Refusal to face reality of death leads to increased use of aggressive, futile health-care efforts

Seriously ill, hospitalized Canadians are increasingly receiving aggressive, invasive and futile care at end of life because patients and families cannot accept the grim reality that they are dying, according to more than 1,200 doctors and nurses surveyed from across the country. Photo: Christinne Muschi for Postmedia News

Seriously ill, hospitalized Canadians are increasingly receiving aggressive, invasive and futile care at end of life because patients and families cannot accept the grim reality that they are dying, according to more than 1,200 doctors and nurses surveyed from across the country.

Unrealistic expectations about life-prolonging treatments and disagreements among family members are also preventing crucial discussions around the use — or not — of CPR, artificial ventilators, tube-feeding and other interventions from happening, according to the survey.

“If we don’t have these conversations, there is a chance of patients receiving care that in the end is going to inflict more suffering than help,” said Dr. John You, lead author of the study and an associate professor of medicine and clinical epidemiology and biostatistics with McMaster University’s Michael G. DeGroote School of Medicine in Hamilton.

“We need to normalize conversations about death and dying so that people can be more comfortable having advance care planning discussions within families before there’s a crisis.”

The study, published Monday in JAMA Internal Medicine, involved a survey of 1,256 staff doctors, residents and nurses working in medical teaching units at 13 hospitals in British Columbia, Alberta, Ontario, Quebec and Newfoundland and Labrador between September 2012 and March 2013.

The questionnaire began with a vignette of a 70-year-old patient with a flare up of chronic obstructive pulmonary disease, or COPD. The man is housebound, on oxygen, and needs others to help provide almost all care for him.

Respondents were asked to rate the most important barriers that would prevent them from engaging the patient or his family in end-of-life discussions around goals of care — particularly around the use of life-sustaining, or death-prolonging, treatments.

Overall the sense from the clinicians is that patients and families tend to get in the way

The three biggest barriers identified by all three groups were difficulty accepting a loved one’s poor prognosis, difficulty understanding the limitations and risks of life-sustaining interventions and lack of agreement among family members about goals of care.

Fear of being sued was the least important barrier.

The survey builds on an earlier study by You and his colleagues from the Canadian Researchers at End-of-Life Network (CARENET) who interviewed elderly patients in a dozen Canadian hospitals who were at high risk of dying in the next six months.

Only about half had discussed their wishes around end-of-life care with a member of their health-care team. Only a minority wanted CPR. But when the researchers looked at the actual “code status” on their charts, many were “full code” — meaning CPR and every other possible measure would be used to try to resuscitate them.

You said the new survey highlights the “sometimes high, but understandable levels of anxiety and denial experienced by seriously ill, hospitalized patients and their families.”

But many doctors haven’t been trained how to initiate difficult conversations with patients, how to be honest and open about their prognosis and listen and respond with empathy to their emotional reactions.

“Overall the sense from the clinicians is that patients and families tend to get in the way” of making concrete decisions about a patient’s care plans, You said. “This is what they perceive,” he said.

“But I think it reflects that if patients and families are having a difficult time then one of the solutions clearly has to be that physicians need to be skilled communicators — they need to know how to navigate these sometimes emotional or difficult discussions and be sensitive,” he said.

“They need tools, they need training and they need to be confident in engaging in those discussions and I don’t think many clinicians are that comfortable. So that’s certainly an area where we need more work,” You said.

“We need to discuss these goals of care head on, instead of putting them off, putting them off, which is what tends to happen.”

skirkey@postmedia.com

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Las bad companies successful en el mundo de los videojuegos

Capcom-income: $ 952 million

 

Las bad companies successful en el mundo de los videojuegos

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From humble beginnings en sus them soportales of articles for the hogar that son hoy en día, los videojuegos se han converted en una fuerza de unstoppable entretenimiento en America and the world. As pasa el tiempo, los videojuegos if convirtiendo están en uno de los popular la mayoría - these forms of medios de todo el mundo - y rentable. Las ventas anuales of videojuegos eliminated $ 78000000000 en 2012, bad del doble de las ventas entries for la película 2012, by value of bad than $ 34,000 millones. Huelga decir que tienen un gran numbers estos number of important companies en el de la industria del aspect entretenimiento en los videojuegos as una fuente important Inflows.

Capcom menudo if barrio bajo la alfombra cuando la gente habla de los players de la industria del juego, pero siempre en los diez primeros Caen employees Activities en el mercado de los videojuegos. Lo más probable es uno de los juegos y más conocido bad successful de la línea es Capcom Street Fighter, which ha given rise to several sequels y spin-offs. Algunos de sus otros successes incluyen Resident Evil, Devil May Cry y Lost Planet franchises, así como los Megaman games, which siguen siendo popular, in spite of su edad on.

 

Federal minister John Baird expected to resign

John Baird is expected to announce his departure from two decades of political life. The announcement is stunning. Photo: Lefteris Pitarakis/The Associated Press

Foreign Affairs Minister John Baird will not seek re-election and will resign his position in the Harper cabinet this week, a source has told Postmedia News.

Baird, 45, was first elected to Parliament in 2006, representing the nation’s capital riding of Ottawa West-Nepean, and re-elected in 2008 and 2011.

He is expected to resign as soon as Tuesday.

Baird is not leaving for any particular job, but has decided the time is right for him to move to the private sector, a friend said Monday.

“He’s at the perfect age and in the perfect place to make a move,” said his friend, speaking on condition that he not be named.

Baird has served in a variety of high-profile roles in Stephen Harper’s Conservative government. Prior to that, he spent a decade in Ontario provincial politics.

