Palliative Care for End-Stage Dementia: The Interface Between Practice, Policy, and Profits
- Fri, 2/12/10 - 1:03pm
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In medicine, we tend to think about end-of-life issues as ethical or legal concerns. What would the patient want? What would be in his or her best interest? If he or she cannot decide, who is empowered to make these decisions? We believe that if such issues are addressed and the appropriate legal papers are signed, then the clinical care will correspond to these decisions. But in actual practice this is usually not the case. If there is an available intervention, it will be applied.
Perhaps the best evidence for this comes from a randomized controlled study of palliative care in 100 patien
Astronomical Science or Astronomical Marketing?
- Tue, 11/10/09 - 9:24am
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Impartial questions should always be asked when a pharmaceutical company sponsors a major clinical trial. This statement especially applies when a clinical trial purports to offer significant new targeted information on a proprietary medication that appears to change the relevance of that medication to medical practice. It is appropriate to ask such questions regarding the much publicized study Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER).1 Is this astronomical science or astronomical marketing? JUPITER reported on 17,802 apparentl
Are New Parameters Needed in Treating the “Old-Old”?
- Mon, 8/17/09 - 3:26pm
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For the year 2010, the percentage distribution of the population in the United States over 85 years is projected to be 1.85% and for the year 2025 it is 2.03%.1 A small percentage, but not insignificant numbers. Hence, geriatricians and primary care providers may need to recalibrate normals in managing the old-old (over age 85 yr).
To start, before writing a prescription, physicians must consider multiple factors, particularly in treating patients in this age group. A good general rule is start with a much lower dosage than usual.2 Perhaps the best maxim to consider is to think of what Vinc
