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Showing posts from April, 2011

Twitter to Tenure: Using Social Media to Enhance Your Career

What good is Twitter anyway?  Why should I contribute to a blog?  What are the limits of what I can say about my patients on social media sites like facebook?  How can social media help my career?

Well I won't answer these questions now, but over the next several days, a group of high-powered academic users of social media will be posting their responses to these and other questions.  This is our ramp up to a workshop we are giving together at the Society of General Internal Medicine (SGIM) Annual Meeting in Phoenix.  For those of you who can't make it to the meeting, here's your chance to learn virtually.  And for those who are going to the SGIM meeting, we hope these posts will get you excited, and we'll see you at the workshop on Thursday from 4-5:50!

Here is the schedule of ramp up posts that address the use of social media to advance your career:

Monday - Vinny Arora (@FutureDocs) will post on Futuredocs
Tuesday - Bob Centor (@medrants) will post on DB's Medi…

Studying Race/Ethnicity and Attitudes Toward Death: Helpful or Harmful?

I received an email yesterday from CNN asking me to comment on a study published today in the Journal Cancer titled, "Racial Variation in Willingness to Trade Financial Resources for Life-Prolonging Cancer Treatment."   This is an interesting study that found that African Americans with cancer are more likely to state a willingness to spend down their financial resources to prolong their life than whites, 80% vs. 54%. 

My first thought was, wow! CNN!  That's the big time!  I then realized that the reporter was not Wolf Blitzer or at least Sanjay Gupta, but rather a blogger for the CNN health blog "The Chart."  I did the interview, and the post came out, and I wasn't quoted :(

What interested me most about the post were the comments.  Here are a few examples:
What a stupid, dumb and racist article and research. WHO CARES....Study something that actually matters and doesn't split up the human race based on skin color.Then there is this comment:
As a pallia…

Geriatrician workforce: Rural-Urban

So the Baby Boom is here, and the US population over 65 is going to rise to 20% of the population by 2030, and we lack adequate geriatric workforce. And in the rural areas of the country, things may be even more challenging! The increase in percent of population over 65 is expected to be even greater in rural areas. Furthermore, elder rural residents have higher rates of chronic disease, have lower self-rated health, and are more likely to live in poverty that their urban counterparts.

Meanwhile, natural decrease (the phenomenon where deaths in a county exceed births) is impacting rural areas especially in the hot spot areas of Great Plains, Upper Great Lakes, Appalachians, Ozarks, and extreme southern Illinois, western Kentucky, and Tennessee. With smaller numbers of births and with young workers' outmigration, health care agencies such as home health and hospice may find it harder to find health care workers as the need increases.

This month's Journal of the American G…

The Effects of DNR Orders on Post-Surgical Outcomes

If you happened to read WebMD the other day you would have seen an article with the headlines ‘DNR Orders May Affect Surgical Outcomes’. This is a fair enough title, as the topic of the article is a recently published manuscript from the Yale School of Medicine that concludes that do-not-resuscitate (DNR) status appears to be an independent risk factor for poor surgical outcome.

At issue though is not the title though. It is the lack of a good understanding of what was actually published in the Archives of Surgery paper and the significance (or lack thereof) of the research results. As a prime example of poor reporting on this particular paper and the harm that may from it, I’m going to start off with the second paragraph in the WebMD article:
"A new study shows 23% of people with DNR orders died within 30 days after surgery compared with 8% of similarly matched surgery patients without DNR orders. They were also more likely to suffer serious complications and have longer hospi…

Book Review: The Salami Salesman and His Daughter Falafel

The Salami Salesman and His Daughter Falafelis Dr. Laurie Mallery’s poignant account of the events leading up to her father’s death and what she learned through the process of caring for him (the book's subtitle pretty much says it all - What an older man's death can teach us about how and how not to care for the frail and dying).

