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Archive for May, 2010

Medical compliance from a patient perspective

Monday, May 31st, 2010

Medical compliance from a patient perspective

by Dave deBronkart

The new definition of participatory medicine at the Society’s website notes that patients “shift from being mere passengers to responsible drivers of their health, and … providers encourage and value them as full partners.” As with any collaboration, this must include a hefty dose of listening by both parties.

I recently returned from an extraordinary week in Minnesota, with visits to several thought-provoking care facilities. The week was all about improvement: I spoke at the Institute for Clinical Systems Improvement and IHI Colloquium, I visited the brand new Frauenshuh Cancer Center where a friend works (wow), and toured the Mayo Clinic. I returned with a headful of what’s possible.

Then I found a post on Paul Levy’s blog at my hospital, “Patients will teach us how to be compassionate.” He relates a problem of a chemo patient, a “difficult stick” for the needle people, who asked for the special IV team, who can handle difficult cases. She was told no, and got hurt. Paul asked the team to come up with a better approach. The team will now flag such patients in the system, and he asked them to convene some patients for a further discussion.

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No comment | Tags: , | Category: Patient care

Proton pump inhibitors associated with fracture and C. difficile

Monday, May 31st, 2010

Proton pump inhibitors associated with fracture and C. difficile

by Charles Bankhead

Proton pump inhibitors (PPIs) significantly increased the risk of both fracture and recurrent infection with Clostridium difficile, investigators in separate studies reported.

PPI use increased the odds of spine, forearm/wrist, and total fractures by 25% to 50% over three years, but had no effect on the risk of hip fracture. Overall, the acid-fighters had a modest effect on bone mineral density (BMD), Seattle researchers reported in the May 10 Archives of Internal Medicine.

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2 comments | Tags: | Category: Drugs and pharma

How the oil shortage will affect hospitals and healthcare

Monday, May 31st, 2010

How the oil shortage will affect hospitals and healthcare

by Marya Zilberberg, MD, MPH

I believe in the peak oil theory.

Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to whether: yes, it will happen. And while a lot of people have conjectured about what the world will look like post-peak oil, there is a surprising paucity of hypotheses or suggestions about healthcare. So, I will try to use my imagination to start to fill this gap.

First, a few facts.

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7 comments | Tags: , | Category: Hospital

Bruce Beresford-Redman Arrest: Mexico Judge OKs Survivor Producer’s Arrest In Wife’s Death

Monday, May 31st, 2010

Prosecutors will seek “international collaboration” in the return of Beresford-Redman once they have officially confirmed his whereabouts, Alor said.

Beresford-Redman has denied any involvement in the death last month of his wife, Monica Beresford-Redman.

Police detained the husband briefly and then released him after confiscating his passport and telling him not to leave Mexico. But Beresford-Redman returned to Southern California and stated in court documents there that he had been living with his two children for more than a week.

His attorney, Richard Hirsch, said in a statement before the warrant was confirmed that issuing an arrest warrant was a rush to judgment.

“We have been advised that Mexican authorities have issued a warrant for the arrest of Bruce Beresford-Redman,” he said. That “is extremely disturbing since it appears that this case is being handled in a manner outside the normal procedures in Mexico.”

Hirsch said his client is innocent and prepared to defend himself in court.

He also issued the first public statement from Beresford-Redman:

“Monica was the axis around which our whole family revolved. From her sisters and parents to my parents and of course to our children and me, she was everything to us,” it said. “I am devastated at her loss; and I am incensed at the suggestion that I could have had anything to do with her death. I am innocent. My children have had one parent taken from them by a senseless act of violence. I implore the Mexican authorities not to take their remaining parent by a miscarriage of justice and to do what is right not just what is expedient.”

Monica Beresford-Redman’s body was found April 8 in a sewer at the Moon Palace Hotel resort in Cancun. Investigators have said her body showed signs of asphyxiation and evidence of a heavy blow to the right temple.

They said Beresford-Redman told them he last saw her after she left the resort to go shopping and never returned. Prosecutors say he reported her missing two days before her body was found.

___

Special Correspondent Linda Deutsch in Los Angeles contributed to this story.


Lauren Selman: ‘Larson’ Narrates Life

Monday, May 31st, 2010

“What have you accomplished” whispers the little voice in my head. Constant questions about my life and my purpose run through my head and I wonder, dear reader, if you have ever had the feeling that you weren’t in control of your life? Or that the voices in your head were unusually loud? Perhaps, there was a narrator to your life?

