Background: The field of palliative care (PC) is growing as the world population ages and burden of chronic diseases increases. Thus, it is important that the general public is knowledgeable about PC and the benefits PC provides. Objective: The aim of this study is to describe the public’s knowledge, awareness, and perceptions of PC and determine whether these have changed over time. Methods: A scoping literature review was conducted from 1968 to May 2019 using PubMed, EMBASE, and MEDLINE databases. Results: Thirteen studies met inclusion criteria that originated from the United States, Canada, Scotland, Italy, New Zealand, Ireland, United Kingdom, Korea, and Sweden between years 2003 and 2019. Participants were adults and mostly younger than 64 years, women, and Caucasian. The majority of studies reported the public having poor knowledge (7/9 articles) and awareness (4/6 articles) of PC over the past 16 years. Top characteristics associated with increased levels of knowledge and/or awareness of PC included women (6/8 articles), age 40+ (6/8 articles), experience with a close friend and/or relative requiring PC (4/8 articles), and working in health-care and/or PC (4/8 articles). The most common perceptions of PC were associated with patients who have terminal illnesses and end-of-life care. Participants commonly received information about PC from the media, having a close friend or relative requiring PC, and working in a health-care setting. Conclusions: The public has poor knowledge and awareness about PC and several misperceptions exist. These findings have remained constant over time despite growth in the field of PC, which highlights the strong need for focused educational interventions.
With the growth of social media platforms, their potential to affect health care, and orthopedics specifically, continues to expand. We reviewed the literature to obtain all pertinent information on social media in health care and examined its strengths and weaknesses from patient and physician perspectives. Health care professionals have slowly begun to use social media to stay connected with patients. The recent use of networking sites aims to improve education, provide a forum to discuss relevant medical topics, and allow for improved patient care. The use of social media, with the understanding of its limitations, may help promote patient happiness and safety and serve as an educational platform.
Metformin, a widely used antihyperglycaemic, has a good safety profile, reasonably manageable side-effects, is inexpensive, and causes a desirable amount of weight loss. In 4 studies of patients with tuberculosis (1 prospective and 3 retrospective), metformin administration resulted in better outcomes. In mice with several models of endotoxemia, metformin diminished levels of proinflammatory cytokines and improved survival. Laboratory studies showed effectiveness of the drug on multiple pathogens, including Trichinella spiralis, Staphylococcus aureus, Pseudomonas aeruginosa, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. Metformin administration in humans and mice produced major changes in the composition of the gut microbiota. These recently discovered microbe-modulating properties of the drug have led investigators to predict wide therapeutic utility for metformin. The recent easing in United States Food and Drug Administration (FDA) guidelines regarding administration of metformin to patients with kidney disease, and reduced anxiety about patient safety in terms of lactic acidosis, increase the probability of broadening of metformin's usage as a treatment of infectious agents. In this text we review articles pertinent to metformin's effects on microorganisms, both pathogens and commensals. We highlight the possible role of metformin in a wide range of infectious diseases and a possible expansion of its therapeutic profile in this field. A systematic review was done of PubMed indexed articles that examined the effects of metformin on a wide range of pathogens. Metformin was found to have efficacy as an antimicrobial agent in patients with tuberculosis. Mice infected with Trypanosomiasis cruzi had higher survival when also treated with metformin. The drug in vitro was active against T. spiralis, S. aureus, P. aeruginosa, and hepatitis B virus. In addition there is emerging literature on its role in sepsis. We conclude that metformin may have a potential role in the therapy for multiple infectious diseases. Metformin, in addition to its traditional effects on glucose metabolism, provides anti-microbial benefits in patients with tuberculosis and in a very wide range of other infections encounters in vitro and in vivo.
1Obesity paradox, obesity orthodox, and the metabolic syndrome: An approach to unity 1 Obesity paradox and the metabolic syndrome. Abstract: 26Obesity and the accompanying metabolic syndrome are strongly associated with heightened morbidity 27 and mortality in older adults. In our review of more than 20 epidemiologic studies of major infectious 28 diseases, including leaders such as tuberculosis, community-acquired pneumonia, and sepsis, obesity was 29 associated with better outcomes. A cause-and-effect relationship between over-nutrition and survival with 30 infection is suggested by results of two preliminary studies of infections in mice, where high fat feeding 31 for 8-10 weeks provided much better outcomes. The better outcomes of infections with obesity are 32 reminiscent of many recent studies of "sterile" non-infectious medical and surgical conditions where 33 outcomes for obese patients are better than for their thinner counterparts ---and given the tag "obesity 34 paradox". Turning to the history of medicine and biological evolution, we hypothesize that the metabolic 35 syndrome has very ancient origins and is part of a lifelong metabolic program. While part of that program 36 (the metabolic syndrome) promotes morbidity and mortality with aging, it helps infants and children as 37 well as adults in their fight against infections and recovery from injuries, key roles in the hundreds of 38 centuries before the public health advances of the 20th century. We conclude with speculation on how 39 understanding the biological elements that protect obese patients with infections or injuries might be 40 applied advantageously to thin patients with the same medical challenges. experts to predict that obesity will shortly become the leading personal health problem worldwide. 52Obesity and the accompanying metabolic syndrome are typically associated with shortened life 53 expectancy, premature disability, and heightened prevalence of cardiovascular disorders, cancer, diabetes, 54and Alzheimer disease as well as multiple other disorders linked to advancing age. 55 ( ¶2) In the jeremiads inspired by obesity, the modest but deeply rooted health advantages of 56 obesity are typically neglected (Table 1). In this paper we add further to the list of advantages of obesity; 57 we review over 20 epidemiology studies of six serious infectious diseases, including tuberculosis, 58 pneumonia, and sepsis, where outcomes are inversely related to body mass index. The consistency of the 59 obesity advantage is especially remarkable because the usual measurements to express adiposity i.e. body 60 mass index (BMI; the weight in kilograms divided by the square of the height in meters) as well as waist 61 circumference or neck circumference are such rough approximations of total body fat or of visceral fat or 62 of metabolic syndrome. The connection between body mass index and the metabolic syndrome in 63 epidemiology studies is further loosened by impressive ethnic differences (Figure 1) [1] and changes in 64 individuals with aging. ...
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