Medical care can extend lives, but should it?

By Michelle Balani
Rock Center

After being married for 21 years, Paul and Jean Pearson thought they had mastered the art of navigating life?s tough decisions, but nothing could have prepared them for Paul?s illness. Paul, a 73-year-old retired architect, was diagnosed in February with inoperable lung cancer.? Although the couple had talked about their healthcare wishes throughout their marriage, the experience forced them to confront how Paul wants to spend the rest of his days.

?Jean and I have been really open with each other and tried to put as much thought into this,? Paul Pearson said. ?It makes you think about, ?What do I want to do?? Do I want to go through the pain, the suffering? And it?s not just me, it?s the whole family.?

The Pearsons didn?t want there to be any doubt about Paul?s wishes to put quality of life over quantity. They decided to put their wishes in writing and file a document called an advance directive at their hospital, Gundersen Lutheran in La Crosse, Wis. ?It?s considered by many healthcare experts to be the best place to die in America.? ?

Having this kind of discussion, say health care advocates, not only gives patients and their families greater peace of mind, it can save the healthcare system a lot of money.


A study conducted by The Dartmouth Institute for Health Policy and Clinical Practice found that seven out of 10 Americans die from chronic disease and, as Americans live longer and longer, many families have no end of life game plan in place. The uncertainty over how to handle a loved one?s last days often results in more medical intervention, according to the Dartmouth study. Researchers found that patients with chronic illness in their last two years of life account for about 25 percent of total Medicare spending, much of it paying for repeated hospitalizations.

The Dartmouth Atlas of Health Care found that the costs of care at Gundersen were significantly lower than the national average. At Gundersen, patients in the last six months of life spend half as many days in the hospital as the national average.

?Our approach is patient-centered,? Bud Hammes, director of Medical Humanities at Gunderson Lutheran Health System, told Rock Center in an interview scheduled to air Thursday, September 20 at 10pm, 9pm central.? ?We really focus on what does the patient want, how can we help them live well. Patients and their families want the best care. And the best care happens to be less care at this particular point in their life. Americans don't want to die hooked up to machines.?

The hospital?s program, Respecting Choices, was developed by Hammes and implemented in the early 1990s. Now a national model, Hammes and his team train other medical professionals.

?Medicine, from my perspective, is the care of humans and it's the care of individual humans.? You know, each human coming through that door is an individual.? And we have to tailor the medical treatment we provide in accordance and in respect of that individual's beliefs, values, and preferences.? And if we're not doing that, we're not really fulfilling the full potential, and the full mission of medical care,? Hammes said.

Gundersen Lutheran?s program encourages patients facing death to have an honest conversation with their loved ones and their doctors about what treatments they wish to have or not have as their health declines. They file a plan, an advance directive, that is adhered to as their health diminishes. The program focuses on having these conversations when patients are healthy enough to have them, not when they are in the ER.?

?This is really a gift that you?re giving to your family because at some point, if they?re needing to make a decision, they can go back to this and say, ?Yes, this is hard.? This is difficult, but this is what mom, or this is what dad, really wanted,?? said Carrie Lapham, a palliative care nurse at Gundersen.

Lapham has been helping patients with incurable illnesses for more than 20 years.

?I?ve seen situations where there hasn?t been a power of attorney for health care or an advance directive done and I?ve seen families struggle and try to determine whether their loved one would want this,? Lapham said.? ?And, wow, you know, a decision has to be made, but family members can live with this for a long time after, wondering whether or not they made the right decision.?

One of things they?ve learned at Gundersen is that talking about how you want to die can help improve the patient?s quality of life.?

?The cost of care goes down, because we are not taking them back to the hospital and doing all of those expensive things they don?t want. Ultimately we all still die and ultimately at some point, in each of our lives, even the best medical care won?t change the outcome,? Hammes said.

According to Hammes, 96 percent of the people living in La Crosse have some type of written end of life care plan in their medical records. The advance directive process starts with a very tough, very honest meeting called ?next steps.? Paul and Jean Pearson allowed Rock Center to sit in on their ?next steps? meeting. The emotional and revealing discussion was led by Jacqui Kartman, a nurse practitioner.

?Give me as much time as I can get, but keep me comfortable,? Paul told Kartman of his wishes for his final days.