CBC broke the news that Baird would leave politics Monday night after Baird informed staffers of his decision.

“He took a look at the calendar and … if he left now, I think people just do their walk in the snow. I think what’s precipitated it is he’s been doing it for 20 years.

This is a personal decision and has nothing to do with Baird’s assessment of the electoral prospects of Harper’s government, his friend said.

Baird is likely to look at private-sector opportunities, perhaps in Toronto.

“He has spent his entire life as an elected official or a political staffer and at this point in his life, in his mid- to late-40s, now is the time for him to build another career,” his friend said.

“He’s had 10 portfolios, which is a lot by Canadian standards, so I think he just felt like personally for him it was time to go.”

The Canadian Press reported Monday night that International Trade Minister Ed Fast is set to perform as acting foreign affairs minister.

Baird’s unexpected departure came as he was actively engaged in trying to convince Egypt to release Mohamed Fahmy from an Egyptian prison. Baird told CBC on Monday that Fahmy’s release was imminent.

Baird’s departure appeared to leak sooner than anticipated on Monday night. There was no immediate comment from the prime minister’s office.

The departure of Baird, a high-profile and effective minister widely considered to be a good communicator, is likely to be seen as a blow to the government.

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Roots of Groundhog Day cast a shadow back to medieval Europe

What do a European Christian tradition, a 19th century American immigration pattern, and a cinema cult classic have in common? They’ve all helped turn groundhogs into North America’s most popular weather prognosticators.

Each Feb. 2, crowds gather to watch Ontario’s Wiarton Willie, Pennsylvania’s Punxsutawney Phil and other furry forecasters take a shot at a task that baffles many humans.

Folklore has it that if a groundhog sees his shadow he’ll flee back to his burrow, heralding six more weeks of winter. If he doesn’t, legend has it that spring is around the corner.

The roots of this light-hearted tradition span both oceans and centuries.

Chris Scott, chief meteorologist at the Weather Network, said Groundhog Day hearkens back to medieval Europe and the Christian festival of Candlemas.

Participants would light candles to brighten a dreary time and watch weather conditions on festival day for portents of what lay ahead, he said.

Groundhog Club co-handlers John Griffiths, right, and Ron Ploucha carry Punxsutawney Phil, the weather prognosticating groundhog, on his rounds through downtown Punxsutawney, Pa. [AP Photo/Gene J. Puskar]

One Scottish couplet succinctly summed up the superstitions of the time: “If Candlemas Day is bright and clear, There’ll be two winters in the year.”

The old proverb had a basis in fact, Scott said, since European weather patterns were markedly different from the ones prevailing in North America today.

“You can get winters that essentially end in early February,” Scott said in a telephone interview. “There was more of a realistic scenario of, ‘Oh, what’s it going to be? Are we going to see winter persisting for six more weeks or is this actually the end?”‘

Scott said early Europeans eventually threw a prognosticating hedgehog into the mix, adding the animals had hibernation patterns that naturally brought them out of hiding around the time of Candlemas.

When German settlers began immigrating to the U.S. in the 19th century, they adapted Candlemas traditions to their new home with one simple innovation — letting the area’s native groundhogs do the forecasting.

Shubenacadie Sam failed to see his shadow after emerging from his burrow at the wildlife park in Shubenacadie, N.S. [ THE CANADIAN PRESS/Andrew Vaughan]

Punxsutawney, Pa., has emerged as the hub of American Groundhog Day festivities. Bob Roberts, protector of the present-day Punxsutawney Phil, said the first official Groundhog Day excursion in the area took place in 1888.

Canada’s marquee Groundhog Day event first took place in 1956 when Mac McKenzie, a resident of the central Ontario town of Wiarton, was looking for a pretext to throw a party.

After settling on Groundhog Day, he sent out his invitations in the form of mock press releases. When one of them fell into the hands of a genuine reporter, however, McKenzie had to get creative.

“(The reporter) had to have a story,” McKenzie explained in documents provided by local festival organizers. “He couldn’t go back to Toronto without something. So we tossed a fur hat with a button on it into the snow. We said it was a groundhog, and the photo ran in the (Toronto) Star.”

Wiarton has been home to Canada’s premiere Groundhog Day event ever since, including in 1999 when organizers discovered Willie had died in the run up to his big day.

Meteorological marmots gained a wave of positive attention after the 1993 comedy film “Groundhog Day” was released.

So how do human forecasters feel about Groundhog Day?

“I’ve never met a meteorologist who is anti-groundhog,” said Scott. “. . . We don’t feel too threatened.”

Michelle McQuigge

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Justin Bieber puts personal items on auction to help hometown food bank

FILE - In this Sept. 30, 2014 file photo, Justin Bieber in a file photo. (AP Photo/Zacharie Scheurer, FIle)

STRATFORD, Ont. — Justin Bieber fans have the opportunity to snatch up a few of the Stratford native’s personal items for a good cause.

An eBay auction began on Saturday with Bieber’s used Toronto Maple Leafs comforter, pillow case, ceiling light and even a pair of his Nike basketball shoes — all of which were autographed by the pop star — starting at $500 U.S. each.

The auction will end at noon on Feb. 7 with the profits going to help support Stratford’s House of Blessing food bank.

Bieber’s grandparents, Diane and Bruce Dale, donated the items to raise money for the food bank and organizers say Bieber signed them when he was in the area over the holidays.

All of the items come with a certificate of authenticity signed by Bieber’s grandmother. The food bank says Bieber and his mother chose to donate the items because they were helped by the organization in their time of need.

A few hours into the auction only two of the items had bids — the shoes and the comforter.

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