If you answered yes, to any of the questions above or the little voice in your head said “What questions?”, then you must go see Carlo De Rosa’s latest film Larsen (Feedback). This delightful short was the winner of the Grand Jury Award for Best Short Film at both the Beverly Hills Film Festival and the Efebo Corto Film Festival in Italy, and has been warmly received all across the world. From Spain to India, from Africa to Norway, audiences have turned down the voices in their heads and have turned up the laughter for the sweet comedy, Larsen.

The film opens in the playful spirit similar to the French hit Amelie which won the heart of the world in 2001 as we followed a young Amelie’s journey to find love and adventure. In Larsen, Zora has just turned 30 and she is looking for her future. She is caught in the midst of relationships, moving and her own decisions and around every corner there is always that voice that is second guessing her. Caught between bad lovers and life’s choices, she struggles with the voice in her head. Immediately, we wonder who really controls her future? We want to believe that it is her, but the voices in her head show us otherwise. Can she go off life’s script and truly accomplish something she can be proud of? Find out in this very clever and charming short, Larsen, where the acting is superb, the writing witty and the message applicable to us all.

For more upcoming screenings worldwide, as well as a special “Women In Film” event in June in Hollywood where you will be able to personally meet the filmmaker, go to www.cometoourscreening.com

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Paul Raushenbush: What Kind of Life Do You Want to Live?

Monday, May 31st, 2010

This was the subject line that I sent to a group of 25 graduating seniors at Princeton University, where I serve as the associate dean of religious life and the chapel. As expected, Princeton students range from the smart to the very, very smart, and during their time at Princeton they become even more capable in whatever academic focus they may have. In many wonderful ways, Princeton is doing its job in training young men and women to be leaders in their fields and fulfilling the university’s unofficial motto: In the Nation’s Service and in the Service of all Nations.

But in addition to imparting knowledge and training, my hope is that those of us in education might also help young people to cultivate the wisdom required to determine what kind of life will be meaningful and good, for themselves and for others, and leave university equipped to make decisions that will lead to that life.

Why is this so important? Because wisdom about living life will ultimately be as least as important to the students as the knowledge they have gained in the classroom. And the ability to make well-considered decisions about how to live life will serve them longer. I know this because at the same time that I was asking these young people to reflect on this question, I was also talking to two middle-aged people close to me who are struggling as they consider what they are doing with their lives. These two individuals are by most accounts “successful,” and yet they admit that they feel inadequate and ill-equipped to answer the question of what kind of life they want to live.

The group of students who assembled was wide-ranging in background and interests. They represented majors from Classics to Chemistry, Religion to Philosophy, and Public Policy to Comparative Literature. The individuals had been leaders in a range of religious communities as well as in the newspaper and eating clubs, and they represented some of the most successful academic careers at Princeton. Although they had been in the same year, some of them were meeting one another for the first time. We started by going around the room with each student reading a passage from a book that they had read, either inside or outside the classroom, that had helped them with the question of what kind of life they want to live. (You can see some of the quotes from the books below.)

Not surprisingly for young people about to graduate, the conversation first veered towards choices around careers. At this stage of life, and perhaps for the first time, young people become aware that making a decision to do one thing also involves making a decision not to do another. For instance, if one chooses to go to graduate school in public policy, it means that one may have to forfeit her desire to be a psychologist. The stakes can seem dauntingly high. And yet, as one of my aunts once taught me, you can have it all, just not all at once.

I often have had students say to me, “Well, this is the last time I will be able to take a month to travel,” or “I may never be able to study painting again,” and my response is always, “Says who?” While making a decision of where to go to graduate school or what job to take is important, it is also just part of long chain of choices we make in life. The practice of discernment will hopefully continue as we grow and learn more about who we are. Change is constant, as a Buddhist reading from one of the students informed us. Living life well requires occasional reassessment of our interests and skills, and taking risks as we embark on new directions that our life may take.

Because it is constantly being drilled into students at places like Princeton that they are being groomed for leadership, our students often look first at success in their work as being the most important element of designing the life they want to lead. And it is important. As one student remarked, being paid to work doing that which we are truly interested in is a great luxury. Yet even interesting and “successful” careers may not provide the kind of life they want to live.

