December 11th, 2011 by KennyLinMD in Health Tips, Research
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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
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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 10th, 2011 by PeterWehrwein in Research
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It’s more than just a few flecks. President Barack Obama, who turned 50 in August, is definitely going gray. He’s said the color change runs in his family and has mentioned a grandfather who turned gray at 29.
But others see it as a sign that the presidency is taking a toll on Obama, as it has other on presidents. Dr. Michael Roizen, of RealAge.com fame, says presidents age twice as fast as normal when they’re in office. The main cause, he says, is “unrequited stress—they don’t have enough friends to mitigate the stress,” which brings to mind the line commonly attributed to Harry Truman: if you want a friend in Washington, get a dog.
Accelerated presidential aging? Not so.
The only problem with this notion of accelerated presidential aging is that it just ain’t so, according to S. Jay Olshansky, a professor at theUniversity ofIllinois at Chicago and a longevity expert. Read more »
*This blog post was originally published at Harvard Health Blog*
December 10th, 2011 by ChristopherChangMD in Medblogger Shout Outs, Research
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An interesting blog article from the folks at Compete came to my attention recently. Compete for those who don’t know is a fantastic analytics site to see how ANY website is doing in terms of popularity (number of visitors in a given time period). The basic data is free. For more in depth information, there’s a charge.
For example, for our practice’s website, here is the Compete data I pulled which is pretty accurate based on my own analytics information:
My nearest local competitor in terms of website popularity is the hospital, Fauquier Health System: Read more »
*This blog post was originally published at Fauquier ENT Blog*
December 10th, 2011 by Berci in Research, Video
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It would be fantastic to use 3D printers to produce bone replacements:
Now, Washington State University engineers are unveiling a unique implementation of the tech that could aid in the regrowth of damaged or diseased bones. Utilizing a ceramic compound, the group’s optimized ProMetal 3D printer builds dissolvable scaffolds coated with a plastic binding agent that serve as a blueprint for tissue growth. The team’s already logged four long years fine tuning the process, having already achieved positive results testing on rats and rabbits, but it appears there’s still a ways to go — about 10 -12 years, according to the project’s co-author Susmita Bose — before orthopedic and dental surgeons can begin offering “printed” bone replacements.
*This blog post was originally published at ScienceRoll*
