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Discretionary Fortification Of Junk Food With Vitamin And Mineral Could Be Approved By Health Canada
Health Canada considers permitting vitamin and mineral (iron, calcium etc.) additives in high-calorie food products of all sorts, such as potato chips, energy bars, fruit flavored drinks. However dieticians and other health professionals caution that those products continue to be fortified junk food and that the little added nutritional value will boost consumption and enhance problems of obesity and diabetes.
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Almost Half UK Hospitals Not Equipped To Deal With Critical Out Of Hours Care
The British Society of Gastroenterology (BSG) is hosting a meeting at Number 11, Downing Street today to raise awareness of how more than half of Britain"s hospitals are providing patients with inadequate services. A UK-wide audit shows that 60% of acute upper gastrointestinal bleeding episodes occurred out of "normal" working hours yet 45% of hospitals do not provide out of hours endoscopy.
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Senate Judiciary Committee Vote Clears Way For Confirmation Of Supreme Court Nominee Sotomayor
The Senate Judiciary Committee"s approval on Tuesday of Supreme Court nominee Sonia Sotomayor "cleared the way" for a vote next week in the full Senate, where she is expected to be confirmed, the New York Times reports. The committee"s 12 Democrats voted in favor of Sotomayor, with one Republican -- Sen. Lindsey Graham (S.C.) -- joining them in the 13-6 vote (Lewis, New York Times, 7/28). According to Roll Call, Sotomayor"s confirmation is not in doubt, as members of both parties have predicted as many as 70 votes in her favor. So far, five GOP senators have said they will support the nomination, including Graham, Susan Collins (Maine), Richard Lugar (Ind.), Mel Martinez (Fla.) and Olympia Snowe (Maine) (Stanton, Roll Call, 7/29). Strategists on both sides who have been following the nomination said that as many as five more Republicans could announce intentions to vote for Sotomayor, the AP/San Francisco Chronicle reports (Hirschfeld Davis, AP/San Francisco Chronicle, 7/29). According to the Chicago Tribune, other Republicans initially appeared open to supporting Sotomayor, but pressure from antiabortion-rights groups and gun-rights advocates has swayed them in the other direction (Savage/Simon, Chicago Tribune, 7/29).The Times reports that Tuesday"s partisan vote indicates that Senate Republicans are "determined to deny ... an easy path" for President Obama in his nominations to fill the dozens of open federal appeals courts seats and any future Supreme Court vacancies. Obama is expected to announce several appeals court nominees in the coming weeks. On some appeals courts, including the Richmond, Va.-based Fourth Circuit, Obama"s nominations could change the ideological balance on the bench (New York Times, 7/28).According to the Tribune, Republicans believe that their strategy in Sotomayor"s confirmation hearings "succeeded in setting a new, conservative standard for judging." Throughout the hearings, Democrats portrayed Sotomayor as a moderate, cautious jurist, while many Republican senators sought to portray her as an activist judge. Sen. Jeff Sessions (Ala.), the Senate Judiciary Committee"s ranking Republican, said that the confirmation process has been a "repudiation of activist legal thought" and that it "will now be harder to nominate activist judges" (Chicago Tribune, 7/29). Committee member John Cornyn (R-Texas), who serves as the chair of the National Republican Senatorial Committee, said he hopes Sotomayor"s hearings serve as an example for future judicial nomination debates. He added that the Republicans on the committee have "made clear that radical views on judging have no place on the federal bench. And we have set expectations for future nominees." Senate Majority Leader Harry Reid (D-Nev.) on Tuesday said that he intends to bring Sotomayor"s nomination to a full Senate vote prior to Congress" August recess. He has not said what day the debate is scheduled to begin or how many days are scheduled, although he noted that debate could take several days (Roll Call, 7/29).
Public Health

Video Can Help Patients Make End-Of-Life Decisions

Viewing a video showing a patient with advanced dementia interacting with family and caregivers may help elderly patients plan for end-of-life care, according to a study led by Massachusetts General Hospital (MGH) researchers. In their report in the journal BMJ, released online, the investigators find that participants who watched such a video in addition to listening to a verbal description of the condition were more likely to indicate they would choose only comfort care if they developed advanced dementia and also said they felt the video was helpful to their decision-making process. "Decisions at the end of life can be complex and abstract; the video makes it real," says Angelo Volandes, MD, of the MGH Department of Medicine, the study"s lead author. "Patients may not have experience with conditions like advanced dementia or the medical interventions involved, other than what they have seen on television or at the movies. Videos of real patients can offer more realistic images." Asking patients about their preferences for treatment in situations they may face in the future is an essential part of quality care, the authors note; but giving patients a clear understanding of the options they are considering and making sure that messages delivered by different health care providers are consistent can be challenging. Terms that have a specific meaning to medical professionals may be interpreted very differently by the general public. To give patients a clearer idea of what advanced dementia involves, the research team developed a decision support tool combining a standard verbal description of advanced dementia - including the fact that patients with the condition cannot move about independently, eat by themselves or communicate with others - and a two-minute video of an 80-year-old dementia patient that clearly shows her inability to walk, to eat or to communicate with family members. While the system had been evaluated in a previous study involving middle-aged participants, it had not previously been tested in older individuals or in a way that allows comparison to verbal explanation only. The current study enrolled 200 patients from four primary care or geriatric practices in the Boston area. Participants were 65 or older and had no significant cognitive impairment, based on a standard test of mental functioning. After an initial introductory interview - which included gathering basic demographic and personal health information, along with assessment of their knowledge about dementia - about half the participants listened to a narrative describing advanced dementia and then watched the video. The other participants, the control group, only heard the narrative description. Then all participants had a second interview that included asking their preferences for the type of care they would prefer to receive if they developed advanced dementia - the options being care designed to prolong life at all costs, limited care designed to maintain physical functioning, and comfort care focused on relieving pain and maximizing comfort. Among the control group that only heard the narrative description of advanced dementia, 64 percent of participants indicated they would choose comfort care, 19 percent limited care and 14 percent would prefer life-prolonging care. Among participants who also viewed the video, 86 percent said they would choose comfort care, while 9 percent choose limited care and only 4 percent indicated life-prolonging care. Most participants were contacted six weeks later and again asked about their care preferences, and while 29 percent of the control group indicted a change, only 6 percent of those viewing the video had changed their preferences. "We also asked those who watched the video about their response to it, and the vast majority said they found it to be helpful, were comfortable watching it and would recommend it to others. We want patients to be as informed as possible when making decisions at the end of life but not coerce them or unduly influence them in any manner," Volandes explains. "Since projections indicate that more than 13 million patients will develop dementia by 2050, it is critical that patients understand their options for end-of-life treatment and be able to communicate their preferences to their physicians," he adds. "Using videos in patient-doctor discussions is new, so we need further work and studies before the use of videos like this can become a standard part of clinical care." Volandes is an instructor in Medicine at Harvard Medical School. Co-authors of the BMJ study are Michael Barry, Kenneth Minaker, Yuchiao Chang, and Areej El-Jawahri, MGH; Michael Paasche-Orlow, Boston University School of Medicine; Muriel Gillick, Harvard/Pilgrim Health Care; Francis Cook, Brigham and Women"s Hospital; Elmer Abbo, University of Chicago; and Susan Mitchell, Hebrew SeniorLife, Boston. The study was supported by grants from the Foundation for Informed Medical Decision Making, the Alzheimer"s Association and the Hartford Foundation. Sue McGreevey Massachusetts General Hospital


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