An example of this was found in the biography of Henry Kissinger, which one student brought to the discussion. While controversial, Kissinger is undoubtedly counted as successful. However, the student brought in the biography as a negative example because of how the book revealed Kissinger’s deeply petty and vindictive nature. While it might be attractive to be Secretary of State and a winner of the Nobel Peace Prize, Kissinger failed at living a life that these students would choose to emulate.

For one Muslim woman in the group the entire conversation about careers was only tangentially related to the kind of life she wanted to live. Coming out of her religious tradition of fasting, she expressed the view that living life well is as much about restraint as it is about action. In other words, just because we can doesn’t mean we should. She warned against the constant focus on striving and how tempting concepts such as “success’ and “happiness” only offer ever-receding horizons. She and others emphasized that family, friends, everyday small actions, and self-awareness are much more important than career. She wants to live a life where the question is not what we do but rather who we are.

Jeff Bezos, the founder and CEO of Amazon.com, was Princeton’s Baccalaureate speaker this year. Bezos relayed the story of being a clever little boy, sitting in the back seat of a car driven by his grandparents, and figuring out how many years his grandmother was going to take off her life through smoking. When the young Bezos proudly announced the figure to his grandmother, she burst into tears. On that day, his grandfather explained to him that there was a difference between cleverness and kindness. Cleverness is something that people like Bezos, who was an undergrad at Princeton, are simply born with; it is a gift. Kindness, on the other hand, is a choice. We have the choice to be compassionate, kind, and thoughtful. While we hope that students will use their gifts to the fullest, even more we hope that they will exercise choices that will guide their lives in the direction of kindness.

But what of tragedy? While much of the conversation with these students focused on the decisions that were theirs to make, others wanted to talk about that which we could not control. Death, suffering, and human frailty must be reckoned with when reflecting on the life we wish to live. One student brought to the discussion a passage from James Baldwin’s The Fire Next Time: “Perhaps the whole root of our trouble, the human trouble, is that we will sacrifice all the beauty of our lives, will imprison ourselves in totems, taboos, crosses, blood sacrifices, steeples, mosques, races, armies, flags, nations, in order to deny the fact of death, which is the only fact we have.”

Several of the students in our discussion had experienced the trauma of the death of a loved one during their time at college, and others had suffered through a variety of difficult times of personal and academic hardship. Part of life is learning that you do not have control over tragedy such as the death and other kinds of losses, and that in relinquishing control and acknowledging our frailties, we are paradoxically made more aware of our power. I know several Princeton students who, like so many college students and 10 percent of our nation, are without jobs or prospects of further study. Living the life we want to live means that in those moments of apparent failure, loss, and setback, we see in even more detail the beauty and possibility of those things that are within our means to influence and enhance. It means that we never feel totally unable to better our situation or our world. As Baldwin goes on to write, “It seems to me that we ought to rejoice in the fact of death — ought to decide, indeed, to earn one’s death by confronting with passion the conundrum of life. One is responsible for life: It is the small beacon in that terrifying darkness from which we come and to which we shall return.”

The conversation on what kind of life these graduating Princeton students want to live was wide-ranging and it ended without anyone developing a resolution or a plan. But my prayer is that our time together may have encouraged these marvelous young people to remain aware of the task. When the hour-and-a-half were finished, I admitted that I did not think we had arrived at any firm closure, to which one student replied that the day when we close the book on these questions is the day that we die — “The unexamined life is not worth living,” as Socrates said. Long may this great Princeton class of 2010 live.

***

Here are a few of the passages selected by the Princeton seniors as instructive in living the life they want to live.

From The Fire Next Time by James Baldwin:

