Stanford physician discusses rapid growth of palliative medicine and legislation to meet demands


Demand for palliative care has grown (.pdf) tremendously over the past decade. VJ Periyakoil, MD, director of Stanford’s hospice and palliative medicine fellowship program, has experienced firsthand how the burgeoning specialty has exploded, and how the nation’s physician workforce has struggled to keep pace.

“We are at a point in time where the demand for quality palliative care far exceeds the supply of clinicians with required expertise,” Periyakoil told me. “It takes a long time to train doctors and currently we are churning out about 300 fellows annually. Each year, the fellows who graduate from our palliative care fellowship get multiple job offers and most are often recruited to leadership positions.”

A recent American Medical News story offered a detailed look at the rapidly growing need for palliative care services, as well as physicians trained in hospice care:

From 8,000 to 10,000 physician specialists are needed to meet demands in hospice and palliative care programs nationwide, according to the [American Academy of Hospice and Palliative Medicine], a professional organization for hospice and palliative medicine physicians. But only 4,500 doctors specialize in the field, and training programs are expected to produce only an additional 4,600 specialists in the next 20 years, the academy said.

The demand for palliative medicine is driven in large part by advancements in biomedicine and the United States’ graying population. Additionally, a growing body of scientific evidence on the speciality is beginning to show it can improve quality of life for patients diagnosed with serious chronic illnesses and can reduce health costs. As a result, an increasing number of  hospitals are adding or expanding their palliative care programs and more patients seeking services.

In an effort to increase interdisciplinary training in hospice and palliative care, Congress is considering legislation that would allocate nearly $50 million for a range of programs, including training for doctors and fellowships to encourage mid-career physicians to transition to the specialty. The Palliative Care and Hospice Education and Training Act was introduced in July and would also provide awards to support educators in the field.

When I asked Periyakoil how the bill, in enacted into law, would help meet future hospice and palliative care demands, she responded:

If we look at the field of geriatrics, the federal Health Resources and Services Administration funds the Geriatric Academic Career Award (GACA) to increase the number of junior faculty at accredited schools of allopathic and osteopathic medicine. It also promotes the development of their careers as academic geriatricians who emphasize training in clinical geriatrics, including the training of interdisciplinary teams of health professionals. The proposed legislation is a similar effort to promote interdisciplinary palliative care.

The bill could also have important implications for Stanford’s fellowship program. Our fellowship is the oldest interprofessional palliative care fellowships in the country. Funded by the Office of Academic Affiliations, the program trains fellows from the field of medicine, psychology, social work and chaplaincy in palliative care. The fellows learn to train together and work together. Currently, this model is restricted to the fellows serving Veterans Affairs hospitals due to funding reasons. In the future, if the legislature passes, I hope that we will have funding to expand these interprofessional fellowships in academic medical centers.

Previously: Helping caregivers practice palliative care and Examining the generational gap between physicians and patients in hospice and palliative care
Photo by Don LaVange

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The big downside of some life-changing medications


Several years ago, I listened in a state of semi-shock as a doctor gave me a classic bad news-good news combination: The autoimmune system disorder I had was incurable and life-threatening, but researchers had recently discovered that a certain package of medications could put it into remission. I remember that conversation well, but I don’t recall the doctor mentioning much, if anything, about the side effects of those medications.

At age 12, Jena Graves of Napa, Calif. faced the same serious situation. She was diagnosed with the autoimmune system disease lupus, and among her essential medications was the same steroid I was given, prednisone. It’s a go-to medication for millions who suffer from conditions including asthma and diabetes; it’s also on a short list of commonly prescribed “obesogenic” drugs whose effect on the body includes rapid weight gain.

Graves, just 5 feet 2 inches tall, shot up from 120 pounds to 272 pounds and developed Type 2 diabetes and other obesity-related health problems.

A colleague recently shared Graves’ story, which was told again in today’s San Francisco Chronicle. In the piece, Stanford’s John Morton, MD, who performed gastric bypass surgery on Graves this summer, raises a flag on behalf of patients like her:

“All these medications are absolutely wonderful when they work in the right patients,” [said Morton]. “But we’ve got to figure out if it’s appropriate or not to blanket America with prednisone and other obesity-generating drugs that are creating problems.”

Graves isn’t the only patient who has paid the price for being on one prescription too many, he said.

“I can’t tell you how many patients come in to see me who’ve been on medications for years,” he said. He asks: “Why are you on this medication? ‘I don’t know.’ Has someone followed up? ‘No. I just get my prescription refilled.”

