Health article

Mind and Body Practices for Older Adults

In 2012, the American College of Rheumatology issued recommendations for using pharmacologic and nonpharmacologic approaches for osteoarthritis (OA) of the hand, hip, and knee. The guidelines conditionally recommend tai chi, along with other non-drug approaches such as manual therapy, walking aids, and self-management programs, for managing knee OA. Acupuncture is also conditionally recommended for those who have chronic moderate-to-severe knee pain and are candidates for total knee replacement but are unwilling or unable to undergo surgical repair.

Current clinical practice guidelines from the American Academy of Sleep Medicine recommend psychological and behavioral interventions, such as stimulus control therapy or relaxation therapy, or cognitive behavioral therapy for insomnia (CBT-I), in the treatment of chronic primary and secondary insomnia for adults of all ages, including older adults. 

Overall, research suggests that some mind and body approaches, such as yoga, tai chi, and meditation-based programs may provide some benefit in reducing common menopausal symptoms.

There have only been a few studies on the effects of tai chi on cell-mediated immunity to varicella zoster virus following vaccination, but the results of these studies have shown some benefit.

There is evidence that tai chi may reduce the risk of falling in older adults. There is also some evidence that tai chi may improve balance and stability with normal aging and in people with neuro-degenerative conditions, including mild-to-moderate Parkinson’s disease and stroke.

There is some evidence that suggests mind-and-body exercise programs such as tai chi and yoga may have the potential to provide modest enhancements of cognitive function in older adults without cognitive impairment.

Source link

Health article

Heat Stroke and Hot Cars

Since 2017, the total number of children in the US that died from heatstroke after being left in a car is 72. Most of these children are under three years of age.   

As an emergency physician practicing in Florida, I’ve seen the devastating impact of heatstroke countless times. The loss of these children’s lives is tragic but avoidable. 

Florida ranked second to Texas with 72 deaths recorded from 1998-2015. When adjusted for per capita (population per one million), Florida is the fifth-worst state in the nation.

This mind staggering research comes directly from Mr. Jan Null, CCM, of the Department of Meteorology and Climate Science at San Jose University. “This danger exists despite public education, efforts, and lobbying for laws against leaving children unattended in vehicles,” Null said.

Consider the human science: What is heatstroke? Heatstroke is defined as a condition by which the body develops hyperthermia (fever), during which the body experiences a failure of the thermoregulatory system.   

We manage heat exposure by way of the brain, circulatory system, and skin – in a way similar to a cooling system of a car.  Humans cool by ways of convection and evaporation of sweat.  Severe hyperthermia is defined as prolonged exposure to a body temperature of 104° F (40° C) or higher.  

During this syndrome, the body first develops thirst, dehydration, and perspires. As the temperature of the infant raises above 104° F, it can lead to the inability to perspire, confusion, mental agitation, and eventual coma. The body’s maximum temperature before protein starts to break down and organ failure ensues is approximately 106° F.  

Children and infants are more susceptible to heat illness due to their innate inability to regulate heat when compared to adults. The important point is that the danger is a function of not only the

Health article

Tips from the ER on Childproofing Your House

Any new parent quickly learns that a toddler is into everything. It only takes a quick second for that child to get out of your sight and around something potentially dangerous. Emergency physicians treat children every day who are injured by something in their own home or someone else’s home.
Many childhood injuries that emergency physicians see daily are easily avoidable. The first step to prevention is to be aware of the items in your home, and knowing how to identify and eliminate potential childhood hazards

Unintentional injuries are the leading cause of emergency room visits among children under age 10 in the United States, according to the Centers for Disease Control and Prevention (CDC). More than 3 million children under age 10 were treated in the ER, while more than 3,300 children under age 10 died as a result of unintentional injuries.

Key Statistics:

  • Falls are the leading cause of non-fatal unintentional injuries for children under the age of 10.
  • 512,33 children under the age of five were injured by home furnishings and fixtures in 2018
  • Drowning was the leading cause of injury death for children ages 1 – 4.
  • Nearly 50,000 children under the age of five were treated in ERs for fire and burn related injuries in 2017. Fire/burn is the fourth leading cause of unintentional death in children between ages 1 – 4, and the third leading cause of unintentional death in children ages 5-9 (National Safety Council)

What You Can do in Your Home Right Now to Protect Young Children:

  • Use safety latches for drawers and cabinets in kitchens, bathrooms, and other rooms that may contain dangerous products. Items like cleaning supplies, sharp objects, and medicines should all be securely stored out of reach of children.
  • Use safety gates to help prevent falls down stairs
Health article

How to Talk About End-of-Life Decisions

When talking about treatment plans with patients in the emergency department, as physicians we lay out our concerns, the pros and cons of different options, and why we recommend one over the other for the particular patient. We do not ask patients which antibiotic combination they would prefer.

Why is it different when we talk about resuscitation or end-of-life wishes? Why do we suddenly ask patients “what they want” with no context or recommendation? We sound like waiters: “Do you want shocks with that CPR?” “What about intubation or pressors?”   

Discussing end-of-life options is a skill, like intubation or placing a central line, one that requires just as much preparation and practice. These options must be discussed in the context of the patient’s illness and his personal goals. Resuscitation should be discussed as an entity – not parsed out as individual selections. The only exception to this is in patients with a primary respiratory illness. In these cases, such as COPD patients, intubation may be discussed separately.

Physicians must think about this discussion as a fact-finding mission to uncover what the patient and family understand about three things: What is going on with your body? What do you understand about what the doctors are telling you?  What is your understanding of resuscitation? We listen, and when they are finished, we educate, give a prognosis and outline our recommendations.

Our recommendations are based on two facts: Whether what brought them to the emergency department is reversible or not. If it is not clear, we can offer “time-limited trials” of aggressive interventions including intubation. The family should understand that if the patient’s condition does not improve over the next several days, then we would withdraw or stop the aggressive treatments. And second, we consider the patient’s trajectory of illness and his