Behind what we think of as the Russian menace lies what we do not wish to face, and what white Americans do not face when they regard a Negro: reality — the fact that life is tragic. Life is tragic simply because the earth turns and the sun inexorably rises and sets, and one day, for each of us, the sun will go down for the last, last time. Perhaps the whole root of our trouble, the human trouble, is that we will sacrifice all the beauty of our lives, will imprison ourselves in totems, taboos, crosses, blood sacrifices, steeples, mosques, races, armies, flags, nations, in order to deny the fact of death, which is the only fact we have. It seems to me that we ought to rejoice in the fact of death — ought to decide, indeed, to earn one’s death by confronting with passion the conundrum of life. One is responsible for life: It is the small beacon in that terrifying darkness from which we come and to which we shall return. One must negotiate this passage as nobly as possible, for the sake of those who are coming after us…It is the responsibility of free men to trust and to celebrate what is constant — birth, struggle, and death are constant, and so is love, though we may not always think so — and to apprehend the nature of change, to be able and willing to change. I speak of change not on the surface but in the depths — change in the sense of renewal. But renewal becomes impossible if one supposes things to be constant that are not — safety, for example, or money, or power. One clings then to chimeras, by which one can only be betrayed, and the entire hope — the entire possibility — of freedom disappears.

From Pride and Prejudice by Jane Austin:

She grew absolutely ashamed of herself. — Of neither Darcy nor Wickham could she think, without feeling that she had been blind, partial, prejudiced, absurd.

“How despicably have I acted!” she cried. — “I, who have prided myself on my discernment! — I, who have valued myself on my abilities! who have often disdained the generous candour of my sister, and gratified my vanity, in useless or blameable distrust. — How humiliating is this discovery! — Yet, how just a humiliation! — Had I been in love, I could not have been more wretchedly blind. But vanity, not love, has been my folly. — Pleased with the preference of one, and offended by the neglect of the other, on the very beginning of our acquaintance, I have courted prepossession and ignorance, and driven reason away, where either were concerned. Till this moment, I never knew myself.”

From “This Is Water” by David Foster Wallace:

But of course there are all different kinds of freedom, and the kind that is most precious you will not hear much talked about in the great outside world of winning and achieving and displaying. The really important kind of freedom involves attention, and awareness, and discipline, and effort, and being able truly to care about other people and to sacrifice for them, over and over, in myriad petty little unsexy ways, everyday. This is real freedom.

From Marcus Aurelius’ Meditations:

The Pythagoreans say this: at dawn, behold the starry heavens, so that we may continue to remind ourselves of those beings that are always in accord with each other and always performing their function; and also that we may remember their order, purity, and nakedness, for a star needs no veil.

“Ode to My Socks” by Pablo Neruda:

Mara Mori brought me

a pair of socks

which she knitted herself

with her sheepherder’s hands,

two socks as soft as rabbits.

I slipped my feet into them

as if they were two cases

knitted with threads of twilight and goatskin,

Violent socks,

my feet were two fish made of wool,

two long sharks

sea blue, shot through

by one golden thread,

two immense blackbirds,

two cannons,

my feet were honored in this way

by these heavenly socks.

They were so handsome for the first time

my feet seemed to me unacceptable

like two decrepit firemen,

firemen unworthy of that woven fire,

of those glowing socks.

Nevertheless, I resisted the sharp temptation

to save them somewhere as schoolboys

keep fireflies,

as learned men collect

sacred texts,

I resisted the mad impulse to put them

in a golden cage and each day give them

birdseed and pieces of pink melon.

Like explorers in the jungle

who hand over the very rare green deer

to the spit and eat it with remorse,

I stretched out my feet and pulled on

the magnificent socks and then my shoes.

The moral of my ode is this:

beauty is twice beauty

and what is good is doubly good

when it is a matter of two socks

made of wool in winter.

From Buddhism Plain and Simple by Steve Hagan:

Everything in our experience — our bodies, our minds, our thoughts, our wants and needs, our relationships — is fleeting. Changing. Subject to death. We die in each moment and again, in each moment, we are born. The process of birth and death goes on endlessly, moment after moment, right before our eyes. Everything we look at, including ourselves and every aspect of our lives, is nothing but change. Vitality consists of this very birth and death. This impermanence, this constant arising and fading away, are the very things that make our lives vibrant, wonderful, and alive. Yet we usually want to keep things from changing. We want to preserve things, to hold onto them. This desire to hold on, to somehow stop change in its tracks, is the greatest source of woe and horror and trouble in our lives.


UN Security Council Members Demand Israel End Blockade

Monday, May 31st, 2010

UNITED NATIONS (AP) — The U.N. Security Council held an emergency meeting Monday on Israel’s deadly commando raid on ships taking humanitarian aid to the blockaded Gaza Strip, with the Palestinians and Arab nations demanding condemnation and an independent investigation.