The conversation took 45 minutes and involved questions ranging from specific treatments to the symptoms Paul worried most about to the bucket list the couple had made for their remaining time together.

He said he worried about not being able to breathe, didn?t want to be a burden on Jean and was scared of the possibility of needing to go to a nursing home.? Both Paul and Jean said that wanted him to have quality time over quantity.

?What I am going to do now is read through these situations [and have you tell me your wishes],? Kartman told Paul during the meeting. ?I have a serious complication from my cancer or treatment for my cancer, so that I was facing a prolonged hospital stay, and my chance of living through the complications is low. For example, only five out of 100 patients would live.?

?I would deny treatment,? answered Paul.

?It was expected that I would never either walk or talk or both and I would require 24 hour nursing care,? continued Kartman.

?It would be the same answer,? Paul said emphatically.

What happened in the meeting seemed as important for Jean as it was for her husband.

?He is my soul mate and the thought of losing him terrifies me,? she told Kartman. ?But he?s not going to get better and we know that.?

Planning ahead has also brought peace to the couple?s six adult children. It was hard to hear about their father talking about his wishes for his last days, but now that they know what he wants, they have accepted it.

?You know, it does put everybody at ease,? said Ryan Pearson.

?All of us can be prepared for each step as it comes,? said Eric Pearson.

The Pearsons don't feel like victims of their circumstances. In fact, it?s just the opposite. The process has helped Paul decide how he wants to live the rest of his life. On the schedule are more fishing trips and historical re-enactments, a favorite pastime of the couple.

?Life is a gift,? Jean Pearson said. ?None of us have a guarantee that we?re going to live forever here. This gives us that advantage that we don?t have to be second-guessing.? What should I do?? We?ve already made those decisions. And they?re hard decisions. But we?re OK with them.?

Editor's Note: Harry Smith's full report airs Thursday, Sept. 20 at 10pm/9c on NBC's Rock Center with Brian Williams.

Source: http://rockcenter.nbcnews.com/_news/2012/09/19/13945441-making-hard-decisions-about-dying-brings-personal-financial-benefits

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Apple Mapocalypse Sends iOS 6 Users Into a Tizzy, Riverbank

Following the official launch of iOS 6 Wednesday, disgruntled users across the globe flocked to share their collective displeasure with Apple's new Maps app. The seemingly premature launch of this error prone app seems an unusual move for Apple, as relying on a quality maps service has become such an integral part of our smartphone experience.

Source: http://feedproxy.google.com/~r/GearFactor/~3/sHlwKnKBG0M/

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Worldwide Transportation & Limo Services ? actionlimousines

19 09 2012

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Source: http://actionlimousines.wordpress.com/2012/09/19/worldwide-transportation-limo-services/

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A big, angry Indonesian protest you may have missed (video)

From a year ago.

By Dan Murphy,?Staff writer / September 18, 2012

Muslim protesters burn a US flag during a protest against the film 'Innocence of Muslims,' which ridicules Islam and depicts the Prophet Muhammad as a fraud, a womanizer, and a madman, outside the US Embassy in Jakarta, Monday.

Dita Alangkara/AP

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A small protest outside the US Embassy in Jakarta last Friday was rolled into the global Islamopocalypse coverage.

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Old friend Arian Ardie pointed out on Facebook that an angry, mostly-Muslim crowd also protested in Jakarta a year ago today. That protest got far less media attention than the one spearheaded by the Front Pembela Islam (Islam Defenders Front) at the embassy last Friday. (I wrote a little bit about the FPI earlier this year). The same number of protesters, more or less, were involved in both, which both started at the Hotel Indonesia traffic circle, not far from the US embassy.

Given recent events I thought the Sept. 18, 2011 protest deserves a little more attention:

What riled those folks up? Jakarta governor Fauzi Bowo said after two horrific gang rapes in the city that women wearing "provocative" clothing were partly responsible for the crimes. He soon apologized.

To be sure, the Islamist protest against the US, over a video clip put on YouTube by an anti-Islam activist, was far more raucous and potentially violent (I've put some footage of the protest -- teargas! shouting! great TV! -- below for comparison). And it certainly should have been reported in the context of a wave of protests across the globe prompted by the insulting YouTube video. But have a look at both protest, and remember that the "Muslim world" monolith is a fiction.

