventing illness and disability, as opposed to treating issues once they have already begun to negatively impact health, according to lead investigator Florence Clark.

“What is critical is that, as we age, we continue to be engaged in life through a sustainable mix of productive, social, physical and spiritual activities. This goal of prevention and wellness is really a key to health care reform, and results in cost savings to society,” said Clark, professor and associate dean of the Division of Occupational Science and Occupational Therapy at the Herman Ostrow School of Dentistry of USC, and president of the American Occupational Therapy Association.

“The emphasis now is prevention,” she said. “There are non-pharmacologic interventions that work.”

The Well Elderly 2 trial was performed between 2004 and 2009, with the write-up appearing in the June 2 issue of the Journal of Epidemiology and Community Health.

Lifelong gap in health between rich and poor set by age 20

 

 

Study by McGill geography professor finds that as people age, the differnce in the health-related quality of life between rich and poor remains constant

From a 8 June 2011 Eureka news alert

 

“We can’t buy our way out of ageing,” says Nancy Ross, a McGill geography professor. “As we get older we start to have vision problems, maybe some hearing loss, maybe lose some mobility – ageing is a kind of a social equalizer.”

Ross is the lead author of a new study about how socio-economic and educational status affects Canadians’ health-related quality of life over the course of a lifetime.

“My research looks at how poverty and social disadvantage affect your health status. Our work was about using social circumstances as a lens to look at how people’s quality of life changes as they age.”

The good news, according to Ross, is that there is no sign of an accelerated ageing process for those who are lower on the social ladder. “The trajectories for declining health as people age look fairly similar across the social spectrum. That surprised me. I thought that there would be a bit more of a difference across social groups.”

But the bad news is that Canadians who are less educated and have a lower income start out less healthy than their wealthier and better-educated compatriots, and remain so over the course of their lives. “What we found, basically, is that people who are more educated and with higher incomes have a better health-related quality of life over their whole lifespan, and that these health “tracks” stay pretty parallel over time.

“The message there is that if you start out with a health-related quality of life deficit through early life experience and a poor educational background, it’s never made up for later on,” says Ross. “Poorer Canadians are in poorer health and they have lower life expectancy than their more affluent counterparts, and by age 20 the pattern for health-related quality of life as people age is already fixed.”

“We might speculate that universal health insurance and other social policies directed to adults and seniors have played a role in preventing accelerated decline in health-related quality of life of the poorer and less educated Canadians. That said, we would need some comparative research in other countries to test this more fully,” she adds. “But this study suggests the need for policies aimed at making sure kids and teens are given the chances early in life to even out socio-economic inequalities that will affect their health as they age.”

 

The Future Of Our Planet Linked To The Health Of Its People

Image via Wikipedia

From the 14 June 2011 Medical News Today article

A major new research project will examine how policies deProfessor Clive Sabel, from the University of Exeter’s Geography department and European Centre for Environment and Human Health (ECEHH) and leader of the project, said: “If we don’t start reducing greenhouse gas emissions from cities, the planet will get hotter and hotter, but every policy to tackle those emissions has a potentially profound effect on human health.

“That could be positive or negative, so in order to make that assessment we have to look at all the evidence and relate that to the on-the-ground technical, social, economic, political and cultural realities. This research aims to integrate data from a large variety of sources to inform key policy decisions to ensure city life is a healthy, positive experience that is sustainable for the future of our planet.”

The European Centre for Environment and Human Health (ECEHH), part of the Peninsula College of Medicine and Dentistry, will also be taking part in the research. Professor Lora Fleming, Director of the centre, said: “One of the unique strengths of this study is the cross cultural comparisons of approaches across many nations, both developing and developed. Climate change is a global environment and human health issue which must be addressed on both local and international levels. This study will help provide some of these future approaches.”

