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Most disease progress in a somewhat predictable manner. Knowledge of the expected disease trajectory is essential for prognostication. Today, let’s talk about the three types of trajectories. Trajectory 1: The patient experiences relative wellness followed by a short but predictable period of decline leading to death. Typically associated with cancer diagnoses, and the expected time from…

The hypertension guidelines recommend that high risk patients should begin medications if their average BP is ≥130/80 mmHg. For lower risk patients (no history of cardiovascular disease or an ASCVD risk <10%) medications are recommended for primary prevention when their average BP is ≥140/90 mmHg. 高血压指南建议，如果高危患者的平均血压为 ≥130/80 mmHg，则应开始药物治疗。对于低风险患者（无心血管疾病病史风险 <10%），当平均血压为 ≥140/90 mmHg…

Studies showed that hypertension affects nearly one in two adults in the United States. More men than women have hypertension up until age 64, when the number of women exceeds that of men. Despite this high prevalence, only two-thirds of adults with hypertension are aware of it. Of those who are aware, only 53% receive treatment. More striking is that only 25% diagnosed with hypertension have…

Learning about Hospice Care as Naive (Reading & Sharing)

This is an X year old man/woman with the hospice diagnosis of Y, and comorbidities of Z. … … Hospice care is a specialized care specifically tailored to terminally ill patients, who no longer receive curative treatments but aim at providing symptom management for patients with terminal illnesses and support for their families. Hospice patients can receive the Medicare hospice benefit.…

Is laughter good for your health?

Driving… Around and Around… It’s Ok… Mommy…

Euthanasia- Good Death vs Killing on Request (Reading & Sharing)

The word euthanasia is combination of the Greek eu= good, and thanatos = death. Literally and etymologically it therefore means “good death”. Historically and scholarly, euthanasia in the strict- and in the Dutch context the only proper- sense refers to the situation in which a doctor kills a person who is suffering “unbearably” and “hopelessly” at the latter’s explicit request (usually by…

Reading and Sharing My Notes (5)

Quality improvement is not a department or a single entity, but an ongoing conglomeration of approaches for improving cost reduction, efficiency, satisfaction scores, and overall outcomes. Research-based outcomes are now the standard for implementing changes within an organization. Bechmarking against successful organizations is another tool used in quality improvement, as well as surveys, root…

When the Movies Promoted Smoking (Piece of History – Reading & Sharing)

When Columbus landed in the New World in 1492, he and his men were astonished to find the native Indians smoking rolled-up tobacco leaves, the forerunners of present-day cigars. In the 16th century, Sir Walter Raleigh set London on its ear by puffing away on an elaborate pipe that he brought back from America. Soon tabacco smoking spread to Europe, and the craze was on. Doctors, noting its…

Reading and Sharing My Notes (3)

Risk factors for complicated grief include a history of mental illness, substance abuse, previous loss, and sudden unexpected death. Medicare pays for bereavement counseling for up to 1 year after the patient’s death. Additional grief counseling would then be through a local support group. Studies have shown that men are less likely than women to openly express emotions or openly cry. This is…

Reading and Sharing My Notes (2)

Hospice eligibility for dementia requires stage 7C or below according to the FAST scale (this means the patient is unable to ambulate without assistance, unable to dress or bathe without assistance, has urinary and fecal incontinence, and cognitive function has declined to the point where the patient can speak fewer than 6 words), as well as one or more qualifiers such as aspiration pneumonia. A…

Reading and Sharing My Notes

Refractory or intractable symptoms are those that cannot be managed, even with agressive treatment. Often, for symptoms that multiple approaches have been used to manage symptoms and have failed, may require transferring the patient to an inpatient hospice facility. Pain management in cancer patients is an important goal of care. Pain presents differently depending on the type of cancer. Usually,…

COVID-19 (Reading & Sharing)

Figure is Ultrastructural morphology of SARS-Co V-2 Pathophysiology of COVID-19 Infection: SARS-CoV-2 is a single-stranded RNA virus that belongs to the Orthocoronavirinae subfamily. It consists of 16 nonstructural proteins and 4 structural components: spike glycoprotein (S), envelope protein, membrane glycoprotein, and nucleocapsid phosphoprotein (N). However, the viral types can differ across…

Delirium in Dementia (Reading & Sharing)

Delirium is defined as an acute change in attention and cognition with the hallmark pattern of waxing and waning behaviors. Anyboy with a preexisting functional or cognitive impairment is at higher risk for develiping delirium, and the diagnosis of delirium in persons with dementia is commonly missed by clinicians because the presentations are mistakenly perceived as being part of the chronic…

Dementia 老年痴呆症 (Reading & Sharing)

Dementia is a neurocognitive syndrome with persistent intellectual and functional decline. Patients with advanced progressive dementia due to Alzheimer’s or multiple infarcts can live a long time until they finally develop complications that take their lives. They are considered close to death when they are functionally incapacitated and complicating conditions develop. (more…)