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AGS Position Paper

To Force Feed the Patient With Dementia or Not to Feed: Preferences, Evidence Base, and Regulation

  • Fri, 9/5/08 - 4:54pm
  • 0 Comments
  • 5788 reads

Michael D. Cantor, MD, JD, Special Assistant to the Director, National Center for Ethics, Department of Veterans Affairs, Washington, DC, discussed when and if food and water can be withheld from a nursing home resident. There are three important considerations when making this determination: autonomy, surrogate decision-making, and the best-interest approach.

Dr. Cantor used a case discussion to illustrate a person who fits the common profile of someone who resides in a nursing home. Mr. Smith is an 89-year-old resident with advanced Alzheimer’s disease (AD) who is dependent for all of



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Osteoporosis: A Neglected but Treatable Disease

  • Fri, 9/5/08 - 4:54pm
  • 0 Comments
  • 2946 reads

Overview of the Problem
When one thinks about common causes of morbidity and mortality in elderly, osteoporosis is probably not one of the first conditions to come to mind. Even though most physicians are aware of osteoporosis, it is generally considered a less important health matter. Because elderly patients often have several medical problems, these other diseases often attract the attention of the health care provider; as a result, osteoporosis frequently is not adequately addressed. Yet, osteoporosis is a serious, debilitating ailment with morbidity, mortality, and economic costs



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One Patient, Many Places: Managing Health Care Transitions, Part III: Financial Incentives and Getting Started

  • Fri, 9/5/08 - 4:54pm
  • 0 Comments
  • 2485 reads

This article is the last in a three-part series. Part I appeared in the September issue and Part II in the October issue of the Journal.

Financial Incentives and Structural Issues

Recommendations
Health care organizations (HCOs) should:

1. Ensure that financial incentives among providers are aligned to promote (1) high quality care transitions, and (2) the transmission of essential data elements to practitioners involved in a patient’s care across different settings.
2. Structure their delivery systems to promote seamless transitions across care settings.
3. Review ben



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From the 5th Edition of the Geriatrics Review Syllabus: Gastrointestinal and Oral Diseases & Disorders

  • Fri, 9/5/08 - 4:54pm
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  • 1549 reads

Karen E. Hall, MD, PhD, Assistant Professor at the Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan, Ann Arbor, and Research Scientist, GRECC, at the Ann Arbor VA Medical Center, MI, suggested that esophageal cancer, like colon cancer, may begin with a progression of mutations rather than a single causative event such as acid reflux.  

Current recommendations include that patients with high-grade dysplastic lesions should be referred for endoscopy (to rule out Barrett’s esophagus) and possible surgery.  Dr. Hall feels, however, that patients with m



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One Patient, Many Places: Managing Health Care Transitions, Part I: Introduction, Accountability, Information for Patients in T

  • Fri, 9/5/08 - 4:54pm
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  • 4571 reads

Introduction

This article addresses how health care organizations (HCOs) can improve the quality of transitions among care venues for patients with complex care needs. In this report, care transitions are defined as patient transfers from one care setting to another. Although transfers within one particular setting (such as from a hospital intensive care unit to a general medical ward) can be problematic, this article will discuss transfers between care settings including hospitals, skilled nursing facilities (SNFs), the patient’s home, outpatient primary care and specialty clinic



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New Concepts in Acute Pain Therapy

  • Fri, 9/5/08 - 4:54pm
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  • 2848 reads

Introduction

The pain that accompanies surgical procedures is often inadequately treated, can affect the perception of subsequent noxious stimuli, and can lead to more chronic painful conditions. Moreover, existing painful conditions and prior painful experiences, regardless of whether they are the current indication for surgery, can exacerbate the pain that accompanies surgical procedures. As the neurobiology of pain perception becomes better understood and applied clinically, it becomes clear why patients with chronic painful conditions could be at risk for a more intense pain experie



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Legal and Criminal Investigation of Health Care Fraud in the Long-Term Care Setting

  • Fri, 9/5/08 - 4:54pm
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  • 1615 reads

**sub**Investigation of Health Care Fraud Among Long-Term Care Practitioners **endsub**
Stuart Silver, a Supervisory Special Agent of the FBI, Atlanta, GA, who heads a squad of agents investigating health care fraud in Atlanta and monitors all health care fraud activity in the state of Georgia, began his presentation by quoting a startling figure of $100 billion as an estimate of the sum that is lost to health care fraud each year. He explained that this figure is obtained by calculating 10% of annual health expenditure in the country. While health expenditure is now at approximately $1.35 b



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Sexuality in Long-Term Care: Ethics and Action

  • Fri, 9/5/08 - 4:54pm
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  • 4560 reads

Introduction
Given the “home-like” atmosphere that long-term care facilities are often committed to creating, plus the ideological stance that provision of a rich and meaningful experience entails addressing sexual desires and needs, an array of challenging ethical issues abound.

This article details a specific case scenario involving two residents experiencing different degrees of dementia, wishing to engage in a romantic and possibly sexual relationship. While not exhaustive, a number of ethical issues are raised, specific to the context of long-term care.

Ethical conc



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Key Considerations When Treating the Older Patient with Symptoms of Urinary Frequency and Urgency

  • Fri, 9/5/08 - 4:54pm
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  • 2885 reads

Introduction

Overactive bladder (OAB) is a chronic and distressing medical condition experienced by many individuals as they grow older, and affecting both men and women equally. Overactive bladder is defined by the International Continence Society as urgency, with or without urge incontinence, usually with frequency and nocturia in the absence of proven infection or other obvious pathology.1 Although the pattern of symptoms varies among individuals, frequency is the most commonly reported symptom; urgency incontinence is less common but is often the most troublesome symptom.2

Age is



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The Care of Dying Patients

  • Fri, 9/5/08 - 4:54pm
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  • 1898 reads

INTRODUCTION

Background
Dying is the final portion of the life cycle for all of us. Providing excellent, humane care to patients near the end of life, when curative means are either no longer possible, or no longer desired by the patient, is an essential part of medicine. The American Geriatrics Society (AGS) recognizes that most people near the end of life want to live as fully as they can. They want their health care providers to honor their wishes and goals and to help them maintain their dignity and independence while relieving symptoms and maximizing comfort. For physicians and heal



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ALTC Blogs

How to Create Collegiality in a Difference of Opinion: Part 1

Neil Baum MD
2/3/12 | 0 Comments | 13 reads

Dutasteride vs Low Grade Prostate Cancer

Alvin B Lin MD FAAFP
1/31/12 | 0 Comments | 37 reads

Finding “Dr. Right” For Your Practice

Neil Baum MD
1/30/12 | 0 Comments | 40 reads
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HMP Communications LLC (HMP) is the authoritative source for comprehensive information and education servicing healthcare professionals. HMP’s products include peer-reviewed and non-peer-reviewed medical journals, national tradeshows and conferences, online programs and customized clinical programs. HMP is a wholly owned subsidiary of HMP Communications Holdings LLC. © 2012 HMP Communications