An internist/geriatrician and head of Geriatric Medicine Dalhousie University in Halifax, Nova Scotia, Dr. Mallery’s role as the informed family member-caregiver is both impeded and enhanced by her medical training. In caring for her 83-year-old father who suffered from a complex interaction of health conditions (i.e. cerebellar strokes, CHF, atrial fibrillation, hemolytic anemia) that contributed to and exacerbated his declining mobility and cognitive impairment, Dr. Mallery undergoes a learning process that informs the reader about pertinent medical and social issues affecting end-of-life care.

The following are salient issues discussed in her narr…

Palliative care Nurse Practitioner Models of Care – It’s all about money. Or is it?

Within the context of an aging population, a US health care system in financial flux, and the shortage of primary care providers, nurse practitioners (NPs) are more and more in the news as a possible solution to provide primary and specialized care.

Marilyn Bookbinder and colleagues recently published an interesting read in the JPSM looking at the sustainability of two Palliative care nurse practitioner models serving people living with serious or chronic illness.

They looked at two models of providing NP based specialized palliative care to see if either of the models could generate enough revenue over a 2-year period to be considered financially sustainable. The first model consisted of an NP and a social worker (SW) with advanced training in palliative care. This palliative care home care team (PCHT-NP-SW) was based out of Beth Israel Medical Center and targeted underserved elderly homebound folks with advanced illness. Their goal was to provide symptom control, advance care pl…

The Match is Moving Leaving Geriatrics and Palliative Care Behind

The word on the street is that the National Resident Matching Program (NRMP) will shortly announce that as of 2012, the medical specialties fellowship match is being pushed back to the middle of PGY3 year. Interviews for medical specialty fellowships will now occur over the summer and fall of their PGY3 year, match lists will be due on November 21st, and subspecialty match results will be released on December 5th.

This is welcome news for residents as they will now have significantly more time to decide whether they want to pursue a specialty career, to advance their scholarly projects and professional development, and to interview in programs across the US during their third year. This new time schedule is very learner centric and should be applauded.

However, there are two medical specialties that continue to hold out in putting learners first when it comes to recruitment. Unfortunately, these specialties are Hospice & Palliative Medicine and Geriatrics. These two fellowships …

Hemoglobin A1C target of 7 in the elderly. Really? REALLY???

I want to draw GeriPal readers attention to a terrific commentary in this week's JAMA by GeriPal's own Sei Lee.  Sei was also interviewed for the New York Times New Old Age blog here (see the comments for some great back and forth between readers and Paula Span).

The topic is very GeriPal - a thoughtful consideration of the benefits, burdens, and potential risks of tight glycemic control in frail elders with diabetes.  National guidelines generally recommend tight glycemic control - meaning a target hemoglobin A1C of less than 7.  Some of the questions Sei addresses in the commentary:

Does it make sense to target endpoints that may take years to achieve in frail elderly patients with a limited life expectancy? (I'll let you answer that)If it takes ~8 years of tight glycemic control to prevent heart attacks and strokes, why aim for tight control in patient with a life expectancy of less than 5 years? (why indeed)What are the burdens of tight glycemic control in the elderly? …

Opioid Analgesics and the Risk of Fractures in the Elderly

Current guidelines from the American Geriatrics Society (AGS) state that "NSAIDs and COX-2 selective inhibitors may be considered rarely, and with extreme caution, in highly selected individuals" for the treatment of chronic pain. This was largely due to their risky side effect profile that includes worsening hypertension, edema, heart failure, and renal failure. The guidelines also state that "all patients with moderate-severe pain, pain-related functional impairment or diminished quality of life due to pain should be considered for opioid therapy".  But what about the risks of using opioids? Are they truly any safer than NSAIDs?

