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A Doctor’s Struggle With Numbers
My youngest child has been struggling with numbers.
This all started around the time of his 4th birthday, in mid-November. He knew he was getting older and asked a lot of questions about babies, who were “too little to have a number,” being less than 1 year old. Then, on the day of his birthday, he wanted to know when he was turning 4.
I told him that today was his birthday, that he turned 4 today.
“But when do I turn 4?” He had recently learned to emphasize certain words in an effort to assist his dim parents in getting his questions answered.
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Patients May Say Turn Off ICD at End of Life
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Most patients with implantable cardioverter defibrillators (ICDs) said they would be willing to have the devices turned off in certain situations towards the end of life, a small survey found.
Among 95 patients with ICDs and who were not cognitively impaired, 71% said they would "possibly" or "definitely" deactivate their device in at least one end-of-life scenario, reported Rachel Lampert, MD, of Yale University, and colleagues in an editor's correspondence online in JAMA Internal Medicine.
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Yahoo News
MONDAY, July 9 (HealthDay News) -- Dying patients face their final days better if they are not in the hospital, not on a feeding tube or chemotherapy and feel that they have a trusting relationship with their doctor, a new survey of terminally ill cancer patients reveals.
Other factors that helped them find peace in the end, the survey showed, were prayer, meditation, a pastor's visit and freedom from excessive worry or anxiety.
The survey involved about 400 U.S. patients with advanced cancer who were told they had less than six months to live, and their closest caregiver, usually a spouse. The cancer patients, whose average age was 59, were surveyed an average of four months before they died. Their caregivers were then surveyed about the end-of-life experience.
Several factors determined how the patients and their caregivers rated their quality of life at the end. Among the most important: not dying in the intensive care unit or hospital; not having to endure aggressive, life-prolonging treatments at the end, such as feeding tubes or chemotherapy; and feeling their doctor saw them as a whole person and treated them with respect, said lead study author Holly Prigerson, director of the Center for Psychosocial Epidemiology and Outcomes Research at Dana-Farber Cancer Institute in Boston.
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Living Life In My Own Way—And Dying That Way As Well
A health foundation executive receives a diagnosis of terminal breast cancer and, with the help of a doctor who respects her goals, forgoes aggressive treatment in favor of palliative care.
BY AMY BERMAN
The day I found out that I was terminally ill, it was misty, just barely raining, appropriately gray and damp. It was November 2010; I was fifty-one years old. My life was normal—wonderful, in fact. My mother and I, both in our raincoats, both carrying umbrellas, were walking down a city sidewalk miles from home when my cell phone rang. It was my oncologist calling to give me test results; she knew I’d want them before a medical appointment the next day. She told me gently. I hung up.
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I WAS standing by my 89-year-old mother’s hospital bed when she asked a doctor, “Is there anything you can do here to give me back the life I had last year, when I wasn’t in pain every minute?” The young medical resident, stunned by the directness of the question, blurted out, “Honestly, ma’am, no.”
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Can you imagine "getting over" the death of someone you love deeply in four days? That's the average paid leave given by American businesses according to "Grief Index: The 'Hidden' Annual Costs of Grief in America's Workplace." The truth is there is no "getting over" the death of a loved one in either our business or private life. Rather, it takes time for us to find a new normalcy and to restore our ability to function effectively.
This is the first in a series of posts on the topic of death that will be published over the next several weeks.
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Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient's five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn't spend much on him.
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Frail elderly patients who have advance directives through a program to communicate treatment preferences have fewer unwanted hospitalizations, according to a new study published online in the Journal of the American Geriatrics Society.
The program uses a form known as POLST — Physician Orders for Life-Sustaining Treatment — which allows patients to document their preferences about certain treatments. Signed by both patient and doctor, the form spells out choices including whether a patient wants to be on a breathing machine or feeding tube.
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For several decades, psychiatrists who work with the dying have been trying to come up with new psychotherapies that can help people cope with the reality of their death. One of these therapies asks the dying to tell the story of their life.
Coming soon to a public television station near you: “Consider the Conversation: A Documentary on a Taboo Subject.”
Two friends and amateur filmmakers in rural southern Wisconsin put together this hourlong look at the way Americans think about, or try not to think about, what we’ve euphemistically come to call end-of-life questions.
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The number of Alzheimer's patients is expected to increase dramatically in coming years, straining the health care system.
Scientists have not discovered the cause nor devised effective treatments. Even diagnosis is difficult.
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Advance directives, which allow people to plan ahead for end-of-life care, can be too vague to cover many medical situations. Now, a growing number of states are promoting another program to help guide physicians with a patient's specific instructions.
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Last year we wrote about a study that found advanced cancer patients who received early palliative care in combination with standard care not only reported increased quality of life, but even lived a bit longer than those who didn’t.
Now a study of four hospitals in New York State finds that using well-established palliative care teams to coordinate the care of seriously ill Medicaid patients can save money, at least in the hospital; their use reduced inpatient costs by about $6,900 per admission for the average patient.
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Patients facing serious or life-threatening illnesses account for a disproportionately large share of Medicaid spending. We examined 2004–07 data to determine the effect on hospital costs of palliative care team consultations for patients enrolled in Medicaid at four New York State hospitals.
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Before her mother's stroke, Brenda Greene says she did not need to talk to her about long-term health care because her mother was "a young 65." So she put it off.
Sound familiar? Many families avoid these important conversations because they are stressful and threaten the parent's independence, says Sandy Markwood, chief executive officer of the National Association of Area Agencies on Aging.
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People with advanced cancer should be told what end-of-life care choices are available earlier in the course of their disease, a new policy statement from the American Society of Clinical Oncology recommends.
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Perhaps no group of nursing home residents is more vulnerable than those with advanced dementia: unable to speak for themselves, suffering the physical as well as the cognitive effects of their terminal disease, prone to confusion or fear when subjected to blood tests or trips in screaming ambulances.
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How far would you go to sustain the life of someone you love, or your own? When the moment comes, and you're confronted with the prospect of "pulling the plug," do you know how you'll respond?
In Facing Death, FRONTLINE gains extraordinary access to The Mount Sinai Medical Center, one of New York's biggest hospitals, to take a closer measure of today's complicated end-of-life decisions.
Click Here to watch the full report and to access additional online resources.
Dying cancer patients often face severe pain and aggressive chemotherapy treatments at the end of their lives. Dr. Jon LaPook reports on how an alternative known as palliative care is relieving some of their suffering.
Click Here to watch the full report and to access additional online resources.
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