This Medscape article deals with many of the problems that physicians have in regard to getting organized. An oft-heard comments is, “We let them do this to us, we gave away our power. If we want to change medicine in a different way, we have to work together to take it back.” But can – or will – that ever happen? This article reviews the options. Click here to read full-text.
News You Can Use
The American Geriatrics Society Position Statement statement: 1. Feeding tubes are not recommended for older adults with advanced dementia. Careful hand feeding should be offered; for persons with advanced dementia, hand feeding is at least as good as tube feeding for the outcomes of death, aspiration penumonia, functional status, and comfort. Tube feeding is associated with agitation, greater use of physical and chemical restraints, greater healthcare use due to tube-related complications, the development of new pressure ulcers. 2. Efforts to enhance oral feeding by altering the environment and creating individual-centered approaches to feeding should be part of usual care for older adults with advanced dementia. 3. Tube feeding is meedical therapy that an individual’s surrogat3e decision-maker can decline or accept in accordance with advance directives, previously stated wishes, or what it is thought the individual would want. 4. It is the responsibility of all members of the healthcare team caring for residents in long-term care settings to understand any previously expressed wishes of the individual (through review of advance directives and with surrogate caregivers) regarding tube feeding and incoproarte these wishes into the care plan. (JAGS, Aug) Click here to read full text.
This updated review (Lancet, March) summarizes the epidemiology, causes, pathophysiology, diagnosis, assessment and workup, non-pharmacological prevention and treatment, pharmacological prevention and treatment, controversies and future directions with recommendations. “Delirium is an acute disorder of attention and cognition in elderly peiople that is common, serious, costly, under-recognised, and often fatal. A formal cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent pharacological approaches are recommended.” Click here to read full-text.
“Use of mortality after bilateral mastectomy compared with other surgical treatments for breast Cancer” and accompanying editorial, “Contralateral prophylactic mastectomy: Is it a reasonable option?”by jmiller on September 11, 2014
This article concludes that the “use of bilateral mastectomy increased significantly through California from 1998 to 2011 and was not associated with lower mortaligy than that achieved with breast-conserving surgery plus radiation. Unilateral mastectomy was associated with higher mortality than the other 2 surgical options.” (JAMA, Sept) Click here to read full-text.
This review article (NEJM, Aug 28) updates the pathogenesis, diagnosis, screening and surveillance, management, endoscopic eradication of dysplasia, management of low-grade dysplasia, and radiofrequency ablation of nondysplastic metaplasia. Click here to read full-text
This article (Mayo Clin Proc, Aug) concludes, “Medication errors are present in approximately half of patients after hospital discharge and are more common among patients with lower numeracy or health literacy. Click here to read full-text.
Is hospital admission for heart failure really necessary? The role of the ED and observation unit in preventing hospitalization and rehospitalizationby jmiller on August 20, 2014
“Evidence-based therapies have resulted in improvements in the outpatient mangement of HF. Despite an increasingly complex population of patients, the overall length of hospital stay has decreased. However, post-discharge event rates remain disturbingly high and it is not clear that hospitalization mitigates these event rates. Emergency physicians are key stake holders in this process, as the ED is the point of triage and disposition fo rthe majority of HF patients who are considered for hospital admission. Alternatives to hospitalization, such as the one posed in this article, are crucail to the overall goal of allocating resources to those high-risk patients in need of intense evalutation and therapy, while simultaneously faiclitating outpatient management of lower-risk patients.” (J Am Coll Cardiol, Jan 2013) Click here to read full text
“Running, even 5 to 10 min/day and at slow speeds <6 mi. hr, is associated with markedly reduced risks of death from all causes and cardiovascular disease. This study may motivate health but sendentary individuals to begin and continue running for substantial and attainable mortality benefits.” (J Am Coll Cardiol, June) Click here to read full-text