The research will look ahead to 2030 and 2080 to see what the impact would be if various carbon reduction policies would be, particularly in context of a warming climate where issues such as heat stress and water availability will become more prevalent.
signed to reduce greenhouse gas emissions could impact human health.

Led by the University of Exeter the three year 3.5 million Euros programme of research will involve experts from 17 institutions across eight countries. …

…Professor Clive Sabel, from the University of Exeter’s Geography department and European Centre for Environment and Human Health (ECEHH) and leader of the project, said: “If we don’t start reducing greenhouse gas emissions from cities, the planet will get hotter and hotter, but every policy to tackle those emissions has a potentially profound effect on human health.

“That could be positive or negative, so in order to make that assessment we have to look at all the evidence and relate that to the on-the-ground technical, social, economic, political and cultural realities. This research aims to integrate data from a large variety of sources to inform key policy decisions to ensure city life is a healthy, positive experience that is sustainable for the future of our planet.”

The European Centre for Environment and Human Health (ECEHH), part of the Peninsula College of Medicine and Dentistry, will also be taking part in the research. Professor Lora Fleming, Director of the centre, said: “One of the unique strengths of this study is the cross cultural comparisons of approaches across many nations, both developing and developed. Climate change is a global environment and human health issue which must be addressed on both local and international levels. This study will help provide some of these future approaches.”

The research will look ahead to 2030 and 2080 to see what the impact would be if various carbon reduction policies would be, particularly in context of a warming climate where issues such as heat stress and water availability will become more prevalent.

Related articles

• Country By Country Analysis Of Years Left Until Science-demanded Zero Greenhouse Gas Emissions (chimalaya.org)
• Climate change education can still be part of a slimmed-down curriculum (guardian.co.uk)
• Human Health Project: Getting Feedback on Cases (scienceroll.com)
• Can cities lead the way in cutting greenhouse gas emissions? [del.icio.us] (guardian.co.uk)

Squeeze An Arm – Protect The Heart, UK

From the 7 June 2011 Medical News Today article

Scientists at the University of Leicester are investigating a novel technique that promises to protect heart muscle from life-threatening damage following a heart attack – simply by squeezing an arm. Heart attacks are the major cause of premature death in England, with massive implications for survival and costs of long-term health care.

A new technique called conditioning is being investigated by Dr Sadat Edroos, a postgraduate researcher from the University’s Department of Cardiovascular Sciences, to determine its effectiveness at protecting the heart of people with cardiovascular disease. This technique promises to reduce the damage to the heart that occurs after a heart attack by as much as a quarter. This would have significant beneficial implications for patients’ long term survival and wellbeing.

The method of conditioning is based on the observation that temporarily stopping the blood supply to a muscle makes it resistant to further damage. However protection from one muscle may be transferred elsewhere through the blood stream to another. Squeezing an arm for a few minutes can shield the heart, reducing the extent of damage after a heart attack. “We hope to shed light on this safe and effective therapy,” said Dr Sadat Edroos, “helping it to benefit patients.”

“This work, in conjunction with other studies published in the past two years, is creating a compelling argument for the application of this technique to clinical use. I hope that by the end of the decade this simple, cheap, safe and effective tool will be in use across the country.” …

Related Resources

• MedlinePlus: Heart Attack (resources and links)
• Net Wellness: Heart Diseases (information, resources, links, )
• UpToDate Patient Information – Heart Attack

Related articles

• One in five heart-attack deaths could be prevented with new drug (medicalxpress.com)
• Reducing the number of heart attack deaths at major sporting venues (medicalxpress.com)
• Magnetic fields could help prevent heart attacks (gizmag.com)

Nursing Research Focuses On Health Trajectory Research

From the 8 June 2011 Medical News Today article

Health care research typically focuses on final outcomes such as cure or death overlooking the fact that health and illness are dynamic states that evolve and change over time. A special collection of articles on health trajectory research is now available in a supplement to Nursing Research***, official journal of the Eastern Nursing Research Society and the Western Institute of Nursing. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special supplement presents a series of original studies and commentaries on the development of nursing intervention science focused on the “promotion, maintenance, and restoration of health over time.” It reflects a growing interest in studying the ways that health care interventions can affect health trajectories at different stages of life…

