Skip to main content

Literature Potpourri


Here are a smattering of interesting articles on my desk I've wanted to blog about, but haven't had time to work into full posts.  Writing about them here briefly doesn't preclude anyone (you?) from posting about these stories in greater detail later!

  • The February issue of the Journal of General Internal Medicine, or JGIM, should be subtitled "The GeriPal Issue."  Lots of great articles on social media, geriatrics, and palliative care topics, including:
    • An article by Matthew DeCamp on social media and conflicts of interest.  Did you know that 65% of patients trust information about cancer obtained from the internet?  (for comparison, 93% trusted information from a physician).  Lot's of nefarious potential here for big pharma  and docs in their pay to steer patients to their products without adequate disclosure.
    • This study by Amy Kelley on of out-of-pocket costs during the last five years of life.  Amy is on a roll, see this post about her recent Health Affairs article. Did you know that one quarter of older adults spend down their assets to nothing in the last five years of life? In the accompanying editorial, Michael McWilliams asks, how much should society protect people against going broke before they die?
    • Elizabeth Eckstrom wrote a terrific thought piece about challenges in cancer screening in older adults. She laments that, "There is little research to guide busy primary care providers and practices in effectively performing cancer screening."  Amen to that.  I like the way she asks the tough questions, like, "Can older adults understand screening complexities in the context of multi-morbid illness?"
    • Deb Barnes presents a prognostic index for recovery of function, persistent dependence, or death following a hospital acquired disability.  Older adults don't just care about whether they will live or not, they also care about what state they will be living in.  Functional ability, or the ability to provide basic daily care for oneself is a part of that. The article features cool multicolored triangles that visualize this three part outcome.
  • A paper by Yoko Tarumi in the Journal of Pain and Symptom Management adds to the weight of evidence that docusate adds nothing to senna based laxatives for opioid related constipation.  
  • AAHPM decided to keep the "H" (for hospice), as reported by Tim Quill in the fall AAHPM quarterly (online for members only).  See this previous post introducing the controversy. The process of deciding about the "H" was thoughtfully done, including focus groups and a member survey.  Only 11% of members responded (guilty as charged) but 87% of those who responded felt the current name describes "who we are and what we do."

by: Alex Smith

Comments

Alex Smith said…
Please note in the original post I transposed two letters in the name of the author for the docusate study, it should be Tarumi, not Tamuri. Also the link to the journal of pain and symptom management isn't working today for some reason, so I changed the link to the pubmed page.
Bruce Scott, MD said…
I'm glad that the newest study is consistent with the idea that addition of docusate to senna is of no utility. The need for adding docusate to senna (or bisacodyl) is on my list of things that I learned when I was training that we no longer think are true. I miss being able to use the phrase "mush without the push", however. Advocating just senna without docusate would be "Push instead of mush", and that doesn't have the same ring.

It's good to see that Louise Walter remains part of the conversation about cancer screening. She has been a consistent voice asking us to consider the risks associated with screening and to urge reconsideration of screening in life-limited individuals. Her life expectancy by age and health quartile graph is a useful tool for practice (and for teaching purposes).
provashi jack said…
it's really a knowledge full post. thanks to shear . this post has removed my some wrong thing . i thing if you carry on your acctivetice you will achive much popularety.. at last..thanks.

Information visualization Low

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…

Opening the Black Box of LTACs: Podcast with Anil Makam

What happens in Long Term Acute Care Hospitals, or LTACs (pronounced L-tacs)?  I've never been in one.  I've sent patients to them - usually patients with long ICU stays, chronically critically ill, with a gastric feeding tube and a trach for ventilator support.  For those patients, the goals (usually as articulated by the family) are based on a hope for recovery of function and a return home.

And yet we learn some surprising things from Anil Makam, Assistant Professor of Medicine at UCSF.  In his JAGS study of about 14,000 patients admitted to LTACHs, the average patient spent two thirds of his or her remaining life in an institutional settings (including hospitals, LTACs and skilled nursing facilities).  One third died in an LTAC, never returning home.

So you would think with this population of older people with serious illness and a shorter prognosis than many cancers, we would have robust geriatrics and palliative care in LTACs?  Right? Wrong.

3% were seen by a geriatrici…