The Palestinians and Arabs, backed by a number of council members including Turkey, also called for Israel to lift the blockade on Gaza, immediately release the ships and humanitarian activists, and allow them to deliver their goods.

Assistant Secretary-General Oscar Fernandez-Taranco said in his briefing to the U.N.’s most powerful body that the early morning bloodshed on Monday would have been avoided “if repeated calls on Israel to end the counterproductive and unacceptable blockade of Gaza had been heeded,”

Turkey’s Foreign Minister Ahmet Davutoglu, whose country had been a longtime Muslim ally of Israel, called the raid “banditry and piracy” on the high seas and “murder conducted by a state.” He urged the council to adopt a presidential statement circulated by Turkey. Many of the activists aboard the ships were apparently Turks.

The original draft text, obtained by the Associated Press, would have the council condemn the attack by Israeli forces “in the strongest terms” as a violation of international law, express deep regret at the loss of life and call for Secretary-General Ban Ki-moon to undertake “an independent international investigation … to determine how this bloodshed took place and to ensure that those responsible be held accountable” and consider the issue of compensation.

The draft also calls on Israel to lift the blockade of Gaza and immediately release the ships and civilians it is holding.

Ban condemned the violence.

“I am shocked by reports of killings,” he said in a statement. “It is vital that there is a full investigation to determine exactly how this bloodshed took place.”

After statements from the 15 council members as well as Israel and the Palestinians, the council moved into closed consultations to consider possible action. The consultations then broke into a smaller group including the U.S., Turkey and Lebanon, which holds the council presidency.

Council members decided to take a brief dinner break nearly seven hours after their meeting began and then resume discussions on the latest draft which calls for “a prompt, independent, credible and transparent investigation conforming to international standards.”

Riyad Mansour, the Palestinian U.N. observer, said he expected further changes to the text. Several diplomats noted that the United States, Israel’s closest ally, was waiting for instructions from Washington.

Mansour called the attack on unarmed civilians on board foreign ships in international waters a “war crime,” and he declared that “those fleets, one after the other, will be coming until the unethical blockade is put to an end and the suffering stops for our people.”

France’s U.N. Ambassador Gerard Araud also called for an “independent, credible” investigation that meets international standards, and the lifting of the Gaza blockade.

But U.S. deputy ambassador Alejandro Wolff, made no mention of an international probe, saying: “We expect a credible and transparent investigation and strongly urge the Israeli government to investigate the incident fully.”

While the Palestinians and Turks insisted that those on the ships were humanitarian and human rights activists, Israel’s deputy U.N. ambassador Daniel Carmon said “this flotilla was anything but a humanitarian mission.”

Some activists have “terrorist history” and its organizers support radical Islamic networks such as Hamas, which controls Gaza and refuses to recognize Israel’s existence, he said.

Carmon defended the legality of Israel’s blockade and the boarding of the ships – which refused repeated calls to send their cargo through Israel – as “a preventive measure” to counter the illegal attempt to break the blockade.

He called the results “tragic and unfortunate.”

Wolff said the United States “is deeply disturbed by the recent violence and regrets the tragic loss of life,” considers the situation in Gaza “untenable” and will continue to urge Israel to expand the scope and type of goods allowed into the territory to meet humanitarian needs.

More on United Nations


Shelly Palmer: New Apple TV Coming Soon

Monday, May 31st, 2010

June 1, 2010 – Today’s most interesting stories in technology, media and entertainment:

New Apple TV: Apple is getting ready to launch a new, cheaper version of AppleTV. It’s completely redesigned, in fact, some sources are calling it an iPhone without a screen. They say the new AppleTV is going to be super small with a super small price, like 99 bucks. You didn’t think Apple was going to let GoogleTV go unchallenged, did you?

Facebook Users Beware: a new clickjacking scam is spreading through the social network. The attack is based on the new ‘likes’ section and creates fake pages that lead to malicious sites. Since these fake ‘likes’ often show up in the news feed, it’s best to simply delete any suspicious ‘likes’ before they accidentally spread through your network.

New Kindle Coming: Amazon will unveil a new Kindle this summer. According to reports, the new device, codenamed Shasta, will be slimmer, offer faster page turns and may be WiFi compatible. There’s no word on color or touchscreen capability. 

Today’s Video — Shelly Palmer Interviews Seth Haberman, Founder & CEO, VisibleWorld

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