…Several types of health trajectories can be affected by nursing interventions. Developmental trajectories refer to normal physiologic changes such as puberty, menopause, or aging or even life transitions such as marriage or retirement. Acute illness trajectories have to do with illnesses that tend to resolve or improve over time, while chronic illness trajectories are associated with illnesses that aren’t curable, but can still have positive health outcomes. Other categories include disability trajectories and end-of-life or dying trajectories. “Having a better understanding of these various health trajectories and how they can be shaped through interventions will help clinicians provide better care for individuals and families at all stages of their lives,” Drs. Wyman and Henly write.

Articles in the special issue present the nursing science perspective on health trajectory research and important theoretical considerations in studying health and illness over time including advances in statistical modeling that support this area of research. The supplement also includes a series of original studies illustrating the health trajectory perspective in health and illness; in community, hospital, and laboratory settings; and across time scales ranging from seconds to years. Topics include:

– Changes in functioning of the parasympathetic nervous system related to feeding in newborns after surgery for major congenital heart abnormalities.

– Changes in patterns of condom use by sexually active teens participating in a pregnancy-prevention program.

– Changes in anxiety related to mechanical ventilation in critically ill patients.

– Changes in patterns of pain (claudication) during treadmill testing in patients with peripheral artery disease.

– Changes in gastrointestinal symptoms in incontinent patients being treated with fiber supplements.

– Changes in burden and depression in caregivers of spouses with dementia as they transition to nursing care.

 

***For suggestions on how to get these articles for free or at low cost, click here

Harnessing The Power Of Open Data

From the 9 June 2011 Medical News Today article

 

The U.S. Department of Health and Human Services (HHS) and the Institute of Medicine (IoM) today co-hosted their second annual event focusing on innovative applications and services that harness the power of open data from HHS and other sources to help improve health and health care.

The Health Data Initiative Forum featured more than 45 new or updated solutions that harness the power of HHS and other federal data to help serve the needs of consumers, health care providers, employers, public health leaders, and policy makers.

“The Health Data Initiative Forum demonstrates our strong commitment to promoting innovative uses of data to advance health and health care in America,” said HHS Secretary Kathleen Sebelius. “This initiative is helping consumers take control of their own health and health care by putting the right information at their fingertips, helping doctors and hospitals deliver better and safer care, helping employers promote health and wellness, helping mayors and county commissioners make better-informed decisions that improve the health of communities.”

The forum also featured panel presentations from leaders in information technology development, privacy, venture capital financing, health care delivery systems, state and local government, and public health. Other federal cabinet secretaries participated in the promotion of the use of their agencies’ data, including Environment Protection Agency (EPA) administrator Lisa Jackson, who announced her agency’s new effort to encourage innovators to leverage EPA data to help power useful solutions for the public.

The forum included nearly a dozen announcements of major new initiatives being launched using federally supplied health data. Among these announcements were the public and private sponsorship of new “challenges” to develop data-powered solutions that help improve health, including challenges issued by Walgreen’s Pharmacy, Aetna Foundation, Sanofi-Aventis, and the National Cancer Institute.

Additional key announcements made at the forum included the University of Michigan’s debut of the nation’s first graduate program to focus on consumer health informatics; the launch of Start Up Health, a new seed accelerator/entrepreneur academy in New York City aimed at developing new health and wellness startups; ESRI’s release of a new public community health analytics tool called Community Analyst; and an upcoming “invent-a-thon” focused on developing nursing homes of the future, hosted by Johns Hopkins University and the National Collegiate Inventors and Innovators Alliance.

