You can reduce depression in palliative care mourners?

It can be a challenge to ensure good quality of life than the life of a person comes to an end. The knowledge that death is imminent, and the realization that it is inevitable-understandable brings intense anxiety and fear for the person who is ill and people who love it.

Palliative care improves the quality of life in extreme circumstances of the last days of a person. You can enable the dying to spend this time in peace, surrounded by family and friends, and little pain. But the role of palliative care goes beyond palliative care. For example, these programs can:

*    Provide necessary medicines, medical supplies and equipment.
*    Teach family members how to care for the person who is ill.
*    Support the dying person as he deals with emotional and spiritual aspects of death.
*    Provide support and advice to friends to relieve pain associated with the loss (mourning) and family.

 Research confirms what many people intuitively know. Family members are likely to suffer from major depression after the loss of a loved one. This is especially true when death occurs in a hospital in the middle of an aggressive medical treatment.

A recent study published in Archives of Internal Medicine online today examined whether palliative care reduces the severity of bereavement-related depression in people who have recently lost a spouse. Although researchers do not see any difference between spouses whose partners were enrolled in hospice and how these are not major depression was less common among spouses who received support from a hospice program.

What this study does suggest is that palliative care should not end when the patient dies. In fact, Medicare requires organizations to provide palliative care services for families mourning until one year after death. However, there is little respect for this obligation. If you have a loved one in a hospital, make sure the agency offers the services they should.

The only palliative care, even with a large loss of loved ones, do not prevent or cure major depression. Even when activated by a painful loss, depression should be treated (usually with a combination of psychotherapy and medication). An additional feature to the hospice after death is to ensure that the spouse or another family member to get the mental health services they need.

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Report proposes new "vital signs" to measure the health of the nation

Doctors use vital signs as a relatively simple way to detect a disease or monitor the health of a person. The keys include blood pressure, body temperature, respiratory rate and heart rate.  

A report from the newly appointed National Academy of Medicine (formerly the Institute of Medicine) proposes to use 15 "vital signs" to track how health care in the United States at the height:

  *     Life spans
  *     well be
  *     Overweight and obesity
  *     addictive behaviors
  *     unwanted pregnancies
  *     healthy communities
  *     prevention services
  *     access to care
  *     Patient Safety
  *     care based on evidence
  *     care that matches the patient's goals
  *     Load personal expenses
  *     weight of the expenditure of the population
  *     individual commitment
  *     community involvement.

Why to create such a list? the costs of health care in the US They are the highest in the world, but people in many countries that spend less on health services are healthier overall and have better health outcomes. To improve the performance of health care, we need to measure how you are doing in a logical and sustainable manner. But this does not happen today.

Many organizations try to measure quality, but the use of a large number of measures. For example, the quality of the National Forum, a nonpartisan organization dedicated to improving health care, more than 600 of these types of measures in their toolbox. And the Centers for Medicare and Medicaid Services has more than 1,700. The new report from the National Academy of Medicine, called Vital Signs, estimated individual health systems employ an average of 50 to 100 people full time to measure performance, with costs ranging from $ 3.5 million to $ 12 organization per year. Factor in the number of health systems across the country, and that adds to real money.

"If we want to know how effective and efficient health are our spending to improve health and reduce costs, we must measure the most important health outcomes to guide our decisions and assess the impact," said chairman of the board David Blumenthal, president of the Commonwealth Fund in New York, said in a statement.

15 proposed measures vital signs panel are not intended to be used alone. Instead, they represent "the most powerful measures that have the greatest potential to positively influence the health and well-being of Americans," said Blumenthal. They pretend to be a reference basis points together to assess the most important aspects of health care and health.

Some of the 15 vital signs such as life expectancy, welfare, overweight and obesity, and addictive behavior, measure aspects of the health of the individual. Others, such as access to care, patient safety and care based on evidence, the assessment of the health system. Two types are needed to measure the health of the nation and the quality of our health care.

These vital signs will answer questions about what we do well and where we need to improve. The repetition of these measures over time will provide essential information on the history of the health of our nation and the course corrections necessary to improve it. Making these changes should improve our vital signs and diminish the monumental amount of money we spend on health care.

Image:pixabay.com

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New delivery classifications assess typical attention of hospitals

The Internet has made it easier to become an educated consumer. Including health services - - consumer groups and other guests at the push of a button, the opinions of thousands of products and services are displayed. No wonder many people have these comments and notes before visiting a hospital.

Over the past 25 years, US News and World Report has a list of "best hospitals" in the United States. In an article in this week's JAMA Mirador, the main magazine health analysts described how are expanding and changing the way it is qualified to hospitals. 

