December 11th, 2011 by KennyLinMD in Health Tips, Research
Tags: Bowels, Complications, Constipation, End Of Life Care, Ileus, Laxatives, Narcotics, Opioids, Palliative Care
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Family physicians who care for terminally ill patients must manage a wide range of bothersome symptoms, including pain, fatigue, dyspnea, delirium, and constipation. According to a Cochrane for Clinicians article in the December 1st issue of American Family Physician, constipation affects up to half of all patients receiving palliative care and nearly 9 in 10 palliative care patients who use opioid medications for pain. Unfortunately, a Cochrane systematic review found limited evidence on the effectiveness of laxatives in these patients, as Dr. William Cayley Jr. comments:
“For patients with constipation, especially those with opioid-induced constipation, there is insufficient evidence to recommend one laxative over another. The choice of laxatives should be based on past patient experience, tolerability, and adverse effects. Methylnaltrexone is a newer agent that may be useful especially for patients with opioid-induced constipation that has not responded to standard laxatives, but there is limited evidence of potential adverse effects. Therefore, judicious use preceded by a discussion with patients about known risks and benefits is warranted.”
The Cochrane Library recently discussed this review in its Journal Club feature, which includes open access to the full text of the review, a podcast by the authors, discussion points, and a Powerpoint slide presentation of the review’s main findings.
Additional resources for physicians and patients on advanced directives, hospice care, and ethical issues are available in the AFP By Topic collection on End-of-Life Care.
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The above post was first published on the AFP Community Blog.
*This blog post was originally published at Common Sense Family Doctor*
December 11th, 2011 by admin in Health Tips, Quackery Exposed
Tags: Alternative Medicine, Arthritis, Diet, Evidence Based Medicine, Mercola, Pomegranate, Rheumatoid Arthritis, Rheumatology, Snake Oil
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There’s an old saying in medicine: “Use the new medicine while it still works.” This is more than just a cute quip. The saying encompasses a few different phenomena. When a drug is tested on a few thousand people, the luck of the draw may show a greater effect than would be seen in a larger, more diverse population. Also, less common side effects will become more evident in a larger sample. Once several million people take the drug, it may turn out that the drug isn’t as spectacular in a large, diverse population, and that certain side effects, though rare, are serious.
This is one of the reasons I’m a very conservative and skeptical physician. Today’s miracle drug may be tomorrow’s Vioxx. Less conservative doctors may make much more enthusiastic recommendations. I found one physician promoting pomegranate juice for rheumatoid arthritis (or at least linking to the article on Joe Mercola’s site without comment). It sounds harmless enough, but what’s the evidence? (You can hunt for the page yourself; I’m not linking to Mercola.)
The statement is based on a pilot study out of Israel consisting of data from six patients. The measures used seem quirky, but are irrelevant anyway. There are no conclusions that can be drawn from such a small sample. Despite this, the authors conclude (and Mercola and the doctor who posted the link presumably endorse) that, “Dietary supplementation with pomegranates may be a useful complementary strategy to attenuate clinical symptoms in RA patients.”
Really? Based on what? Read more »
*This blog post was originally published at ACP Internist*
December 9th, 2011 by HarvardHealth in Health Tips, Research
Tags: Cardiology, Cardiovascular Health, Diet, Exercise, Fitness, Heart Disease, Men's Health, Obesity, Overweight
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These days, most adults are overweight, not active, or both. If you could change just one—become active or lose weight—which would be better?
At least for men, being more fit may have a bigger health payoff than losing weight, according to a new study of more than 14,000 well-off middle-aged men who are participating in the Aerobics Center Longitudinal Study. Researchers followed their health, weight, and exercise habits for 11 years. They estimated how physically fit the men were by calculating their metabolic equivalents (METs) from a treadmill test.
Compared with men whose fitness declined over the course of the study, those who maintained their fitness levels reduced their odds of dying from cardiovascular disease or any other cause by about 30%, even if they didn’t lose any excess weight. Those who improved their fitness levels saw a 40% reduction.
Body-mass index (BMI), a measurement that takes weight and height into account, was not associated with mortality. The results were published in the journal Circulation.
What is “fitness”
Fitness is a measure of Read more »
*This blog post was originally published at Harvard Health Blog*
December 3rd, 2011 by Paul Auerbach, M.D. in Health Tips, Research
Tags: Adrenaline, Allergic Reactions, Drug Absorption, Emergency Medical Services, EMS, Epipen, IM, Injection Site, Intramuscular injection, Prehospital Emergency Care, Subcutaneous injection
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For management of a serious (even life-threatening) allergic reaction, I have been teaching adults to administer epinephrine (adrenaline) by injection for years. This can be a lifesaving intervention. The Emergency Medical Services (EMS) community now concurs that EMS personnel should be trained to recognize a serious allergic reaction and be allowed to administer epinephrine. In a recent issue of the journal Prehospital Emergency Care (2011;15:570-576), there is an article by Jacobsen and Millin entitled “The Use of Epinephrine for Out-of-Hospital Treatment of Anaphylaxis: Resource Document for the National Association of EMS Physicians Position Statement” that details the use of epinephrine for this purpose.
The major new thrust of this document is to highlight the fact that the intramuscular (IM, directly into the muscle) injection route of administration is preferred, rather than the traditional primary recommendation to inject into the tissue space just under the skin layers (“subcutaneous”). This is because injection into the muscle tissue results in smoother and more reliable drug absorption, with higher peak therapeutic levels of the drug achieved sooner than with subcutaneous injection. The lateral thigh is often used for the IM injection; the outer upper arm is most commonly used for the subcutaneous injection. In an “autoinjector pen” used to administer epinephrine (often referred to by the brand name “EpiPen”), the needle may not be long enough to reach the muscle tissue of a large and/or obese person. However, if the epinephrine is injected into the subcutaneous tissue, it will in all likelihood still be effective, albeit perhaps not as quickly following the injection.
Here is advice about how to give epinephrine for a severe allergic reaction: Read more »
This post, Article Details The Best Uses Of Epinephrine For Severe Allergic Reactions, was originally published on
Healthine.com by Paul Auerbach, M.D..
December 3rd, 2011 by Linda Burke-Galloway, M.D. in Health Tips, News
Tags: Airport birth, Babies, Bathroom, BWI, Dr. Linda Burke-Galloway, Healthy Pregnancy, OB/GYN, Obstetrics And Gynecology, Pregnancy, Premature Birth, Undiagnosed, Unexpected birth, Unnoticed, Urine analysis
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On a recent Sunday in the bathroom of the Baltimore-Washington International Thurgood Marshall Airport, a baby boy made his entrance to life. His mother was approximately 28 weeks and delivered prematurely, however both baby and mother were healthy according to the media. Although the details of the delivery are sketchy, anyone involved in obstetrics can predict what occurred.
The mother might have had a previous history of a urinary tract infection, or complained of back pain. Did her ultrasound reveal a short cervix? Or perhaps she had a history of a previous early delivery. If it was her first pregnancy, did she complain of mild abdominal pressure? Premature labor is one of the most common reasons for birth defects and has a price tag of approximately 26 billion dollars per year. The signs and symptoms of preterm labor Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