Previously: When medications cause severe obesity

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25 sitios inspirados en el rosa


Existen sitios inspirados en el verde,púrpurablanco y negro… Cada uno busca la inspiración en un determinado color. El rosa es un color muy bonito, moderno, que refleja un atractivo y rebeldía en los sitios web que muy pocos colores pueden conseguir. Si estás buscando un color atractivo y original para tu diseño, seguramente esta lista de 25 sitios web inspiradosen el rosa te ayudarán:

MailChimp 5.3

pinksites23

odopod

pinksites01

GoodBytes

pinksites02

Stack

pinksites03

Digital Devotion

pinksites05

We Shoot Bottles

pinksites06

LizLance

pinksites07

Solid Giant

pinksites08

Leer más “25 sitios inspirados en el rosa”

Herramientas para gestionar tu propia Identidad Digital


Social BlaBla

En gran parte de la formación y charlas que estoy impartiendo últimamente surge la pregunta y el miedo latente a lo que Internet “dice de mi”. No cabe duda de que Internet avanza a pasos de gigante hacia convertirse en algo imprescindible e inherente a nuestras vidas como ciudadanos del siglo XXI. Queramos o no la digitalización de información pública, como la relativa al BOE o Boletines Oficiales de Provincia, y otros tantos espacios donde se recoge información de nuestras personas como ciudadanos, hace de la aparición de nuestro nombre y apellidos en Google cada vez algo más frecuente.
identidad digital

Ello, unido a que cada vez más empresas buscan los perfiles de los candidatos a ofertas de trabajo en Internet y las redes sociales, hace que la preocupación por no estar en Internet sea un miedo cada vez más innecesario y que debemos olvidar. Los datos así lo avalan, ya que, por ejemplo, Catenon, multinacional española de búsqueda global de profesionales, utiliza Internet y las redes sociales en el 80% de los procesos. Por tanto, hemos dejado de ser una mera marca blanca para convertirnos en empleados con nombre y apellidos y que deben reflejar el valor de lo que saben, hacen y conocen en Internet (La búsqueda de empleo se hace global con Catenon)

Ante este panorama la gestión proactiva de la Reputación Online de cada uno es más necesaria que nunca con el fin de evitar algunos de los incidentes que podemos ver en noticias como “Condenados a permanecer en la Red” o “La web no olvida“. Está claro que en Internet conviven nuestra Identidad presente con la atemporalidad característica de la red y acontecimientos del pasado pueden afectarnos en el futuro a la hora de acceder a un determinado puesto profesional o afectarnos en nuestra propia vida. Por eso, el mejor de los consejos es el sentido común a la hora de publicar contenido ya sean en nuestras propias redes sociales o blogs como en otros medios y canales en los que realicemos comentarios reflejando nuestra identidad real. Además, preocuparnos por gestionar las opciones sobre nuestra privacidad en las diferentes redes sociales en las que estamos presentes es algo más que recomendable.

Sin entrar en detalle de las redes sociales en las que podemos establecer una presencia personal (Facebook, Twitter, Linkedin, etc.) y la optimización en privacidad o participación de cada una de ellas, si quería compartir algunas herramientas que me han parecido interesantes a la hora de buscar personas, buscar nombres de usuario, visualizar información o establecer de una manera sencilla nuestra presencia en Internet.

Buscadores de personas: Leer más “Herramientas para gestionar tu propia Identidad Digital”

PayPal expands presence in US retail stores with new Discover partnership


PayPal already has a partnership with MasterCard in place that lets you use its debit cards in stores, but the company has now expanded that retail presence even further with a new deal it’s struck with Discover. Starting sometime next year, that arrangement will let PayPal customers use their charge cards at any of the 7 million retail locations that accept Discover cards, with funds drawn directly from their PayPal account. What’s more, PayPal says that retailers won’t have to make any hardware or software upgrades to accept the PayPal payments, noting that they’ll simply have to let customers know of the new option with in-store signage. Of course, the deal also likely has implications beyond traditional plastic cards, as PayPal is now also pushing its mobile payments more than ever, not to mention its own triangular Square competitor. You can find the official announcement below.

Press Release:

PayPal and Discover to Bring PayPal to Millions of In-Store Locations

PayPal’s 50+ Million U.S. Customers Will Be Able to Pay with PayPal in Millions of Merchant Locations in 2013

SAN JOSE, Calif. & RIVERWOODS, Ill.–(BUSINESS WIRE)–Today, PayPal announced an extension of its offline strategy by teaming up with Discover to bring PayPal to more than 7 million merchant locations across the U.S., and potentially to millions of international merchant locations in the future. Starting in 2013, Discover will work with PayPal to enable participating merchants to accept PayPal easily through their existing relationship with Discover. Consumers will be able to take advantage of the benefits of PayPal at these merchant locations, providing them with the simplicity, speed and security they’ve come to expect from PayPal across any channel, any time.

