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3 posts from December 2013

12/21/2013

Life (and Death) as a Hospice Physician: A Conversation with Bruce Doblin (December 20th)

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Of the two and a half million Americans that die annually, less than half, or 45%, die under hospice care.  About one-third of these deaths are cancer related the remainder are moreover from heart and lung disease and dementia.  Of the over 5,000 hospice providers nearly two-thirds are for profit.  Over 80% of all hospice care is paid for by Medicare.  While hospice care is ever-increasingly becoming accepted by the public, the program's benefits are compromised largely due to the fact that over one-third of hospice enrolled decedents were enrolled in the program for too short a period of time, or less than seven days.  

During this 21 minute podcast, Dr. Doblin discusses why he became a hospice physician, what makes for good hospice care, why the benefit remains under-utilized, what constitutes a "good death," how might hospice and palliative care be improved and how these services might better fit  in ever-evolving changes in the health care industry.     

Dr. Bruce H. Doblin is currently a Physician in the Department of Internal Medicine at Northwestern Memorial 005412[1]Hospital.  He also serves as an Instructor of Clinical Medicine-Internal Medicine at the Northwestern University Feinberg School of Medicine.  Previously, Dr. Doblin served for over ten years as the Medical Director for Seasons Hospice and Palliative Care in Chicago.  Dr. Doblin earned his BA in Economics at Williams College and his MD and Masters in Public Health from Northwestern University.  He completed fellowship training at UCLA in health services research and at the University of Chicago in Clinical Medical Ethics.

12/18/2013

The Mind-Body-Heart Connection in Health and Evidence for Meditation: A Conversation with Robert Schneider (December 18th)

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 Transcendental Meditation (TM) has long been studied as an approach to improving health status generally and lowering blood pressure specifically.  For example, the American Heart Association published research in 2012 that found African Americans who practiced TM regularly over five years were almost half as likely to have a heart attack or stroke or die from all causes compared to African Americans who attended health education classes due to lowered blood pressure and improved anger management.  Among other applications, TM has also shown to be effective in reducing PTSD and polytrauma among active military service members and veterans.  

During this 21 minute podcast Dr. Schneider discusses what's meant by the "mind-body-heart" connection, what role can/does TM play in influencing these connections, the research evidence for TM's use in reducing hypertension and more generally stress and anxiety for a wide variety primary and secondary disease prevention purposes and the level of acceptance for TM within the medical community.     

Dr. Robert Schneider is currently the Director and Senior Investigator of the Center for Natural Medicine and Prevention at the Maharishi University of Management Research Institute.  Over the course of his career Dr. Schneider has been awarded more than $20 million in grants from the NIH for his pioneering research on natural approaches to reducing heart disease.  Dr. Schneider is a Fellow of the Photo_schneider[1]American College of Cardiology, a former member of the White House Commission on Complementary and Alternative Medicine Policy and has has served on numerous commissions and expert panels for the Congress, the CDC and others.  Dr. Schneider is the author of Total Heart Health and over 100 medical research articles.  He has been featured in numerous media reports including CNN, The New York Times, and Time magazine.  He received his MD from the University of Medicine and Dentistry of New Jersey and did his residency training at the University of Michigan Medical Center.

12/09/2013

Declining Heart Rate Variability as a Predictor of the Onset of Disease: A Conversation with James Palmer (December 12th)

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Human physiology or biological functioning exhibits fractal or irregular patterns.  When heart rate, (or respiration rate, blood pressure, brain waves and even walking stride length) begins to lose its fractal dimension or there is a loss of heartbeat variability, this is an indication of illness.  In order to respond best to environmental circumstances, adaptative variability (not homeostasis) is what organisms strive toward.  Measuring therefore the decline in heart rate variability over time can serve as a clinically effective biomarker for the onset of disease, for example, the onset of chronic obstructive pulmonary disease (COPD), one of the leading causes of hospitalizations and re-hospitalizations.  

During this 20 minute interview Professor Palmer explains briefly the science behind what explains heart rate variability and variability more generally in biological functioning, what are the clinical or health care or clinical applications for this research, his research to avoid COPD hospitalizations and the onset of infection for leukemia patients, the larger implications of this research work and receptivity toward this different paradigm in understanding biological functioning and disease progression.

Dr. James Palmer is an Assistant Professor in Family Medicine at the University of Colorado's Anshuyltz Medical Campus in Denver.  His research concerns testing and developing the use of heart rate interval dynamics as an actionable prognostic biomarker for earlier detection and PhotoHandler[1]diagnosis COPD exacerbation.  Dr. Palmer also has an independent professional practice that designs applications of complexity sciences to improve clinical care processes and outcomes.  His work has helped to develop and implement healthcare improvement projects both in the US and Canada.  Dr. Palmer completed his Doctor of Management in 2007 at the Complexity and Management Centre, University of Hertfordshire, UK.  He was also educated as an economist at the University of Chicago (MA) and Texas Christian University (BA).

For a review of the theory behind and applications for monitoring variability see, for example, Andrew JE Seely, et al. "Continuous Multiorgan Variability Monitoring in Critically Ill Patients - Complexity at the Bedside," at: http://www.therapeuticmonitoring.com/files/IEEE-CIMVA-paper_Boston_Sep-2011.pdf