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Pregnancy
and the Risk of Blood Clots
Of all the complications that may occur during pregnancy, clots that
obstruct blood vessels are the leading cause of death in pregnant women.
Still, such occurrences are relatively uncommon. How do you know if
venous thrombosis, as the condition is called, is something that you
should worry about? How do you know if drug treatment is necessary?
Researchers are trying to answer these questions.
In Germany, physicians conducted a study to determine the risk of clots
associated with certain genetic and protein factors in pregnant women.
The researchers collected and analyzed blood samples from women with
a history of blood clots during or after pregnancy. These samples were
compared to blood samples from women who did not experience these problems.
According to the results, women with normal genetic and protein factors
had only a 0.03% risk of formation of blood clots. The findings also
showed that two genetic abnormalities, known as G20210A prothrombin-gene
mutation and factor V Leiden, are individual risk factors for blood
clots, increasing the risk of blood clots to 0.5% and 0.25%, respectively.
In addition, a woman who has both variations has a greater probability
of experiencing blood clots during pregnancy (4.6%). However, only
9.3% of the women with a history of blood clots had both genetic variations.
Women with deficiencies in proteins that prevent blood clotting were
also at increased risk for this complication during pregnancy (0.4%
probability).
The results do not suggest that every pregnant woman should be screened
for the genetic variations associated with blood clots. Rather, women
who have a personal or family history of problems due to blood clots
should discuss the need for screening with their obstetrician. Treatment
is available to help prevent the formation of blood clots in women
who are at an increased risk.
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Dying
a Good Death
All of us must
die at one point or another. While there is no "correct" way
to die, researchers have identified six themes that are
important to patients and their families as a terminally
ill person approaches death.
The purpose of this preliminary study was to gather
descriptions of the components of a “good” death
from patients, families, and healthcare providers.
Through the use of focus groups and in-depth interviews,
the researchers were able to identify the attributes
of a good death in terminally ill patients. Study participants
included physicians, nurses, social workers, chaplains,
hospice volunteers, patients, and recently bereaved
family members (77 people participated in the study).
Six common themes emerged from the information collected:
pain symptoms and management, clear decision making,
preparation for death, completion, contributing to
others, and affirmation of the whole person. Participants
feared dying in pain. To them, a good death involved
a provider who attended to these fears. Through clear
decision making and communication, participants believed
the fears about pain could be reduced. By participating
in decision making, patients felt empowered and in
control. Individuals wanted to be prepared for death
and to know what would happen during the dying process
and afterward. Discussions involved the need for a
sense of completion by spending meaningful time with
loved ones and paying attention to spiritual beliefs.
Many described the importance of allowing the patient
to contribute to the well being of others by passing
on knowledge or gifts and spending time with them.
A recurring theme was the importance of treating the
patient as a unique, whole person and not a disease
or case.
While the researchers recruited study participants
primarily from the Veterans Affairs system and many
of the patients were men, these volunteers represented
a broad range of ages, educational levels, socioeconomic
backgrounds, and healthcare settings. The results of
this study offer a starting point from which we can
attend to the needs and values of a dying person and
his or her desire for a good death.
The
Role of Colonoscopy in Colon Cancer Screening
Colon cancer is the second leading cause of cancer deaths in the
United States. Despite its prevalence, researchers are uncertain
how best to screen people for the disease. Typically, physicians
perform sigmoidoscopy on their patients who have no symptoms of
colon cancer. This procedure, however, allows doctors to view only
the lower third of the colon, so cancer can go undetected. Colonoscopies,
which allow the physician to view the entire large intestine, are
usually reserved for patients with positive screening results in
the lower colon or those with a higher-than-average risk for colon
cancer.
The thought of a colonoscopy may leave some people squeamish, but
two recent studies suggest the procedure deserves more attention.
Both studies investigated the risk of tumors in the upper portion
of the colon in patients with and without abnormal growths in their
lower colons. The first study, which involved colonoscopies performed
on over 3,000 participants, found that patients with growths in
the lower portion of the colon were more likely to have tumors
in the upper portion of the colon than patients without growths
in the lower colon. However, over half of the patients with growths
in the upper colon did not have any abnormal growth in the lower
colon. This suggests that the majority of tumors in the upper colon
would not be detected if colonoscopies were reserved only for those
patients with positive results from sigmoidoscopies.
The second study, involving nearly 2,000 participants, echoed the
above results that stressed the role of colonoscopies in detecting
colon cancer. In addition, this study found that older age and
male sex, as well as growths in the lower colon, were risk factors
for cancer in the upper portion of the colon.
Keep in mind that colonoscopies involve more bowel preparation
(which include a clear diet and laxatives) and intravenous sedation.
Colonscopy also carries a slightly higher risk of complications
than does flexible simoidoscopy. For these reasons, colonoscopy
is not necessarily always the first choice for screening for every
patient.
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