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Terminally Ill Patients And Their Physicians Delay Conversations About End-of-Life Choices, Study Finds
About half of terminally ill patients do not have discussions with their physicians regarding end-of-life choices, according to a Harvard Medical School study published in the Archives of Internal Medicine, the Boston Globe reports.The study, funded by the National Cancer Institute, examined files on 1,517 patients in California, Iowa and Alabama with metastasized lung cancer. According to the Globe, a majority of patients diagnosed with metastasized lung cancer do not survive two years. Researchers asked the patients whether a physician or other health care provider had recommended hospice care or discussed end-of-life care preferences with them. According to the study, about 49% of blacks and 43% of Hispanics had discussed end-of-life care preferences with a physician or health care provider within four to seven months of their diagnosis, compared with 53% of whites and 57% of Asians. Lead study author Haiden Huskamp, an associate professor at Harvard Medical School, said, "Patients who had unrealistic expectations about how long they had to live were much less likely to talk about hospice with their doctor." Huskamp theorized that patients who said they did not discuss end-of-life options with providers might not have completely understood their prognosis or chose to believe in a better outcome. Huskamp also said physicians typically are not well-trained to handle some delicate conversations (Lazar, Boston Globe, 5/26).
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Baton Rouge, La.'s High AIDS Rate Examined
The Baton Rouge Advocate on Sunday examined reasons behind Baton Rouge, La."s high AIDS rate. The most recent data from CDC ranks the Baton Rouge metro area third nationally for AIDS cases for 2007, with 31.4 cases per 100,000 people, according to the article. "State health officials, medical professionals and people who work in HIV/AIDS prevention say there are a variety of reasons the Baton Rouge metro area ranks near the top," including delayed testing, denial of high-risk behavior among individuals and medical advances that are allowing people to live longer with the virus, the Advocate reports. Beth Scalco, the Louisiana director of the HIV/AIDS Program for the state Office of Public Health, said the city"s close proximity to four prisons also contributes to the high rates. Arnold "A.J." Johnson, founder of the Baton Rouge AIDS Society, said the government does not adequately fund HIV/AIDS education in the area. He added, "Part of the problem is the culture and atmosphere. The government needs to come here and attack this area like they did when Hurricane Katrina hit" (Ward, 7/26).
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"Body-count" Processing Must End At VA, Says The American Legion
An immediate overhaul of the Department of Veterans Affairs disability claims processing system is the only way out of a fast-growing nationwide backlog of unresolved cases, American Legion National Commander David K. Rehbein said after a congressional hearing last Thursday evening.
Oncology

Skills For Catheter Insertion Improved By Simulation Training

New technology allows student doctors to practice operations and other procedures on simulators before trying them out on real patients, just as pilots practice for emergencies on aircraft simulators. Medical educators feel that this will increase patient safety, by avoiding first-time mistakes being made on live patients. But does education by simulation actually work? Can doctors learn new skills on simulators instead of on humans? A team of researchers at Yale University, led by Dr. Leigh Evans, trained half of a group of junior doctors a new skill using simulation, while the other half of the group learned the skill in the old-fashioned "bedside" manner. The skill being studied, inserting a "central line" into one of the major veins in the body, is a very important one for doctors in many specialties. After watching these junior doctors perform the procedure on nearly five hundred patients, the team found a much higher success rate for the doctors who trained with simulation. The technical error and complication rates were roughly the same, showing no increase in risk to training doctors on a simulator instead of on human patients. Dr. Evans and colleagues feel that these findings support using simulation to allow for safe training of complex technical skills that could pose a risk to patients if tried for the first time by inexperienced students and doctors. The presentation, entitled "Simulation Training for Central Venous Catheter Insertion on a Partial Task Trainer Improves Skills Transfer to the Clinical Setting," was given by Dr. Leigh Evans at the plenary paper session at the 2009 SAEM Annual Meeting at the Sheraton New Orleans on May 14. Abstracts are published in Vol. 16, No. 4, Supplement 1, April 2009 of Academic Emergency Medicine, the official journal of the Society for Academic Emergency Medicine. Sean Wagner Wiley-Blackwell


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