Health and Medical News and Resources

General interest items edited by Janice Flahiff

Website launched to help patients prepare for complex medical decisions

photobar_0.jpgDid a test drive…While it is indeed “written” at a 5th grade level, it does not talk down to adults.
Worth checking out/recommending.

From the 4 January 2013 EurkAlert

San Francisco VA Medical Center and UCSF develop user-friendly online tool for advance care planning

 IMAGE: This is Rebecca Sudore, M.D.Click here for more information.

A new patient-friendly online resource called PREPARE has been developed to help people make complex medical decisions. The website was developed by researchers from the San Francisco VA Medical Center, UCSF, and NCIRE – The Veterans Health Research Institute.

The PREPARE website incorporates content identified in new research to address key patient- and surrogate-identified aspects of preparing for advance care planning and decision making. The site provides concrete examples through videos and other mechanisms on how to identify what is most important in life, how to communicate that with family and friends and doctors, and how to make informed medical decisions….

There are few resources which can adequately prepare patients and their families to face serious illness or a medical crisis – situations which often involve complex decisions over time,” said lead study author Rebecca Sudore, MD, SFVAMC geriatrician and palliative medicine physician and associate professor medicine at the UCSF School of Medicine.

“Advance directives are important, but they are just one piece of the puzzle,” she said. “We wanted to develop a value-driven, easy-to-use tool to prepare people to make medical decisions that reflect their values and needs while preparing them to effectively communicate these wishes with others.”

This study identified key themes critical to successful advance care planning that go beyond completing an advance directive form. These include successful surrogate selection and communication with the surrogate, determination of the surrogate’s role, and communication with family and doctors.

The website’s audio-visual interface is tailored to typically underserved populations (including users with low health or computer literacy and/or visual or hearing impairment) and aims to incorporate a patient-centered, comprehensive and manageable approach.

The PREPARE website is written at a fifth-grade reading level, and includes voice-overs of all text, closed-captioning for the hearing impaired, and large font for the visually impaired. In preliminary pilot testing, older adults from diverse backgrounds rated PREPARE a nine out of a 10- point-scale for ease of use, according to Sudore.

“We wanted to make the website free and easy-to-use by everyone,” she said. “We made sure to take advice given to us by patients and surrogates. The site doesn’t merely ask people to do advance care planning, but actually shows people, through videos and a step-by-step process, how to actually have the conversation and make informed medical decisions.”

The study included 69 English and Spanish-speaking patients and surrogate decision makers who reported having to make serious medical decisions for themselves or loved ones. The mean age of patients was 78 years and 61 percent were non-white. The mean age of the surrogate decision makers was 57 years, and 91 percent were non-white.

Qualitative analysis revealed that advance directives were not enough to prepare patients and surrogates for medical decision making. Many participants stated that solely focusing on treatments, such as mechanical ventilation, was not sufficient to help with the “many decisions” with which they were facing…

Read the entire article here

January 7, 2013 Posted by | Health Education (General Public) | Leave a comment

2 ways to help your patients get better sleep

English: A photo of a cup of coffee. Esperanto...

English: A photo of a cup of coffee. Esperanto: Taso de kafo. Français : Photo d’une tasse de caffé Español: Taza de café (Photo credit: Wikipedia)

 

By JULIA SCHLAM EDELMAN, MD , 5 January 2013 post at KevinMD.com

 

1. Avoid looking at back-lit screens for 60 minutes before bedtime. That means no television, iPad use, laptop use, checking the smartphone, or reading a back-lit e-reader before bed.  Reading a book made from trees is ideal, as is listening to music or having a relaxing conversation, if you remember that vanishing social custom.

2. Taper the amount of caffeine you consume. Even if you finish your coffee in the morning, you will benefit.  It takes six hours to clear half the amount of caffeine you consume.  With super-sized coffee cups, a large cup may contain more than 200 milligrams of caffeine.  Here is the math.  If you drink three large cups of coffee by 11am, you have consumed 600 milligrams of caffeine.  Six hours later, at 5pm, 300mg of caffeine remain in your body.  Six hours after that, at 11pm, 150mg remain.  At 5am the next morning, 75mg of caffeine remain from the previous morning.  This compromises your ability to fall asleep readily, and makes your mind race.  It also prevents deep, rapid eye movement (REM) sleep.  If your patient offers to stop “cold turkey,” don’t let her.  A slow taper prevents caffeine-withdrawal headaches.

 

Read the entire article here

 

 

 

 

January 7, 2013 Posted by | Consumer Health | , , , | Leave a comment

The role of alcohol in health costs

This blog post brought to mind a dear friend of mine, deceased now about 8 years. She was staying at our house, basically to get out of an abusive relationship. She had a myriad of health problems…Once I came home and she was passed out. I thought it was one of her many medical conditions that was the main factor…and somehow with the help of neighbors got her in my car and we sped to the emergency room. To make a long story short, it turned out her blood alcohol was extremely high….I know now the alcoholism not only “translated” into high medical costs for her, but also a short life.
May she rest in peace, rest in peace….

From the 6 January 2012 post by EDMUND KWOK, MD at KevinMD.com

Defined as someone “having the faculties impaired by alcohol, those of us who work in an acute healthcare facility are witness to many illustrious examples of drunk patients coming through our doors.

 

Underaged kids passed out at a house party? Yup. Raging alcoholics who are brought into the ER at least once a week? Sure. Elderly women who secretly binges on wine at home and falls down the stairs repeatedly? You betcha. What they all have in common is an apparent complete oblivion/ignorance to the source of the problem, and the associated ill effects on themselves.

Sometimes I wonder if the healthcare/political/legal system itself is “drunk”, in its own oblivion and inaction towards the impact alcohol abuse is having on our society.

The average sober Canadian would be shocked to hear of the types of alcohol-related ER visits that come through a hospital’s doors every weekend.

Empirical data supports this theory of absurd and inefficient healthcare dollar usage on alcohol abuse related hospital visits. As reported in the Recommendations for a National Alcohol Strategy published in 2007, “the economic impact of alcohol-related harm in Canada totaled $14.6B, taking into account the costs associated with lost productivity, health care, and enforcement. This amount is slightly less than the estimated cost of tobacco at $17B, but nearly double the cost attributed to illegal drugs at $8.2B”.

Anecdotal evidence reports many unnecessary ER visits where drunk patients simply take up an acute care bed for the night to sober up, eat a free breakfast in the morning and then get discharged. It is estimated that 0.6% of all U.S. ER visits are made by people who have no other problems beside being drunk, translating to over 900 million dollars just for ER visits alone….

 

 

 

January 7, 2013 Posted by | Consumer Health, Consumer Safety, health care | , , , , , , | Leave a comment

   

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