Older patients experience a “nearly inescapable obligation” to pursue cardiac interventions
When older patients are facing decisions about whether to undergo cardiac interventions, such as bypass surgery or angioplasty, they experience an “almost inexorable momentum towards intervention,” say researchers in an Essay in this week’s PLoS Medicine.
In their interviews with patients, physicians, and patients’ families, Janet Shim (University of California San Francisco) and colleagues found that even when there are reservations about the appropriateness of cardiac interventions, decisions tend to be weighted towards intervening.
One physician they interviewed characterized the successive and escalating cardiac interventions often undertaken for very elderly people as a “speeding train,” while another called it “an extravaganza of cardiology.”
Shim and colleagues use the term “the treatment imperative” to describe the nearly inescapable obligation to pursue cardiac interventions. The treatment imperative is driven, they say, by rising expectations for vitality and longevity, the growing availability of options for intervention, changing norms of old age, and the stark urgency presented by cardiac risks that are reducible through increasingly reliable medical procedures.
In their Essay, the authors offer suggestions for how physicians might better guide their older patients in making treatment decisions.
Citation: Shim JK, Russ AJ, Kaufman SR (2008) Late-life cardiac interventions and the treatment imperative. PLoS Med 5(3): e7.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050007
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-03-shim.pdf
CONTACT:
Janet Shim
University of California San Francisco
Dept of Social and Behavioral Sciences
3333 California Street, Suite 455
San Francisco, CA 94143-0612
United States of America
+1 415-514-9392
+1 415-476-6552 (fax)
janet.shim@ucsf.edu
How can we develop new treatments for idiopathic pulmonary fibrosis?
Idiopathic pulmonary fibrosis (IPF) is a devastating lung disorder of unknown cause that leads to death in a relatively short time because of the lack of any effective treatment. In an article in this week's PLoS Medicine, a team of researchers from Mexico and the US discusses how a better understanding of the molecular pathways involved in causing IPF may lead to the development of new therapies.
Moisés Selman (Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico) and colleagues say that the lungs of patients with IPF are enriched with genes associated with lung development in the embryo. In healthy adults, these genes are switched off but they appear to be abnormally switched on in IPF. "Dysfunctional activation of embryological pathways regularly repressed in the adult life may explain the persistent nature of the disease," say the authors.
"Designing and implementing interventions that target these embryological pathways may be required to develop novel anti-IPF therapies and to significantly improve the outcome of IPF patients."
Citation: Selman M, Pardo A, Kaminski N (2008) Idiopathic pulmonary fibrosis: Aberrant recapitulation of developmental programs? PLoS Med 5(3): e62.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050062
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-03-selman.pdf
CONTACT:
Moisés Selman
Instituto Nacional de Enfermedades Respiratorias
Tlalpan 4502
Mexico City, DF 14080
Mexico
moiselman@salud.gob.mx
mselmanl@yahoo.com.mx
About PLoS Medicine
PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org
About the Public Library of Science
The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org
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