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Hospitals May Not Be The Best Places To Treat Dementia Patients

Sending dementia patients to the hospital could overwhelm the health care system and not offer them any better care at the end of life, researchers noted.

The researchers obtained data on all hospitalizations involving a dementia diagnosis for the 85 years and older group between years 2000 and 2008 from the nationally representative Nationwide Inpatient Sample database, a part of the Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project.

Annual hospitalization data came from the U.S. Census Bureau. They projected the future volume of hospitalizations involving a dementia diagnosis in the 85 years and older group two ways, Read more »

*This blog post was originally published at ACP Internist*

Patient History Found To Be Key Element In Making A Diagnosis

Four out of five doctors agree that they don’t need scans to make the right diagnosis.

It’s an old-fashioned concept frequently discussed among ACP members, but the history and physical combined with basic tests is way more important to diagnosis than ordering scans and advanced tests. A recent research letter in the Archives of Internal Medicine makes the case.

In the letter, Israeli researchers described a prospective study of 442 consecutive patients admitted from the emergency department in 53 days.

A senior resident examined all patients within 24 hours of admission (mean=14), including a history, physical, and review of ancillary test findings done at the emergency department, such as blood and urine tests, electrocardiography, and chest radiography. The resident also reviewed additional tests such as Read more »

*This blog post was originally published at ACP Hospitalist*

Do-It-Yourself Health Care: A New Form Of Outsourcing?

Jessie GrumanThe outsourcing of work by businesses to the cheapest available workers has received a lot of attention in recent years.  It has largely escaped notice, however, that the new labor force isn’t necessarily located in Southeast Asia, but is often found here at home and is virtually free.  It is us, using our laptops and smart phones to perform more and more functions once carried out by knowledgeable salespeople and service reps.

This was particularly salient to me this week: I spent an hour online browsing, comparing prices, reading customer reviews and filling out the required billing and shipping information to get a great deal on a new lamp.  An airline would charge me 99 cents to talk to a person but provides information for free online.  Calls to Amtrak to make train reservations are routinely answered with a message that the wait to talk to an agent is 30 minutes, but that I can book travel myself – plus get better deals – if I do it online.  My bank has a small staff, limited hours and it charges extra for paper checks and mailed hard copy statements… but its Website is welcoming and useful, even at 3 a.m. Read more »

*This blog post was originally published at CFAH PPF Blog*

Some Physicians Fear Airport Scanner Radiation, Despite Evidence

In preparation of Internal Medicine 2011 in San Diego this week, the unavoidable choice to make isn’t which sessions to attend, but even before arriving: Will you pass through the airport’s security scanners, or opt for the pat down?

Physicians themselves are split on the issue, with some physicians opting out of repeat scanning in favor of the pat down search.

“I do whatever I can to avoid the scanner,” one physician told CNN. Other physicians interviewed were split on the issue one way or another. But as a frequent flier, this doctor was concerned about the cumulative effect. “This is a total body scan–not a dental or chest X-ray. Total body radiation is not something I find very comforting based on my medical knowledge.” Read more »

*This blog post was originally published at ACP Internist*

Stress In Life: Respond Differently And Live Longer?

“This job is killing me” is not a statement of jest. It is a desperate plea of outright sincerity.

Stress, anxiety, depression — all have been associated with an increased risk of cardiovascular disease and mortality. But can interventions to help people cope with stress positively affect longevity and decrease risk of dying? The results of a new study in the Archives of Internal Medicine would imply the answer is an encouraging “yes.”

Constructively dealing with stress is easier said than done, but it would seem logical that if we can reduce our psychological and social stressors we might live longer and delay the inevitable wear and tear on our vessels. This study proved that one such intervention, cognitive behavioral therapy (CBT) for patients who suffered a first heart attack, lowered the risk of fatal and nonfatal recurrent cardiovascular disease events by 41 percent over eight years. Nonfatal heart attacks were almost cut in half. Excitement may be dampened by the fact that all-cause mortality did not statistically differ between the intervention and control groups, but did trend towards an improvement in the eight years of follow up.

Definitely less suffering. Maybe less deaths.

The authors state that psychosocial stressors have been shown to account for an astounding 30 percent of the attributable risk of having a heart attack. Chronic stressors include low socioeconomic status, low social support, marital problems, and work distress. Emotional factors also correlated with cardiovascular disease include major depression, hostility, anger, and anxiety. Read more »

*This blog post was originally published at The Examining Room of Dr. Charles*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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