Common procedures include the conditions

Since 1990, US News has analyzed the information of about 2,000 major hospitals in the US and ranked among the top 50 in each of 16 different specialties. "The program is designed for people with complex medical needs who can not find treatment in their community hospitals, and are looking to go elsewhere," Ben Harder, director of the Health Analysis by US News and World Report, I said it. in fact, the classification "are not designed for use by patients who need hospital care typical," he and co-author Avery Comarow writes in JAMA.

It changes. New American team spent over a year analyzing more than 5 million patient records under more than a dozen of common procedures and medical conditions of more than 4,300 hospitals. Scores for five of them were published online today. They are: 

     *  hip replacement
     *  knee replacement
     *  chronic obstructive pulmonary disease
     *  congestive heart failure
     *  bypass surgery of the coronary artery.

"We want to help people make important decisions about hospitals in your community," he said harder.

The new ratings used alone performance measures, such as patient safety, technology and the survival rate after admission. The data are taken from various sources, such as reports of Medicare, the American Hospital Association, the Centers for Disease Control and Prevention of Diseases, and the Society of Thoracic Surgeons. Unlike other rankings of US News rankings do not include new surveys of doctors. 

Weighing information

If you rely solely on the ranking of hospitals in US News or anyone else when deciding where to go for treatment? "These assessments can help, but are mostly limited to data, and you are not give a complete picture," says Dr. Thomas Lee, a cardiologist and director of the Harvard Heart Letter Harvard foundation. "Rank hospitals height and weight. Patient surveys are emotional intelligence. 

"Dr. Lee is certainly biased, because it is also the medical director of the Press Ganey, a national firm that utilizes extensive investigations, patient satisfaction surveys, especially to help hospitals and other health care providers to improve services. "What people really want peace of mind, and you will not receive as statistics."

It points to many hospitals' websites now post comments on all patients and physicians, including critics of the University of Utah Health Care.

" Just to have that kind of information gives an idea of what the doctors are very similar," said Dr. Lee. "In fact, we realize that doctors with more comments get more referrals.  
As a physician, I can tell you of comments posted on you that makes you better because you know you are being assessed. "

Choose your hospital 

With so much information available, it can be overwhelming to dig through it when it is time to choose a hospital. Dr. Lee believes that the most effective way to start is to talk to your doctor. "I do not think it works well when patients try to start with a blank slate and choose the best place in the country. Ultimately, I think the coordination of care is so important that the recommendation of your doctor about where to go and looking questions. You want someone who will work with your doctor, "he explains.

His advice is to get a recommendation from your doctor first, and then look for reviews and ratings. And US News are not the only group that offers information. Other classifications of the hospital include:

  *   Consumer Reports ratings hospital (subscribers)
  *   HealthGrades Hospital Law
  *   Leapfrog Hospital Safety Score
  *   Truven Health Analytics 100 best hospitals
  *   Centers for Medicare and Medicaid Services Hospital Compare. 

It is also important to pay attention to how a doctor or an institution is responsible for their particular condition. Find answers to these questions can help:

   *   Does the hospital provides the best test for diagnosis and treatment for your health?
   *   Are teaching hospitals conduct research in his state?
   *   What the hospital most of the procedure you need?
   *   How many times a month is the doctor who performs the procedure you need?

 "And remember," says Dr. Lee, "just because the hospital is famous for research and the Nobel Prize does not mean you'll do a great job on the specific problem you have." In other words, it is only by using all available information, you will have a clearer picture of what awaits idea. And that leads you to be an educated consumer to a patient and confident.

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Grip strength can provide clues to heart health

Strong or weak handshake takes more just social signals. You can also help measure the risk of having a heart attack or stroke or of dying from cardiovascular disease than one person.

As part of the urban and rural epidemiological prospective international study (PURE), the researchers measured grip strength on nearly 140 000 adults in 17 countries and followed their health for an average of four years. A device called a dynamometer was used to assess grip strength.

Every drop of 11 pounds in grip strength during the study was associated with an increased risk of dying from any cause, an increased risk of dying from heart disease by 17%, 9% higher risk of 16% stroke, and 7% increased risk of heart attack.

Connections between grip strength and death or cardiovascular disease remained strong even after the researchers adjusted for other things that can contribute to heart disease and death, such as age, smoking, exercise and other factors. The results were published online in The Lancet. Interestingly, grip strength was a better predictor of death or cardiovascular disease blood pressure.

"The grip strength could be an easy and inexpensive way to assess the risk of death and cardiovascular disease testing of an individual," said the lead author, Dr. Darryl Leong Health Research Institute population Hamilton health Sciences and McMaster University in Canada, in a press release. 

Grip strength is a measure of biological age?

PURE study results are not new. Previous research has also linked grip strength with future incapacity, death and cardiovascular diseases in adults. But this is the largest to have made the connection study. The fact that the grip strength was a relevant measure among high-income countries, middle-income and low-income gives credibility to the results.

The age of an individual over time (chronological age) can be very different from their biological age. Although there is no exact definition of biological age, usually indicates that the body performs better or worse than their chronological age.