“This initiative will result in real change and innovation for the industry by bringing new technologies to the point of sale that benefit merchants and PayPal customers.”
“We’re delighted to enable PayPal’s efforts to provide their U.S. customers acceptance at millions of physical point-of-sale locations by leveraging our unique payment services assets. The establishment of this relationship is a major industry milestone, which will help shape the emerging payments landscape by bringing together an established direct banking and payments company with a leading commerce enabler to create an alternative payments option for consumers at the point of sale,” said Diane Offereins, President of Discover Payment Services. “This initiative will result in real change and innovation for the industry by bringing new technologies to the point of sale that benefit merchants and PayPal customers.” Leer más “PayPal expands presence in US retail stores with new Discover partnership”

Facebook transforms Messages into a more functional email inbox


http://venturebeat.com

Facebook Messages, the company’s long-promised answer to email, now actually
looks and functions a lot more like a typical inbox.
Image representing Facebook as depicted in Cru...The social network today launched a new version of Messages with cosmetic and under-the-hood improvements designed to make a person’s Facebook inbox a more appropriate place for speedy web and mobile exchanges.With the new version of Messages, Facebook has made it clear that intends to make the product a full-fledged replacement for email.

“We know how to scale email,” Facebook’s vice president of infrastructure Jay Parikh said in a meeting with the press today. “This is a scaling problem that’s well understood for two decades now. From a perspective of comparing that to what we’re doing, you’ll see that we’ve had to innovate around how to make that real-time and dynamic for our users.” Leer más “Facebook transforms Messages into a more functional email inbox”

Fully electric urban car can make itself smaller


Researchers at MIT’s Changing Places Group and Denokinn have now begun testing the Hiriko Fold, a fully electric vehicle which is able to collapse into a more compact shape when parking.

alttext

 The two-seater vehicle has one large door at the front to save yet more space. Each wheel can be controlled independently of the others, allowing for sharper turning and easier parallel parking into tight spaces. The following video gives a demonstration of the Hiriko Fold in action:

We recently saw the Lit C-1 provide a glimpse into the future of transport design, and now researchers at MIT’s Changing Places Group and Denokinn have begun testing the Hiriko Fold, a fully electric vehicle which is able to collapse into a more compact shape when parking.We first heard about the project while it was still in the concept development phase, but the team have since created a working model of the Fold, which is being test driven around the streets of Vitoria-Gasteiz, in the Basque region of Spain. Leer más “Fully electric urban car can make itself smaller”

Create your own definition of innovation | game-changer.net


by Jorge Barba
innovation clarity

As part of my auditing process, one of the key questions I ask is: what was the most recent innovation in your industry?

Depending on how this question is answered, it will tell me a few things:

  • How this company both defines and perceives innovation
  • If they are focused on innovation
  • If they are keeping tabs on their respective industry

That question is followed up with a similar but less obvious question: who is the most loved in your industry and why?. This one tells me if they even care about delighting their customers. But it can also tell me if they associate customer loyalty with innovation. Leer más “Create your own definition of innovation | game-changer.net”

My customers are paying their bills late!


http://freelanceswitch.comGetting Paid by Freelance Clients

Freelancers have the most unusual type of obstacles when it comes to getting their clients to pay them. Beyond customers going M.I.A. or claiming they forgot, sometimes freelancers find clients refusing payment because they are unsatisfied with the work or not sure if it’s what they wanted. Yet, the work was done, so you deserve to be paid. End of story.

As a freelancer, you need to take proper and effective precautions to make sure you don’t find yourself in a position where a customer is paying you late or not even paying you at all.

1. Do Your Research

Get to know as much as you can about a client before you agree to do business with them. Get references from people who have worked with them and even pull a business credit report on a client if necessary. You must find a way to verify their financial behavior. You don’t want to bother wasting your time with someone who is notoriously a deadbeat.

2. It’s About the Contract

Never do any work on a freelance basis without having a well-structured, detailed contract. Although this takes time to prepare, it can end up saving you time (and huge amounts of money) in the end. Verbal agreements, handshakes, etc., these kind of agreements will never be enough. You need it ALL in writing.

You need to make the customer sign to the fact that, basically, they won’t be wishy-washy.

Be sure the contract specifies exactly what the payment terms are. Do they owe you money up front? When is the exact due date of the payment? And of what amount? Don’t leave any room for questions. Make sure a customer knows exactly when and how much they have to pay and signs to acknowledge this.

Include in the contract that “opinionated oppositions” will not be accepted. Specify that customers are paying for the service provided regardless of final reactions and that you are promising to deliver the service to the best of your ability in line with everything they ask.

Include in a note that if a customer decides that the original service was not what they had intended, or if they’ve changed their mind, that is to be considered a separate process and transaction. You need to make the customer sign to the fact that, basically, they won’t be wishy-washy. This video provided by the “Don’t Get Screwed Over”campaign highlights exactly what I mean by “wishy-washy”.

3. Utilize the Invoice

Leer más “My customers are paying their bills late!”

