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Showing posts from November, 2012

Bed Alarms in Hospitalized Patients: Useless

Many older patients fall in the hospital and these falls often lead to injury.  Hospitals are under a lot of pressure to reduce falls.   Generally, these falls happen when patients transfer such as when an older person tries to get out of bed or get up from a chair.   While hospitalized, many patients are weak, dizzy, or confused, and they can be at risk of falling when ambulating without assistance. To reduce this risk, bed alarms have become ubiquitous at hospitals throughout the US.  When a patient is deemed to be at high risk of falling, weight sensitive pads are applied to the bed, chair, or commode.   When a patient tries to get up, an alarm sounds in the room and at the nursing station.  The alarm reminds the patient to wait for assistance, and alerts nursing staff to assist the patient. Remarkably, these alarms have become widely used with virtually no evidence that they actually reduce falls, let alone any studies that examine the adverse consequences of restricting mobi

The new brain scan for Alzheimer's: what's early certainty worth?

Last week the  NY Times story on a new scan that identifies Alzheimer's in the brain caught my eye, and probably caught yours too. What is the benefit of this test, wondered my colleague Alex Smith in a recent Geripal post , and is it worth the cost? What is the value of "knowing for sure -- period"? I can't say I know the answer for sure, but I do know that the period of uncertainty is hard on most families when we work up early cognitive impairment in the outpatient setting. (It usually lasts for months, if not longer.) I also know that for geriatricians in outpatient clinical practice, the diagnostic question isn't just "Is it or isn't it Alzheimer's?" It's also: What's causing this cognitive impairment?  Is it dementia (of any stripe)? Are there any additional factors making the cognition worse? (As in: medications, medications, and oh yes, medications. Benzos and anticholinergics, I'm talking about you.)

Phishing for Geriatrics and Palliative Care

This is generally not a post that I would do for GeriPal but in the last week I’ve received about 20 direct messages on twitter from well known faculty in both geriatrics and palliative care.  The content of these messages are all similar: “Exactly what have you been doing in our video clip”  “Hi. somebody is saying real bad rumors about you here ”  “Have you seen what this person is saying about you?”  “Hey someone is making up dreadful things that are about you”  This is a phishing scam. What ever you do, do NOT click on the link . Once you do you will be asked to fill out login information so the scammers can steal your username and password. Once they have your password, they may send out messages to all your twitter followers or try your password and email combinations on banking or ecommerce websites. So please, don't click on the link.  You may have done something embarrassing.   However,  I can promise you, if one of your colleagues found out about your

Without a Treatment, Why Test for Alzheimer's?

The New York Times has a front page (at least online) story today about testing for Alzheimer's Dementia .  The story follows a 61 year old woman who has started to forget things.  She undergoes testing for Alzheimer's and the test is floridly positive: she has the early stages of Alzheimer's dementia. The problem, as the article notes, is that treatments for Alzheimer's dementia are not effective.  The test is about knowing for sure - period. I'm interested to hear what other folks think about testing.  We at GeriPal are obviously big proponents of estimating prognosis (see ePrognosis ), but testing for Alzheimer's strikes me as both similar and different at the same time. Knowing your prognosis can help with a whole host of decisions, such as medical decisions like screening for cancer, or life decisions such as spending time with the grandkids while you're still able.  Testing for Alzheimer's may also help clarify such health decisions and lif

Vaseline Balls for Constipation?

Note: Before you read any further, please consider taking Candice Tavares’ 3 minutes survey on use of Vaseline balls ( ) in hospice and palliative care. Candice is currently completing a specialty practice residency in palliative care and can really use your help with her research project evaluating the opinions and experiences of hospice and palliative care nurses, pharmacists and physicians with the use of petroleum jelly oral preparations for the management of constipation. The first time I’ve ever heard of Frozen Vaseline balls was at this years AAHPM annual meeting. At first I thought it was a joke, but after seeing several tweets go out about this, I thought that eventually I’d need to look it up. We’ll the time has come. Frozen vaseline balls for constipation/impaction.Not published but I'm wondering why not study it. Get an Ignobel prize? #HPM — Christian Sinclair (@ctsinclair) March 9, 2012 Tip frozen Vaseline ballswork really well

Is it time for another lawsuit? Advocating to change the Medicare Hospice Benefit eligibility requirements

By now most everyone has heard about the proposed settlement of a nationwide class-action lawsuit against Medicare that would do away with the requirement to show a likelihood of medical or functional improvement before Medicare would pay for skilled services such as physical therapy. This has led me to wonder if it is time to rewrite the Medicare manual to do away with the requirement for Hospice patients to : Have a life expectancy of 6 months or less if the illness runs its normal course  Sign a statement choosing hospice care instead of routine Medicare covered benefits {i.e. curative care} for their terminal illness. The case for the Medicare skilled nursing benefit lawsuit ( according to the New York Times ): Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement,” but is based on the beneficiary’s need for