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Esteban Delisio





    People recovering from surgery now have a new option for pain relief that allows them to avoid oral narcotics, which can have severe side effects, such as confusion, respiratory depression, nausea, and constipation. The ON-Q Pain Management System consists of a small round pump filled with a non-narcotic local painkiller that is attached to a small tube and inserted during surgery. The pump slowly delivers the painkiller for one to five days following the operation. Once the anesthesia is gone, either the doctor or the patient can remove the pump. Doctors at John F. Kennedy Memorial Hospital in Indio, California, are using the system for many common surgeries including colon and heart procedures, cesarean delivery, and hernia repair. Patients using the system have experienced better pain relief and have required shorter recovery periods and hospital stays than people receiving traditional narcotic therapy.
    No one likes to think of putting a loved one in a nursing home, but it's a sad reality many of us must face at some time. Researchers at the University of California, San Francisco, have identified some basic categories of things to look for when evaluating the quality of a nursing facility. Those categories are: general quality of care (maintaining good nutrition; preventing or treating pressure ulcers, incontinence, and weight loss; maintaining independence); preventing abuse and the use of physical restraints; providing appropriately for the resident's health needs; protecting their rights; providing a safe and clean environment; proper administration of drugs; and employing a staff in compliance with minimal state and federal standards. This information will be included in a new consumer web site under development with funds from the California HealthCare Foundation.
    Elsewhere at UCSF, doctors have found that folic acid and vitamin B12 may offer cost-effective treatments for heart disease and could reduce deaths related to heart disease among adults in the US. Principal investigator Jeffrey Tice, MD, and his colleagues studied the available data on blood levels of a compound called homocysteine in the general population. Earlier studies have shown that even modest elevations in this substance are associated with higher mortality from strokes and heart attacks. However, recent trials also have shown that folic acid and vitamin B12 can lower homocysteine levels by nearly one-third when taken together. Using a computer model, Tice and his associates determined that enriching the American grain supply with folic acid would lower cardiovascular deaths by 8 to 13%. Additional supplements of folic acid and vitamin B12 would result in 310,000 fewer heart-related deaths over 10 years. The supplements would save money as well a! s lives: $24 billion between 2001 and 2011, simply by treating heart disease patients with vitamin B12 and folic acid.
    A new program sponsored by the American Medical Association will help families recognize when an elderly loved one should hang up the car keys. Working with gerontology and other medical and driving experts across the country, John Flynn, a medical student at the University of Virginia, is developing a series of pamphlets that doctors can distribute in their offices and use as starting points for discussions on what can be a difficult and emotional topic for seniors and their relatives. The top medical conditions that affect an older person's ability to drive include Alzheimer's disease, arthritis, cataracts, diabetes, glaucoma, macular degeneration (deterioration of the retina), Parkinson's disease, the use of sedating medications, seizures, sleep apnea (difficulty breathing while asleep), and a history of strokes. "The goal of this effort is not to stop the elderly from driving," says Joanne Schwartzberg, MD, of the AMA. "We have to be realistic about ! the impairments from chronic illnesses that mount up as we get older. We want to provide the best information possible so families and physicians can make difficult decisions together."
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