As a geriatrician, another reminder of the work that I do and why it is so important in today’s delivery of healthcare as it relates to chronic, complex diseases (especially with the explosion  in the sheer numbers of Boomers into that hallowed 65-and-older territory):

Some 89 percent of the state’s medium and larger hospitals offer palliative care — which focuses on easing pain and discomfort while often continuing aggressive treatment. That placed Minnesota among seven states getting an A in a report released Wednesday by the Center to Advance Palliative Care at Mount Sinai School of Medicine in New York City.

The report also cites cost-of-care decreases in aspects of delivery of care to the very infirmed while noting the provisions of dignified, compassionate care characteristic of established palliative care programs. Imagine that. | PDF LINK to report

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Since the late 20th century, innovation in long term care (LTC) has been fueled by a desire of healthcare systems  – in this case, owners of skilled nursing facilities — to achieve new quality benchmarks in healthcare delivery at a reasonable cost. Thanks to major pieces of legislation over the past 15 years emphasizing patient safety, healthful outcomes, and cheaper methods of treatment delivery; LTC as a discipline has undergone a sea change for the better. As a geriatrician, I have seen this evolution firsthand. That’s why I absolutely love seeing developments like this

Working with a psychiatrist and a pharmacist, [nurse and resident care coordinator in a Two Harbors, MN nursing home, Eva] Lanigan started a project last year to find other ways to ease the yelling, moaning, crying, spitting, biting and other disruptive behavior that sometimes accompany dementia. They wanted to replace drugs with aromatherapy, massage, games, exercise, personal attention, better pain control and other techniques. [..] Within six months, they eliminated antipsychotic drugs and cut the use of antidepressants by half.

The savings in cost due to the cessation of expensive psychotropics (even if informed consent enabled usage), the avoidance of chemical restraint and its obvious negative effect on patient safety, and the increase in patient quality of life without the need for specialized dementia care (again, at an enormous increase in care delivery cost) are at least three major reasons why innovation in geriatric care is so important in the age of reform. And it’s happening right here in Minnesota. Excellent.

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The battlelines are drawn in the latest medicolegal war which tests how far patient activism can go when the patient asks for, rather demands, a particular treatment regimen unproven in the pantheon of well-studied and documented clinical medicine. The treatment of Lyme disease, an infectious disorder in which the deer tick (found in abundance here in Minnesota) acts as a vector of transmission, is under fire from patient activist groups who say that they aren’t being treated effectively for the disorder’s possible long-term effects, which can be disabling.

Pity the role of infectious disease experts who are often called upon to consult and produce national guidelines based upon sound medical and clinical research. These intrepid physicians now have to navigate and overcome the legislative process which appears to be siding with patients who feel as though they are being maltreated. In Minnesota, the state medical board (which regulates, disciplines, and licenses physicians) has had to initiate a moratorium against actions that may arise out of patient complaints with respect to the treatment of Lyme disease. Elsewhere, activist groups are gaining steam and appear to be influencing its evaluation, classification, and treatment^[1] without the involvement of physician specialists and experts…and with the support of lawmakers. | LINK

1. which often involves the unproven use of chronic antibiotics, for a year or more..

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• Somali gunmen kidnap Doctors Without Borders workers.

Another elder in the region was hopeful the kidnapping could be resolved quickly. “We are hopeful that the gunmen will release the aid workers peacefully, soon after our negotiations come to an end today,” Edin Malag said. Kidnappings of foreign aid workers and journalists by ransom-seeking armed groups are frequent in conflict-wracked Somalia. UN agencies attempting to deliver food aid to the 3.25 million Somalis it estimates need humanitarian support have been repeatedly targeted.

• New fund promises low-cost anti-malaria treatment.
• What happens when COBRA coverage is terminated without warning?
• Times are tough for some (Shriners) hospitals.
• Three Vet. Administration hospital patients test positive after exposure to non-sterilized clinic equipment.

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One of the harmful by-products of an always-on, twenty-four hour Internet world is the sheer preponderance of conflicting information. Behind the need to know about things is the drive to find out exactly what is true and what constitutes sheer fallacy. The implications for the savvy, Web surfing 21st century healthcare consumer increase the burden of assimilating information on both of these levels.

So, with that in mind, consider what researchers are saying about the beneficial effects of caffeine on heading off dementia; as opposed to what other researchers are saying about the harmful effect on mental status in those who imbibe too much of that black nectar we call coffee.

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What motivation do, um, motivated smokers have in their arsenal to kick the habit? They need look no further than the efforts of the President (-Elect) of the United States, Barack Obama.

He told Tom Brokaw of NBC several weeks ago, for example, that he “had stopped” but that “there are times where I’ve fallen off the wagon.” He promised to obey the no-smoking rules in the White House, but whether that meant he would be ducking out the back door for a smoke is not known. His transition team declined to answer any questions about his smoking, past or present, or his efforts to quit.Antismoking activists would love to see him use his bully pulpit to inspire others to join him in trying to kick the habit, but he has not yet taken up their cause.

An interesting history of those Commanders-In-Chief who were defined, in part, by the stogies they nursed, in the NYT.

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With the clock ticking ever so quickly toward Jan. 1, asthma sufferers will no doubt try to make a run for the border to get refill scripts on their inhalers. Because, effective that date, metered dosed inhalers must go green:

“It’s possible people may skimp on their medicine because of the cost,” said Dr. Bradley A. Becker, co-director of the Asthma Center for Children at Cardinal Glennon Children’s Medical Center in St. Louis. “Clearly that would not be a good strategy because you might end up in the emergency room.”

Many doctors have been prescribing the new inhalers for several months, helping their patients transition to the devices, which use the more environmentally friendly propellant hydrofluoralkane (HFA) and deliver the quick-relief drug albuterol.

Some physicians and pharmacists, however, say they wouldn’t be surprised to see patients rush to snag up the old inhalers, which utilize harmful chlorofluorocarbon as a propellant. The last day for the old inhalers to be sold is Wednesday.

Seems a little late for environmental concerns, don’t you think?

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As a nation of healthcare consumers, as opposed to “patients”, advocates on both sides of the healthcare delivery equation talk about giving choice to the patient as consumer so that the responsibility of maintaining one’s health is as much the patient’s as it is the provider’s. Given the dire short term outlook of the economy, patients may not even be in that position to make a healthcare choice, as their coverage will more than likely be lost with their jobs.  For many, the only “choice” for health maintenance will involve turning to complementary or alternative medications. | LINK

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