Posts Tagged ‘Heart Attack’

Hospitals and Health Care

Monday, February 8th, 2010

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“Following the release of the original data, we began a number of initiatives that are still ongoing toward defining the patient’s wishes at the time of admission regarding the extent of care that he or she wants provided.” But Press also notes that many patients and families served by his hospital “really desire very aggressive care. We are changing this to the extent it can be changed, but it is a cultural change.”

Cedars-Sinai Medical Center in Los Angeles ranked second for aggressiveness of end-of-life care. Thomas M. Priselac, the hospital’s president and CEO, says that while Dartmouth is doing “very important work,” without more detailed hospital-specific data “it raises more questions than it provides answers.”

A key question, of course, is whether patients are being kept alive longer in the regions that spend more money and deliver more aggressive care. “To judge survival, you have to look at people who are similarly ill and then follow them forward over time,” says Elliott S. Fisher, M.D., Wennberg’s longtime research collaborator.” And we’ve done that.” Their study of 969,325 Medicare beneficiaries hospitalized nationwide for three common conditions – colon cancer, heart attack, and hip fracture – published in the Feb. 18, 2003, issue of the Annals of Internal Medicine, analyzed the follow-up tests and treatments the patients received for up to five years after their very similar initial treatment.

Patients in the highest-spending areas received 60 percent more treatment than those in the lowest-spending areas, but the extra care didn’t seem to help at all, and it made some things worse. Patients in the high-spending, aggressive-care regions waited longer in emergency rooms and doctors’ offices than patients in lower-spending regions did. They were less likely to get recommended preventive treatments, such as aspirin to prevent future heart attacks, or appropriate immunizations. They were slightly more likely to die, and those who didn’t die weren’t any better off in terms of their ability to function in daily life. And overall they were no more satisfied with their care.

Other research groups have had similar findings using different methods.

A state-by-state score card on health system performance was issued in 2007 by the Commonwealth Fund, and independent health-quality research group. It graded such factors as overall population health, quality of care, access to care, and avoidable hospitalizations. Of the 13 states with the best scores, 10 have below-average end-of-life costs. And the three states in the Dartmouth study that spend the most on end-of-life health care – New York, New Jersey, and California – ranked 22nd, 26th, and 39th, respectively, in the Commonwealth Fund overall ranking.

A February 2008 study by the nonpartisan Congressional Budget Office found a reverse correlation between per capita Medicare spending and care quality. The percentage of patients hospitalized with heart attacks, pneumonia, and heart failure who get recommended treatments is lower in the higher-spending areas.

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The Animal Evidence part 1

Thursday, October 8th, 2009

The Greyhound stopped at 300 yards and pitifully crawled to the finish tape. This act of courage revealed its fighting spirit, as well as its ill health. When it was brought to Dr. Lambert’s clinic, the greyhound was immediately diagnosed as a heart disease case and put on Vitamin E therapy. To quote the exact words of Dr. Lambert: “He improved beyond belief and has since won seven races, is very fit and the heart appears normal.”

And have you read about the “brave bulls” which are supposed to charge the men opposing them until they are dispatched in the so-called, much-publicized “moment of truth”? There are, of course, many bulls that are sacrificed in this fashion in the Spanish bull rings every year. Yet who is aware that many bulls, in spite of their deliberately inbred and carefully fostered hatred of man, really cannot perform properly in the arena due to a lack of Vitamin E?

Many bulls who apparently would like to gore their tormentors cannot do so because they fall down in the fight before being killed by the gracefully performing matador or his cohorts. They are victims of what we call either “strokes” or “heart failures” in humans. Yet even after their seizures, some try nobly to perform their set roles in the drama of the bullfight, but usually they are unable to carry on; in the end, all are knifed and wheeled away, classified as cowards by the watching humans, who would think themselves extraordinarily courageous if they could, after suffering a heart attack, stagger to the nearest telephone or doctor’s office. Now, however, we have the benefit of some Spanish investigators who have determined the cause for the failure of some bulls to continue performing in the ring. Dr. D. Jordano and Dr. C. Gaspar Gomez studied 513 bulls who fell in the ring before they could be killed. They concluded that the circulatory and central nervous systems were drastically affected and that there was a “direct relationship between this condition and Vitamin-E deficiency.” (See also Bonadonna and  Kaan.

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