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The decision to insert a percutaneous endoscopic gastrostomy tube in a family member with advanced dementia is often made with inadequate discussion of the risks involved, said a study published May 3 in the Journal of the American Geriatrics Society.
Nearly 90% of patients with advanced dementia have problems feeding themselves, lose weight or choke on food. About 40% of these patients die within six months of developing eating problems, previous research shows.
But feeding tubes may not be the right response to the problem. Observational studies have found that feeding tubes do not prolong life, reduce aspiration pneumonia risk or improve quality of life for these patients.
And the tubes come with risks. Patients with advanced dementia who have tubes inserted often attempt to pull the tubes out, with the result that many patients are physically restrained or sedated. Feeding tubes also can become clogged and cause diarrhea.
Yet those risks are not usually discussed, said ...
In front of her fellow first-year medical students, Natsai Nyakudarika spoke about the difficulty she had looking at the face of her anatomy class cadaver, a man named Gerald.
"I can't look at Gerald's face," she said. "I'm afraid that I will see in it the face of everyone I've loved who has died."
Nyakudarika was among several students at Northwestern University's Feinberg School of Medicine in Chicago who talked about their experiences with dissection as part of the school's closing ceremony for its anatomy class.
Most medical schools now host such ceremonies, but Northwestern is unusual in that it invites cadaver donors' family members to attend.
"We never did that before last year," said Larry R. Cochard, PhD, who directs Northwestern's anatomy lab and helps organize the annual ceremony. "It's a whole different dynamic with the families here. We didn't know what to make of that, but it's been great."
Of the 29 cadaver donors honored, the families of six donors were p ...
Oregon Gov. John Kitzhaber, MD, is backing across-the-board Medicaid pay cuts to close nearly the entire remaining $735 million revenue shortfall in the state's two-year, $15 billion 2012-13 budget.
The proposal would reduce Medicaid rates by 19% in fiscal 2012, which begins July 1, and could require an additional 15% cut in fiscal 2013 if a new care coordination program fails to produce enough savings, according to estimates by the Oregon Assn. of Hospital and Health Systems.
Oregon Medicaid physician pay rates already are as low as 60% of what Medicare pays, said Betsy Boyd-Flynn, spokeswoman for the Oregon Medical Assn. These cuts "would really reduce access, and they would probably drive more physicians into retirement."
Hospital Medicaid rates cover only about 70% of costs, said Andy Van Pelt, a spokesman for the hospital association.
Some primary care doctors already limit their Medicaid participation. In 2009, 53% of all Oregon physicians accepted new Medicaid patien ...