Source: http://rss.csmonitor.com/~r/feeds/csm/~3/2N1cEkiOqbU/A-big-angry-Indonesian-protest-you-may-have-missed-video

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10 Things to Know for Today

Afghan police stand by burning tires during a protest, in Kabul, Afghanistan, Monday, Sept. 17, 2012. Hundreds of Afghans burned cars and threw rocks at a U.S. military base as a demonstration against an anti-Islam film that ridicules the Prophet Muhammad turned violent in the Afghan capital early Monday. (AP Photo/Ahmad Jamshid)

Afghan police stand by burning tires during a protest, in Kabul, Afghanistan, Monday, Sept. 17, 2012. Hundreds of Afghans burned cars and threw rocks at a U.S. military base as a demonstration against an anti-Islam film that ridicules the Prophet Muhammad turned violent in the Afghan capital early Monday. (AP Photo/Ahmad Jamshid)

Chicago Teachers Union lawyer Robert Bloch, left, talks to CTU delegates following a meeting Sunday, Sept. 16, 2012 in Chicago. The Chicago teachers union decided to continue its weeklong strike, extending an acrimonious standoff with Mayor Rahm Emanuel over teacher evaluations and join security provisions central to the debate over the future of public education across the United States. (AP Photo/Sitthixay Ditthavong)

Myanmar opposition Leader Aung San Suu Kyi, center, arrives at Yangon International airport to leave for United State Sunday, Sept. 16 2012, in Yangon. Suu Kyi leaves Sunday on her first U.S. trip since she was put under house arrest in 1990. (AP Photo/Khin Maung Win)

Your daily look at late-breaking news, upcoming events and the stories that will be talked about Monday (times EDT):

1. DEMONSTRATION IN KABUL TURNS VIOLENT

Hundreds of Afghans burn cars, throw rocks at a U.S. military base to protest an anti-Islam film.

2. SCHOOL'S STILL OUT IN CHICAGO

Parents scramble to find daycare as the teachers' strike enters its second week; the mayor says he will sue to end the walkout.

3. A STRATEGY SHIFT FOR THE GOP

With polls showing Obama leading nationally, Romney intends to more clearly outline what he'd do if elected.

4. HOW 'OCCUPY' HAS EVOLVED

Worldwide rallies Monday will mark the one-year anniversary of the movement, which these days is less organized but has more targets.

5. U.S. KIDS EAT TOO MUCH SALT, RESEARCHERS FIND

Extra salt is linked to higher blood pressure, especially for overweight or obese children.

6. FOUNDATION FOR SUCCESS

Men in South Korea ? the male makeup capital of the world ? turn to cosmetics to get an edge in workplace, romance.

7. LOTS OF UNCERTAINTY IN DECIDING WHEN TO TAKE KEYS FROM ELDERLY DRIVERS

States are all over the map when it comes to making rules targeting older, unsafe motorists, an AP review finds.

8. ANOTHER MILESTONE FOR EX-POLITICAL PRISONER

Myanmar democracy leader Aung San Suu Kyi will be honored with Congress's highest award this week in Washington.

9. WHY R&B SINGER HAS A COURT DATE

At 5 p.m., Chris Brown attends a hearing in Los Angeles amid questions about whether he's fulfilling his community service.

10. A KING'S RANSOM

Britain's royal family will sue the photographer who snapped photos of Kate sunbathing topless.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/3d281c11a96b4ad082fe88aa0db04305/Article_2012-09-17-10-Things-to-Know-Today/id-3cc4797d11a046308f4ba4fa78369bb6

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John Cage's Prepared Piano: Annoy and Educate Your Friends With Experimental Music [App Of The Day]

Not everyone can be as smart as all of us geniuses who studied experimental music in college. IGNORANT WRETCHES! If this app annoys them they can either learn what they should know anyway or be forever bummed at the atonal clangs that emanate from your ring tones. More »


Source: http://feeds.gawker.com/~r/gizmodo/full/~3/eRcHpmtIMQU/john-cages-prepared-piano-annoy-and-educate-your-friends-with-experimental-music

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How would you change SMS Audio Sync by 50?