Cancer Experts Offer Four Tips For Healthy Grilling

Image via Wikipedia

From the 10 June 2011 Medical News Today article

 

“Two aspects of the traditional American cookout, what you grill and how you grill it, can have a role in raising risk for cancer,” said AICR spokesperson Alice Bender, MS RD. “Big portions of red and processed meat are a well-known concern with respect to colorectal cancer. And although the evidence on the link between grilling itself and cancer risk is less strong, it only makes sense to take some easy cancer-protective precautions.”

Bender noted that when any kind of meat, poultry or fish is cooked at high temperatures, especially when well-done or charred, cancer-causing compounds called heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) form. These substances can theoretically damage DNA in ways that make cancer more likely.

“The good news is that there are four simple strategies you can use to make allowances, manage risks, and grill more safely,” said Bender.

. Get the Red (Meat) Out, Add Other Colors 

- Focus first on grilling colorful vegetables and fruits, and cut back on the amount of red and processed meat on your cookout menu. Plant foods contain a variety of naturally occurring compounds called phytochemicals, many of which provide their own anti-cancer protection.

- Vegetables like asparagus, onions, mushrooms, zucchini, eggplant and corn on the cob are favorites, because grilling brings out flavors that even the pickiest eaters enjoy. Cut into chunks for kabobs, cook in a grill basket, or toss with a small amount of olive oil and grill whole.

- Cut fruit before putting it on the grill: apples, peaches and pears can be halved and bananas split lengthwise. Use fruit that is about a day or two away from being completely ripe so it retains its texture. If you brush fruit or the grill with a bit of oil, it won’t stick, and remember to watch closely so it doesn’t get overdone. Serve as is, with a sprinkle of cinnamon or a dollop of plain frozen yogurt.

2. Marinate the Meat 

- If you choose to grill meat, mix it up: Try chicken or fish instead of sticking with burgers and hot dogs. Whatever meat you choose, start by mixing up a marinade with some of your favorite herbs along with vinegar or lemon juice. Keep the meat marinating in the fridge while you prepare the sides. Marinating meat has been shown to reduce the formation of HCAs. Precisely why marinades are protective is still under investigation; some evidence points to the acids (vinegar and citrus) or the antioxidant content. Even just 30 minutes in the marinade can help.

3. Partially Pre-cook 

- You can do this in the microwave, oven or stove to help reduce the amount of time the meat sits on the grill exposed to high heat. To ensure safe food handling, just be sure to put the partially cooked meat on the preheated grill immediately to complete cooking.

4. Go Slow and Low 

- To reduce the amount of HCAs and PAHs that end up in, and on, the meat, slow down the cooking time with a low flame and keep burning and charring to a minimum. More tips: cut off any visible fat (to reduce flare-ups), cook food in the center of the grill and move coals to the side (to prevent fat and juices from dripping on them) and cut off any charred portions of the meat.

Related articles

• Summer Tips for Delicious, Healthy Outdoor Cooking (webmd.com)
• Healthy Reasons Why You Should Marinate Your Meat (fitsugar.com)

Carcinogens – Eight Substances Added To The List

From the 12 June 2011 Medical News Today article

Eight substances have been added to the list of carcinogens by the HSS (US Department of Health and Human Services) today. The Report of Carcinogens has added formaldehyde, aristolochic acids, o-nitrotoluene, captafol, cobalt-tungsten carbide (in powder or hard metal form), riddelliine, certain inhalable glass wool fibers, and styrene to the list of carcinogens….

…The NTP prepares the Report on Carcinogens for the HHS Secretary. It is a congressionally mandated document. It identifies substances, agents, mixtures or exposures in two categories:

• Those that are known to be human carcinogens
• Those reasonably anticipated to be human carcinogens

A substance which is included in the list in the Report on Carcinogens does not in itself mean it causes cancer. There are many factors which cause cancer, including how long the human is exposed and a person’s susceptibility to a particular substance.

There are now 240 carcinogens in the list.