Many things influence the biological age. Key factors include restoration general fitness, the presence or absence of certain medical conditions, and muscle strength.  

The study suggests that simply measuring handle PURE force itself could be a good way to assess the biological age. In an editorial accompanying the PURE results Aihie Avan Sayer and Thomas Kirkwood of the University of Southampton and the University of Newcastle, UK, suggests that "the clamping force can act as a biomarker of aging through path of life. "

An interesting finding is that the weaker hand grip was not associated with an increased risk of developing type 2 diabetes, cancer and other chronic diseases. So why would it not be linked to an increased risk of dying? The researchers suggest that the weaker muscle strength, it is more likely that a person will die soon if he or she a chronic medical problem develops, relative to those with more muscle. In other words, muscle strength could be good for survival.

Strong muscles need work, nutrients, rest

To build muscular strength, do the two resistance training three times a week. Give your muscles a day or two of rest between workouts.

Most people go to weights and weight machines to strengthen the muscles. Resistance bands work as well. Rubber bands are flat or tubular providing strength to move his arms and legs through various ranges of motion.

You should not limit muscle building workouts. Use everyday activities to challenge your muscles. For example:  

* Lift up a carton of milk a few times before putting it in the fridge for building arm muscles.

 * Take the stairs whenever possible. This will build the leg muscles, hips, buttocks and abdomen.

 * Stay active while talking on the phone or tail do leg lifts and heel raises. This will help strengthen leg and buttock muscles.
 It is also important to get enough sleep. Sleep is essential for muscle recovery and healing of tissues out well. Try seven to eight hours a night. This will give your body time to repair muscle tissue and restore muscle strength.

Finally, the muscles healthy nutrients need to become stronger. You do not need supplements of protein and lots of meat. Beans, nuts and fish can provide lots of healthy proteins. Get your carbs from whole grains and foods that result. And eating five or more servings of fruits and vegetables daily. 

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Draft recommendations on screening mammography always provoke debate

The launch of new guidelines on mammography never fails to renew the controversy about the advantages and possible disadvantages of this procedure.  

The latest draft guidelines Preventive Services Task Force (USPSTF) are no exception. Several expert bodies have taken contradictory positions on them. You can give your opinion, too, if you hurry - Public comments on the draft closes today.

Mammography screening is performed on healthy women to detect the hidden breast cancer. Some expert groups say women should start having regular mammograms at age 40, others set the age of onset at 50. The age at which women should stop having mammograms is also discussed.

The USPSTF is an independent panel of experts in primary care and prevention. It is responsible for making recommendations on the use of preventive services. Its final recommendations on mammography, completed in 2009, said that women between the ages of 50 and 74 should be tested every two years. 

The new draft recommendations are similar to those published in 2009, although there are some differences. Age starting and ending mammography screening are the same. The new project, says there is insufficient evidence to recommend for or against the use of a new technique called 3-D mammography for screening. The task force also says there is not enough evidence to recommend that women with dense breasts who are at greater risk of breast cancer should have an ultrasound or MRI in addition to mammography screening.

The American Cancer Society and other medical organizations recommend that women begin having regular mammograms at age 40. The USPSTF, however, advises women between the ages of 40 and 49 to talk to their doctors to make their own decisions based on the detection of how they evaluate the advantages and disadvantages of possible mammogram.

Many women and their doctors do not think much about the possible harms of screening mammography. A statistical model included in the USPSTF project shows that annual mammograms from 1,000 women 40 years would prevent one death compared to 1,000 women of the same age who did not have mammograms (7 vs 8). But screening in this age group 576 also trigger false positive tests, 58 unnecessary breast biopsies, and two other tumors over-diagnosis (20 against 18) have not affected the health or longevity.

A study recently published in the journal Health Affairs study estimates that the false positive mammograms and over-diagnosis of breast tumors costs the health system $ 4 billion a year. This figure is much higher than previous estimates and should be part of the national conversation on the use of screening mammography.

While annual savings lives, there are many false positive mammography scans and a few more-diagnosed tumors. Individual women may weigh these figures differently and make different moral judgments to decide to start having mammograms at age 40.

For women aged 75 and older, the USPSTF panel keeps saying that there is not enough evidence to recommend for or against routine mammograms. Other experts suggest that mammograms make sense to women is expected in this age group living 10 years or more, on the basis of good health.
You can comment on the USPSTF draft until 20:00 Eastern time today. It is expected that the final recommendations will be published in autumn 2015. 

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There is no "best" treatment for common uterine fibroids

The other night I sat in a restaurant with a group of friends. We share laughter, good conversation and great wine. Looking around, I realized that we were ready to share something else: uterine fibroids. Of the ten women who were sitting at the table, there was a good chance that seven of us have uterine fibroids at some point in our lives. 

