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Checklist approach to be tested in end-of-life care planning
Researchers from Harvard Medical School soon will begin testing a checklist-style approach to helping cancer patients get the kind of end-of-life care they want. The plans, detailed in June at a meeting of the International Society of Advance Care Planning and End of Life Care, are aimed at helping oncologists discuss end-of-life care issues with patients at an earlier stage in the disease process. The trial of the serious illness communication checklist will involve 60 practicing oncologists and begin enrolling 450 patients in June. Data on patient and family satisfaction and treatment choices will be collected over three years, researchers said. A wide body of research has found that patients who plan ahead are likelier to get the treatments they want as they near death. These patients tend to get less-aggressive care, earlier referral to hospice, are more satisfied with their care and see lower burdens placed on family members, experts say. Yet fewer than one in three American [Read more]
Study links lower education levels to higher obesity rates
Possessing a high school diploma and a college degree may be a major factor in having a family with smaller waistlines and longer lives, according to a new federal report on the nation’s health. Researchers found that lower education levels in a household generally translated into higher obesity rates. Less education also impacted other health markers. Life expectancy was lower for 25-year-olds without high school diplomas, and smokers were more prevalent among adults younger than 65 who didn’t have some form of higher education. The report is issued annually by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention. From 2007 to 2010, lower obesity rates for children 2 to 19 could be correlated with higher levels of education for the heads of their households. In instances where the head of the household had less than a high school education, 24% of boys and 22% of girls were obese. Obesity levels were significantly lower — [Read more]
Task force recommends against PSA test for prostate cancer
New guidance urging physicians to stop using the prostate-specific antigen test to screen men of any age for prostate cancer has raised objections among some doctors and at least one medical organization. The recommendation, issued May 21 by the U.S. Preventive Services Task Force, says the small potential benefit of PSA screening in asymptomatic patients does not outweigh the expected harms of biopsies and treatment for cancerous tumors that often are slow-growing and not life-threatening. Such problems include fever, bleeding and infection from biopsies and urinary incontinence and erectile dysfunction due to radiotherapy and surgery, the task force said. The guidance does not apply to men who have been diagnosed with prostate cancer or those being treated for the disease. Some critics worry that the recommendation could cause health insurers to stop covering the test for men who still want it, causing prostate cancer deaths to increase. The task force released a draft re [Read more]
Some patients fear speaking up will upset their doctors
Even well-educated, well-to-do patients have trouble asking their physicians questions about treatment options or expressing their medical preferences and values, said a study drawing on focus groups with older adults in the San Francisco Bay Area. Clear themes emerged from six focus group sessions with 48 patients in Palo Alto, Calif., the study said. Patients said they wanted to have a more active role in making medical decisions with their physicians, but feared upsetting them. The patients, all of whom were 40 or older, said they did not feel as though their physicians listened to or respected what they had to say. Many patients worried that questioning their physician’s recommendations could hurt the doctor-patient relationship. “If I were to do that, I would think … is the guy going to be … [angry] at me for not doing what he wanted?” asked a 64-year-old man quoted in the study. “Is it going to come out in some other way that’s going to lower the quality of [Read more]
Medical schools close to reaching long-term enrollment goals
The nation’s allo-pathic medical schools are on track to increase enrollment by close to a 30% goal set by the Assn. of American Medical Colleges six years ago. But future physician shortages won’t be alleviated unless more graduate medical education positions are created to keep pace with the growing number of medical degree graduates, education officials say. “This won’t amount to a single new doctor in practice without an expansion of residency positions,” said AAMC President and CEO Darrell G. Kirch, MD. Based on expanded class sizes from the addition of new medical schools and expansions at existing medical schools, first-year allo-pathic enrollment is projected to reach 21,376 by 2016-17, a 30% increase above first-year enrollment of 16,488 in 2002-03. That means the schools will have reached the AAMC goal just one year behind schedule. “U.S. medical schools are doing all that they can to address a serious future physician shortage in this country,” Dr. [Read more]
CMS eases rules to cut doctors’ regulatory burdens
The Obama administration removed several duplicative and burdensome regulations from Medicare that will save physicians and hospitals more than $1 billion, officials announced on May 10. The Centers for Medicare & Medicaid Services finalized two regulations that eliminated rules deemed to have adversely affected those participating in Medicare. In one regulation, billing privileges for physicians will be protected from unjust revocations. In another rule, CMS increased flexibility on governance boards at hospitals but protected the autonomy of medical staff at each facility. “These changes cut burdensome red tape for hospitals and providers and give them the flexibility they need to improve patient care while lowering costs,” said acting CMS Administrator Marilyn Tavenner. “These final rules incorporate input from hospitals, other health care providers, accreditation organizations, patient advocates, professional organizations, members of Congress and a host of others who a [Read more]
Teen immunization rates improve with middle school vaccine mandates
States that require middle-schoolers to be up to date with vaccines have greater coverage among teens for those particular immunizations than states without such mandates, a recent study shows. But because no state requires all of the three vaccines recommended for adolescents, physicians should review youths’ immunization history at each visit and offer any vaccine the teen is missing, said Shannon Stokley, MPH, co-author of the study published online May 7 in Pediatrics. The Centers for Disease Control and Prevention recommends that youths 13 to 17 receive the following vaccines: meningococcal conjugate (MenACWY); tetanus, diphtheria, acellular pertussis (Tdap); and human papillomavirus (HPV). “We need to do a better job of reducing missed opportunities to vaccinate adolescents and taking advantage of every visit with” adolescent patients, said Stokley, a CDC epidemiologist. Researchers examined data from the National Conference of State Legislatures and several oth [Read more]
Physicians receive federal innovation grants
Physicians and other health care professionals will be developing medical homes, employing health information technology and taking various other measures to boost access to primary care under the first series of innovation grants announced by the Centers for Medicare & Medicaid Services on May 8. The CMS Center for Medicare and Medicaid Innovation issued 26 grants totaling $122.6 million as authorized under the Patient Protection and Affordable Care Act, with an aim toward reducing health spending by $254 million over three years. The projects will involve the collaboration of physicians, hospitals, nurses, pharmacists, technology innovators, community-based organizations and patient advocacy groups in urban and rural communities, according to CMS. One of the award recipients, University Hospitals Case Medical Center’s Rainbow Babies & Children’s Hospital, known as UH Rainbow, will use its $12.8 million grant to implement a “Physician Extension Team.” The PET model is a [Read more]
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