British recommendations for prevention of delirium

The National Institute for Health and Clinical Guidance (NICE) in Britain creates medical practice guidelines for the country’s National Health Service. Last year, the institute released delirium guidelines. Administrators, doctors, and other clinicians are the intended audience, but friends and family members might also find the NICE suggestions for preventing delirium useful. We’ve made a few minor edits for clarity. (Locked) More »

Controlling what - and how much - we eat

Because humans have evolved to crave fat, salt, and sugar, it is difficult to shift away from them and toward a healthier diet, but it is possible to learn to like vegetables, fruits, and whole-grain foods more. Eating a variety of vegetables at a single meal is a way to encourage greater intake. If you keep an open mind and try a variety of vegetables, you might find varieties that contain bitter compounds to which you are less sensitive. The genetic variations that affect reactions to bitter-tasting vegetables may also influence a person's liking of whole grains.  One strategy for making whole grains more appealing is simply to mix in some refined grains. You can sneak more whole grains into your diet by substituting half the flour in cookie, muffin, or bread recipes with whole-wheat flour, mixing wheat germ into meatballs, meatloaf, or burgers or adding barley, a whole grain that's mild in flavor, as a thickener in soups and stews. (Locked) More »

Preventing delirium in the hospital

Delirium occurs frequently in older people who are hospitalized. It can manifest as a state of confusion and agitation, or one of withdrawal and lethargy. Dr. Sharon Inouye, a Harvard Medical School professor, developed a delirium prevention program called the Hospital Elder Life Program (HELP). British health officials issued prevention guidelines in 2010 that included 13 separate recommendations, many of which are similar to elements of Inouye's HELP program. Delirium prevention hasn't been thoroughly tested; the British guideline writers identified only two high-caliber studies. But if the results of those studies hold up, perhaps up to a third of delirium cases in hospitals could be prevented. Here are a few suggestions from the HELP program and the British guidelines: (Locked) More »

A matter of opinion

Getting a second opinion about a medical issue is a good idea. A second opinion may simply confirm a first diagnosis or treatment recommendation, but that doesn't mean it was a waste. If the two opinions agree, so much the better, and it's certainly reassuring. A second opinion can be helpful just because another doctor may explain things in a way that's more understandable to you. Second opinions can also save money by steering treatment away from expensive tests, medications, or procedures, so insurers often encourage them and may, in fact, require them for some situations. Still, check with your health plan before getting a second opinion to see whether the visit and any additional costs will be covered. More »

Novel therapy for C. difficile infections

Recurrent infections with Clostridium difficile bacteria are one of the main causes of intestinal distress.  Antibiotics are capable of killing many of its bacterial competitors, but often not C. difficile, which allows C. difficile to run wild. Mild C. difficile cases are typically treated with the antibiotic metronidazole (Flagyl), and more serious cases with vancomycin (Vancocin). Both drugs are capable of killing the active form of the bacterium, but the spore form may survive. As a result, in about a fifth of cases, the spores spring to life once treatment with the antibiotic has stopped. AfterC. difficile recurs, over half of all patients may develop chronic, and potentially fatal, infections. Now, some doctors think they've found an effective, if somewhat off-putting, treatment for patients whose intestinal microbiomes have been compromised by C. difficile infections. Fecal transplant, a procedure in which feces from a healthy donor are transferred into the gut of a sick patient, is supposed to restore the damaged microbial community in the patient's intestine. The idea of fecal transplant isn't new — the first case report was published in 1958 — but the popularity of the procedure has increased since 2000. (Locked) More »