The Journal of the American Geriatrics Society (JAGS) recently published a retrospective cohort study comparing the risk of fracture associated with initiating opioids with that of initiating NSAIDs. Long story made short – initiating opioids seemed to be riskier than initiating NSAIDs (at least in regards to fractures). My questions abo…

From Red to Gray: The New Older China

According to a United Nations study, developing countries such as China are seeing a rapid graying of their population that is out-pacing the rates seen in developed countries.
The Chinese Ministry of Civil Affairs reported that close to 13% of China’s population is 60 and older. A recent BBC news article reports on the growing number of older persons in China and the corresponding strain felt by adult children who have to choose between fulfilling their filial or professional/personal duties.
In China, the one-child policy implemented in 1979 means there are fewer adult children available to care for aging parents at home.
Developers in China see this as an opportunity to turn senior care, once a practice of filial piety, into a lucrative industry. Retirement communities in major cities are proposed as viable solutions to the problem of elders growing older without children to care for them. While developers stand to gain financially, both the adult child/children and the aging parent(…

Poll: What Does Personalized Medicine Mean to You?

Much has been made of the potential of the genome, perhaps none of it more tantalizing than the concept of "tailoring" therapies to individual patients' genes.  But to date, examples of successful use of this technology are scarce, and completely absent from the daily practice of most clinicians I know.

There has been a big push from some scientists to define this technology as "personalized medicine" - a term that has been around for a long time (longer than the genome has been sequenced).  Is this what personalized medicine means to you?

On the one hand, I believe these efforts are important (I voted to take the pill that would extend my life 500 years in the last poll).  On the other hand, I worry that the focus and expense of this effort may detract from other areas of research.  Like researching how to teach clinicians to really get to know the patient in front of them (not just their genes).

Maybe we should take back this term.

by: Alex Smith

Phoenix Rising: Geriatrics & Palliative Care Sessions at SGIM

For those on the fence about whether to attend the 2011 Society for Internal Medicine Meeting in Phoenix, or for attendees who want to be in the know......
Here is a list of all of the exciting geriatrics and palliative care-related programs and sessions happening at SGIM this year.
If you know of other geriatrics or palliative care-related presentations, posters, or workshops please share them with the group by commenting below.
See you there!

THURSDAY

10:30 to noon: Session WA04 Workshop, Transitions in Care for Vulnerable Populations: One Size Does Not Fit All. Location: Paradise Valley 2nd floor
10:30 to noon: Abstracts A2, Geriatrics Oral Abstract Session. Location: Ahwatukee B Room, Second FloorLee Lindquist: Seniors Unnecessarily Complicate their Home Medication regimens post discharge Lee Lindquist: Hiring and Training Processes of Agencies Supplying Paid Caregivers to Older AdultsSangeeta Ahluwalia: Missed Opportunities for Advance Care Planning in Primary CareAlex Smith: Factors I…

Aging Women and Stereotypes

Most of us grew up learning that it was rude to ask a woman her age. But did we ask why this was so?

Our society tends to create unkind stereotypes of aging women that make it difficult for them to embrace their older selves. The following factors contribute to these stereotypes. From a biological standpoint, women may be considered less “useful” in society when they’re not at the height of their fertility. Furthermore, they may be perceived as physically vulnerable and socially needy. These perceptions negatively affect older women’s self-image and may serve to impede their physiological and psychological well-being.

To demystify the myths surrounding older women and to shed a more positive light on this population, the New Dynamics of Ageing project based at the Department of Sociological Studies at The University of Sheffield recently launched an exhibition - the Look at Me! Images of Women and Ageing project– to challenge socially constructed perceptions of older women. Participan…

Doctor Develops Cure for Burnout, Compassion Fatigue

In a breakthrough that could revolutionize medical practice, the University of Mumchester announced today that a new technique has been developed to prevent physician burnout. Dr. Elias Moore, Chair of Interventional Biophysics, described the new procedure, called “transient mirrectomy,” as a non-invasive method of numbing brain centers that may induce clinicians to identify with pain and suffering to a disabling degree.

“Basically, we direct a tightly-focused beam of non-ionizing radiation at locations in the supplementary motor area, as well as the premotor, primary somatosensory, and inferior parietal cortices,” said Dr. Moore. “Our objective is to desensitize, but not permanently damage, mirror neurons. We want to buzz those babies just enough to put them to sleep for a while.”

The mirrectomy technique utilizes stereotactically-directed microwave radiation of varying frequencies and intensities, depending on the effect desired.

“To prepare for those weekends on call, where you migh…