Related Resources

• Environmental Health and Toxicology (specialized information services from the US National Institutes of Health and US National Library of Medicine)
• HazMap -an occupational toxicology database designed to link jobs to hazardous job tasks which are linked to occupational diseases and their symptoms. It is a relational database of chemicals, jobs and diseases.ToxNet - Databases on toxicology, hazardous chemicals, environmental health, and toxic releases
• Household Products Databases - This database links over 8,000 consumer brands to health effects from Material Safety Data Sheets (MSDS) provided by the manufacturers and allows scientists and consumers to research products based on chemical ingredients and many more databases..
• Toxicology Web links from NIH & NLM (extensive list of govt, non-govt, and international Web sites)
• Toxicology Resources especially for the public (from NIH and NLM), including ToxTown and ToxMap

Related articles

• Cancer Link?: Styrofoam Chemical Added to Govt. List (abcnews.go.com)
• Industry Bucks At NIH’s List Of New Carcinogens Styrene, Formaldehyde (MedicalNewsToday)
• It’s official: Formaldehyde is a “known Human Carcinogens”- via ProPublica and Democracy Now (euzicasa.wordpress.com)

Income Disparity Makes People Unhappy

From the 13 June 2011 Medical News Today article

Many economists and sociologists have warned of the social dangers of a wide gap between the richest and everyone else. Now, a new study, which will be published in an upcoming issue of Psychological Science, a journal of the Association for Psychological Science, adds a psychological reason to narrow the disparity – it makes people unhappy.

Over the last 40 years, “we’ve seen that people seem to be happier when there is more equality,” says University of Virginia psychologist Shigehiro Oishi, who conducted the study with Virginia colleague Selin Kesebir and Ed Diener of the University of Illinois. “Income disparity has grown a lot in the U.S., especially since the 1980s. With that, we’ve seen a marked drop in life satisfaction and happiness.” The findings hold true for about 60 percent of Americans-people in the lower and moderate income brackets. …

…The conclusions: That grim mood cannot be attributed to thinner pocketbooks during periods of greater inequality-though those pocketbooks were thinner. Rather, the gap between people’s own fortunes and those of people who are better off is correlated with feelings that other people are less fair and less trustworthy, and this results in a diminished sense of wellbeing in general.

Studies Evaluate Criteria For Detecting Potentially Inappropriate Medications In Older Hospitalized Patients

From the 13 June 2011 Medical News Today article

 Using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria was associated with identification of adverse drug events in older patients, according to a report in the June issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The article is part of the journal’s Less Is More series.

According to information in the article, adverse drug events (ADEs) are a significant issue in the older population, and are thought to represent an important cause of hospitalization and account for substantial health care expenditures. Some ADEs are associated with potentially inappropriate medications (PIMs): agents that may cause problems in older patients “because of the higher risk of intolerance related to adverse pharmacodynamics or pharmacokinetics or drug-disease interactions.” During the last two decades, the Beers criteria for judging whether a medication is appropriate for use in an older patient have become the leading standard. Nevertheless, the authors write, research into whether the Beers criteria are associated with avoidable ADEs has not generated consistent results….

…According to the authors, the results suggest that STOPP criteria were more likely than Beers criteria to reveal ADEs in general, avoidable or potentially avoidable ADEs, and ADEs that may have factored into the patient’s hospitalization. “We believe that this finding strengthens the argument for the use of STOPP criteria in everyday clinical practice as a means of reducing the risk of ADEs in older patient,” they write. …

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Article Outlines Principles For A Conservative Approach To Prescribing Medication

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From the 14 June 2011 Medical News Today article

 

 shift toward more conservative medication-prescribing practices would serve patients better, according to a review article published Online First today by Archives of Internal Medicine, one of the JAMA/Archives journals***. The article is part of the journal’s Less Is More series.