Tienda on-line contrata modelos que darán abrazos gratis en NY


http://news.iguanahosting.com/

Vivir en una ciudad como Nueva York puede ser muy duro. Shoptiques.com lo sabe, por lo que emprendió una misión para combatir las rudezas de la Gran Manzana y sacarle un par de sonrisas a sus habitantes: Contrató a cinco amigables modelos que recorrerán las calles dando abrazos gratis.

Las bellas embajadoras de la marca abrazarán a los paseantes desde las 11 a.m. en SoHo y terminarán horas después en Columbus Circle (mira la ruta completa al final de la nota). Para garantizar tu abrazo, el sitio hizo disponible un mapa del recorrido y la posibilidad de “apartar” los cariños de las modelos.

Shoptiques.com…  Leer más “Tienda on-line contrata modelos que darán abrazos gratis en NY”

Parque temático israelí instala WiFi en burros


 

FayerWayer
burro

El parque temático Kfar Kedem en Israel busca recrear cómo era vivir en los tiempos bíblicos, cuando no había automóviles, ni teléfonos móviles ni tampoco WiFi. Sin embargo, Kfar Kedem sí tiene WiFi, para permitir que las personas que lo visiten puedan comentar su experiencia en Twitter o subir fotos de los tiempos bíblicos a Instagram, por ejemplo. Leer más “Parque temático israelí instala WiFi en burros”

Smoking rates increasing in the developing world


Although smoking rates in the United States have been slowly declining, tobacco use is on the rise in several developing countries.

In a recent Atlantic post, Lindsay Abrams takes a closer look at the pervasive influence of cigarette manufacturers in the developing world and offers data from the latest Global Adult Tobacco Survey (subscription required).

Survey results show that nearly half of men in 14 developing countries are tobacco users and that women are starting to smoke at younger ages. Overall, researchers predict smoking will cause one billion deaths in the 21st century. Despite the grim outlook, Abrams says there’s reason to be optimistic:

Quit rates are noticeably higher in countries with programs in place for discouraging tobacco use and helping with quitting, such as the U.S., the U.K., Brazil, and Uruguay.

As the world looks to countries as models for tobacco use, Uruguay deserves note. It was included in GATS precisely because of its stringent anti-tobacco policies, including mandated graphic labels that take up 80 percent of cigarette packaging, sales tax increases, and bans on tobacco advertising and on indoor smoking in public places. Earlier this month, the International Tobacco Control Policy Evaluation Project (ITC) released a report indicating that the prevalence of tobacco use in Uruguay has decreased by 25 percent over three years.

Among other promising data, 70 percent of Uruguay’s smokers expressed regret for every having taken up smoking, and in the five-year period covered by the survey, over two-thirds of smokers at least attempted to quit. Positive health changes are already being seen, and may in part be attributed to these policies. The ITC found a 22 percent reduction in the rate of hospital admissions for heart attacks and a 90 percent decrease in air contamination in enclosed public spaces in the year after they were enacted.

Previously: A call to stop tobacco marketing, Study suggests genetics may predict success of smoking cessation methods and What’s being done about the way tobacco companies market and manufacture products
Photo by Alex Dram

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¿Cuánta gente vivió a lo largo de la historia?


En la década del 70, un escritor señaló que el 75% de todas las personas que habían vivido en la Tierra a lo largo de la historia estaban vivas en ese preciso instante.

Su apreciación era difícil de comprobar en ese momento. Esa estimación habría sido verdadera si el número de personas nacidas en el siglo XX hubiese superado con creces el de cualquier época precedente o si gran parte de la población viva en 1970 hubiera sido extraordinariamente vieja.

La Oficina de Referencias sobre Población (Population Reference Bureau), una organización no gubernamental con sede en Estados Unidos, ha puesto en cuestión la validez de estas premisas. Según han explicado, de ser cierta esa teoría, el siglo XX se habría caracterizado por el extraordinario ritmo de crecimiento de la población. Pero si es falsa la idea de que ahora están vivas las tres cuartas partes de la población que alguna vez existió, ¿cuál es la estimación verdadera?

A lo largo de toda la historia han nacido 108.000 millones de seres humanos.

Foto: Infobae


Este resultado no deja de ser una estimación. Pero tampoco debe ser desechado como si fuera una quimera. De entrada, es algo interesante conocer esta conclusión que tiene al menos una base semicientífica, como indica el PBR. Ellos mismos reconocen que no hay documentación demográfica disponible para el 99% del tiempo que abarca este estudio.

Para suplir esta deficiencia, la Oficina parte del año 50.000 a. C. Aunque los homínidos caminaron sobre la Tierra hace millones de años y el Homo sapiens ancestral ya existía en el año 700.000 a. C., la ONU considera que el Homo sapiens moderno apareció en aquella época.

El punto de partida Leer más “¿Cuánta gente vivió a lo largo de la historia?”