Fibroids are non-cancerous tumors that develop in the uterus. They may be smaller than a grain or greater than a grapefruit. A woman can only have one fibroid or she can be many. Depending on their size, number and location, fibroids can cause heavy bleeding and long menstrual periods (which can, in turn, cause anemia), pelvic pain, frequent urination or constipation. Fibroids can also cause infertility and repeated miscarriages. 

There is no "best" treatment

Considering how uterine fibroids are common, you might think that there would be a lot of research comparing treatment options. In fact, there are only a few randomized trials to guide treatment. In an article in clinical practice in the current New England Journal of Medicine, Dr. Elizabeth A. Stewart, professor of obstetrics and gynecology at the Mayo Clinic, set options and factors that women and their doctors should be analyzed consideration when making treatment decisions.

First, are the fibroids cause symptoms? If not - as is often the case - no treatment is necessary.So what are the symptoms? These can be divided into two categories: menstrual bleeding and symptoms "in bulk". Bulk symptoms such as pelvic pain and frequent urination are caused by the presence of large fibroids in the abdomen.

"I think that the severity of symptoms and impact of symptoms on women's quality of life to be the basis for making treatment decisions," said Dr. Aaron Styer, obstetrician-gynecologist affiliated with Harvard Hospital Massachusetts General. "For example, women's unemployment, which require frequent hospitalizations, or missing in normal life, every day? If so, this information will recommend treatment. " 

If a woman wants to have children, your age, and how close you are to menopause, you can also ninfluence the treatment decision. Once a woman enters menopause, fibroids often shrink or even disappear. But until menopause, they can continue to train or to return after retirement. 

Hysterectomy, hold the power of fragmentation

The removal of the uterus (hysterectomy) is a popular choice for women who are done with children. The uterus is gone, new fibroids can not be formed. But traditional hysterectomy, wherein a surgeon makes a large incision in the abdomen, is a major surgery.

In laparoscopic hysterectomy, the surgeon removes the uterus through three or four small incisions in the abdominal wall. Recovery is faster and there are usually fewer complications than traditional hysterectomy.

Laparoscopic hysterectomy has always been accompanied by a procedure called power fragmentation. A device is used to cut the uterus into fragments so that it can be removed through small incisions. But the FDA recently recommended limiting the use of the power of fragmentation due to small chance that a woman has surgery to remove uterine fibroids may have an undiagnosed cancer. If the fragmentation is carried out feeding in these women, there is a risk that the cancer of the spreading procedure throughout the abdomen and pelvis. This is precisely what happened in the highly publicized case of Dr. Amy Reed, an anesthesiologist at Boston Brigham and Women's Hospital.   

Treatment options for heavy bleeding

Women with heavy bleeding that do not want a hysterectomy can convert options for both medical and surgical. Some drugs reduce heavy bleeding by helping blood clot. Hormonal birth control works by thinning the endometrium. This is the rich nutrient lining of the uterus that is shed during a woman's period. Medicines can relieve symptoms but not treat the underlying problem.

One surgical option to treat heavy bleeding is hysteroscopic myomectomy. In this procedure, a thin tube called an endoscope is passed through the cervix and into the uterus. The fibroid is shaved and removed, but the uterus is left intact. If a woman does not want children, you can opt for endometrial ablation. In this procedure, it destroys the endometrium is often hot or cold.  

Treatment options for bulk symptoms

When fibroids cause pelvic pain or frequent urination, the goal of treatment is to reduce the size of fibroids. Drugs called GnRH agonists effectively shrink fibroids. However, fibroids grow back once treatment is stopped, and these drugs are not intended for long term use.

Myomectomy - this time done through a large incision in the abdomen - can reduce the size of fibroids while preserving the ability of a woman to have children. However, fibroids can return after myomectomy. Another option is embolization of the uterine artery. This procedure blocks the blood supply to the fibroids, causing them to shrink and die. Women are much more likely to have a successful pregnancy and delivery after myomectomy after embolization.

A treatment option that is increasingly used for the treatment of uterine fibroids is ultrasound guided surgery MRI. It uses ultrasonic waves to shrink fibroids and reduce heavy menstrual bleeding.  

Which treatment is right for you?

While there are many treatment options for uterine fibroids, there is no clear winner. This means that you and your doctor may choose according to their preferences and plans of reproduction, as well as other processing of medical considerations.When deciding, ask your doctor:

*  What treatment gives me the best chance of having a healthy pregnancy?
*  Which treatment is most likely to provide permanent removal of fibroids?
*  What are my personal risks and benefits of options for medical or surgical treatment?Tell your doctor:

* if you plan to have more children
* if you want to keep your uterus, even if their fertile days are over
* symptoms that are most bothersome and how they affect your quality of life.

It may not be "best" treatment for uterine fibroids. But there is a better treatment for you. 

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