As background, the article notes that the majority of patients under age 65 years receive at least one prescription drug annually. However, according to the authors, not every patient visit needs to result in a prescription. They point to “the recent spate of revelations of undisclosed and unexpected adverse effects of drugs in multiple therapeutic categories” as just one reason to take a more measured approach to medication usage…

…Among the steps they recommend for conservative prescribing:

• Think beyond drugs. Would other interventions help? Would a medication simply mask symptoms without treating the problem? Can a condition be prevented instead of treated? Would waiting to see if the symptoms self-resolve be wise?
• Practice more strategic prescribing. Do you have a solid understanding of medication choices? Is there a valid reason to switch to a new drug? Is it the right drug for your patient? Can you avoid using multiple medications?
• Maintain heightened vigilance regarding adverse effects. Do you check with patients about potential drug reactions? Do you teach them the warning signs? Are the drugs you’re choosing prone to withdrawal symptoms or relapse?
• Approach new drugs and new indications cautiously and skeptically. Where do you get your information about new treatments? Can you wait until a new drug has had a longer track record? Does the drug actually help resolve the core problem? Is it actually indicated for this problem? Does it deliver what it promises? Do studies tell the whole story on a drug?
• Work with patients for a more deliberative shared agenda. Can you persuade patients not to demand drugs they have seen or heard advertised? Is a patient’s noncompliance with therapy the source of the problem? Has the patient already tried this drug without success? Can you encourage healthy skepticism in your patients?
• Consider longer-term, broader effects. Would a different therapy be less likely to cause future harm? Can you find a way to make the prescribing system better?

***For suggestions on how to get this article for free or at low cost, click here

Brain Structure Adapts To Environmental Change

From the 14 June 2011 Medical News Today article

Scientists have known for years that neurogenesis takes place throughout adulthood in the hippocampus of the mammalian brain. Now Columbia researchers have found that under stressful conditions, neural stem cells in the adult hippocampus can produce not only neurons, but also new stem cells. The brain stockpiles the neural stem cells, which later may produce neurons when conditions become favorable. This response to environmental conditions represents a novel form of brain plasticity. The findings were published online in Neuron on June 9, 2011….

Contrary To Common Beliefs, Studies Find Aggressive Care May Yield Better Patient Outcomes

From the 24 June 2011 Medical News Today article

Health services researchers who studied controversial aspects of Medicare spending and quality of patient care received a prestigious award yesterday from the nation’s largest health services research professional association….

…The Article of the Year Award recognized two companion studies by Silber and Kaestner: “Aggressive Treatment Style and Surgical Outcomes,”*** published in the December 2010 issue of the journal Health Services Research, and “Evidence on the Efficacy of Inpatient Spending on Medicare Patients,” ***published the same month in The Milbank Quarterly.

As an indicator of aggressive care, Silber and Kaestner used the Dartmouth Index, a prominent set of measures of inpatient spending on elderly patients. In studying over 5 million Medicare admissions for various surgeries between 2000 and 2005, they found that surgical patients in hospitals with a more aggressive treatment style were less likely to die within 30 days of admission compared to patients in less aggressive hospitals. They also found that this benefit was stable, persisting after the 30-day mark. …

***For suggestions on how to get these articles for free or at low cost, click here

Related articles

• A promising way to control health costs (money.cnn.com)
• Fewer Medicare Patients Being Hospitalized for Heart Problems (insurance.zocdoc.com)
• Medicare premiums, saving Medicare and more; keep on eye on the real concerns (quinnscommentary.com)

Cross Agency Portals : USA.gov

 

 

Link to federal government cross agency portals. A cross agency portal
is a government website on a specific topic with information from
several or many federal government agencies,

HowTo.gov : Helping Agencies Deliver a Great Customer Experience

HowTo.gov is a website to help government workers who manage or support
a government customer service channel (call center, web site, etc.)
deliver a better customer experience to citizens.
Includes info on web content and design, communicating using social
media, managing call centers, writing content, etc.