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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).

Rep. Wolf Says Entitlement Programs Could Affect U.S. Bond Rating
Rep. Frank Wolf (R-Va.) on Friday in a letter to President Obama said that the U.S. could lose its triple-A bond rating if Congress does not act quickly to overhaul U.S. entitlement programs, including Medicare and Medicaid, and reduce federal debt, the AP/Detroit News reports.Several lawmakers in Congress over the past two years have introduced bills to create a bipartisan task force to address the growing costs and potential insolvency of entitlement programs, such as Medicare and Medicaid. Wolf is a co-author of one such bill (HR 1557). A federal report issued earlier this month found that the trust fund Medicare uses to pay for beneficiaries" hospital care will be insolvent by 2017, two years earlier than previously predicted.According to the legislation, the task force would be responsible for developing a "grand bargain" package of recommendations to Congress on tax increases and benefits related to the entitlement programs. However, the task force has been opposed by House Speaker Nancy Pelosi (D-Calif.), several top congressional committee leaders and White House aides who said that other priorities, such as a health care system overhaul, need to be addressed first.Wolf said, "The fact that the leadership has been opposed to it has been a problem," adding, "There"s an economic tsunami off the coast and it"s ready to wipe us out." David Walker, president of the Peter G. Peterson Foundation, said that currently the potential for the task force is not good but that it should improve as the economy recovers and Congress can offer more attention to the plan (Raum, AP/Detroit News, 5/24). Opinion Pieces
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Ilaris® Recommended For European Approval As New Biologic Drug To Treat A Rare But Serious Group Of Auto-inflammatory Diseases
The biotechnology medicine Ilaris® (canakinumab) has passed another major milestone with a recommendation for approval in the European Union to treat patients with a life-long and potentially fatal auto-inflammatory disease called cryopyrin-associated periodic syndrome (CAPS). When approved, Ilaris will be the only treatment in the EU indicated for CAPS patients aged four years and older[1].
Public Health

Pediatric Obstructive Sleep Apnea Treated Effectively By Surgery

Infants and young toddlers with obstructive sleep apnea and sleep disordered breathing experience significant improvement following surgical treatment of the ailment, according to an invited article in the June 2009 issue of Otolaryngology-Head and Neck Surgery. The study evaluated 73 cases in which children younger than two years old were treated for obstructive sleep apnea through the removal of the adenoids, tonsils, or both (adenotonsillectomy). Those treated through surgery experienced significant improvement on the apnea-hypopnea index (AHI), an index that measures the severity of sleep apnea. Those treated medically, but not surgically, exhibited no improvement after treatment. The study"s authors also concluded that the rate and types of post-surgical complications were within acceptable levels. Sleep disordered breathing (SDB) in children, from infancy through puberty, while similar to adult sleep apnea, actually has different causes, consequences, and treatments. A child with SDB does not necessarily have this condition when they become an adult. The consequences of pediatric obstructive sleep apnea include snoring; sleep deprivation (which can cause moodiness and behavioral issues); abnormal urine production; slowed growth and development; and attention deficit and attention deficit hyperactivity disorders. Matt Daigle American Academy of Otolaryngology -- Head and Neck Surgery .


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