How would you change SMS Audio Sync by 50

Rap singer, philanthropist, actor and high-end sound designer, truly Curtis Jackson is the Aristotle of our day. Of course, it's his latter profession that brings him to the coveted pages of How Would You Change, as we delve into his SMS Audio Sync by 50 wireless headphones. When our in-house audio maven strapped them to his head, he found that $400 price tag to be a little steep given how messy the overall experience was -- with features like "Thumpp" bass boost only available when connected via dongle and other features absent unless you buy more accessories. Our reviewer hoped that Version 2.0 would iron out all of those creases, but how about you? What suggestions would you like to send to the venerable 50 Cent about how he can improve these high-end cans?

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How would you change SMS Audio Sync by 50? originally appeared on Engadget on Sun, 16 Sep 2012 22:53:00 EDT. Please see our terms for use of feeds.

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Source: http://feeds.engadget.com/~r/weblogsinc/engadget/~3/mWNntxDZN1Y/

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Panasonic teases 42.5mm f/1.2 and 150mm f/2.8 MFT lenses, slated for release by 2014

Panasonic teases 425mm f12 and 150mm f28 MFT lenses, slated for release by 2014

Panasonic further reinforced its commitment to the Micro Four Thirds form factor when it released the Lumix GH3 mirrorless camera today, but the company also announced the development of a pair of prime lenses, set to ship next year or in 2014. Details are spotty at this point (limited to what you see in that slide above, in fact), but you can expect a 42.5mm f/1.2 optic (85mm equivalent) and a 150mm f/2.8 lens, which offers a 35mm equivalent of 300mm. There wasn't even a hint of pricing, but we'd expect both of these offerings to be quite costly, though they'll likely be significantly less expensive than DSLR equivalents.

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Panasonic teases 42.5mm f/1.2 and 150mm f/2.8 MFT lenses, slated for release by 2014 originally appeared on Engadget on Mon, 17 Sep 2012 07:47:00 EDT. Please see our terms for use of feeds.

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Source: http://www.engadget.com/2012/09/17/panasonic-teases-42-5mm-150mm-lenses/

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AlexandriaNews - Prostate Cancer: To screen or not to screen?

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September is National Prostate Cancer Awareness Month which brings with it questions about prostate cancer screenings, specifically the use of Prostate Specific Antigen testing.

There are studies that suggest that PSA testing leads to unnecessary treatments. Many urologists know that PSA tests are limited, but agree with The American Urology Association and The American Cancer Society revised screening guidelines recommending that doctors more heavily involve their patients in the decision about whether to be screened for prostate cancer.

?The types of tests used matter little compared to the mutual understanding between a man and his doctor about the risk factors for prostate cancer and? available treatment options,? says Dr. Yousef Salem, Urologist at Inova Alexandria Hospital. ?It?s important to understand a man?s baseline PSA levels and then track the changes in those levels over time. Therefore, PSA testing needs to be individualized?.

The combination of the PSA test (a blood test) with a digital rectal examination is the best way to detect prostate cancer and early detection is considered the best prevention. The increased incidence of earlier diagnosis of prostate cancer has led to men living longer with the disease. ?Data from screening studies showed PSA screening reduces prostate cancer mortality by 21%,? notes Salem.

The American Urology Association recommends baseline PSA screenings for me at ages 40 and 45, followed by annual screenings at age 50 for men who are not considered high risk for prostate cancer. Men with a family history of prostate cancer should be screened every year beginning at age 40. Annual screenings for men ages 40 and above are also recommended for African American men, who are at higher risk.

For more information on prostate cancer, please visit inova.org/cancer. There will be a free prostate screening held on November 4 at Inova Alexandria Hospital. To sign up, call 1-855-My-Inova (694-6682).

Source: http://www.alexandrianews.org/2012/09/prostate-cancer-to-screen-or-not-to-screen/

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Reply - Weblogs at Harvard Law School

Clinical Professor Phil Malone, who directs the HLS Cyberlaw Clinic, said: ?I am thrilled that these distinguished entrepreneurs will be sharing their expertise and wisdom with Harvard students working at the i-Lab. As we engage HLS students in the i-Lab both as innovators and as providers of legal services to i-Lab users through our Cyberlaw and Transactional Law Clinics, these new EIRs will serve as valuable mentors and inspiring examples.?

via HLS appoints four 2012-2013 Innovation Lab Experts-in-Residence.

This entry was posted in Uncategorized by amar. Bookmark the permalink.

Source: http://blogs.law.harvard.edu/berkmannews/2012/09/13/hls-appoints-four-2012-2013-innovation-lab-experts-in-residence-12-september-2012/

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