By Marcos Montagnini, MD
Marcos Montagnini, MD, is a staff physician and the director of the Palliative Care Program at the VA Ann Arbor Healthcare System, Geriatric Research, Education and Clinical Center (GRECC) in Ann Arbor, Michigan, and an associate professor of medicine in the Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, at the University of Michigan in Ann Arbor, Michigan.  

Having good communication skills is essential for health care providers. In the November 2012 issue of Federal Practitioner, the article “A Palliative Care Coordination Program for Veterans With Advanced Cancer,”  written by Judith R. Knudson, MPAS, PA-C, BSN; Stephanie Borchardt, PhD, MPH; Tracy Pedersen, BS, RHIT, CTR; and myself, was published. The article described the benefits of a palliative care coordination program for patients with advanced cancer. In this study, we demonstrated that the implementation of a program that strongly emphasized communication improved the utilization of end-of-life interventions for veterans with advanced cancer.

By Ellen T. Thatcher, GNP-C, CHPN
Ellen T. Thatcher, GNP-C, CHPN, is a certified geriatric, hospice, and palliative care nurse practitioner and community hospice care coordinator at the Bay Pines VA Healthcare System in Bay Pines, Florida.

The principle of double effect (PDE) has been around for centuries. It originated in Roman Catholic theology, as in aborting a fetus to save the mother’s life. PDE posits that, if the intention is not to do harm or kill, then it is morally ethical and allowable. This theory is now often used in hospice bioethics.  

By Muhammad Jawad Sethi, MD
Dr. Sethi is an endocrinology fellow at the University of Arizona in Tucson, Arizona.

There is no doubt that statins are revolutionary medications. But like anything else, they can cause adverse effects (AEs). Hypogonadism may be one of those AEs and is often missed. In the big picture, patients who are on statins, especially in higher doses, also have other comorbidities. These may include obesity, type 2 diabetes, and coronary artery disease. Type 2 diabetes and obesity are known risk factors for hypogonadism. So if the patient has these 2 risk factors, is on a high-dose statin, and complains of decreased libido, statins should be considered a potential contributor.

By Robin Shah, DO, MBA 

Robin Shah, DO, MBA, is an internal medicine resident at The Christ Hospital in Cincinnati, Ohio.

My article in the July 2012 issue of Federal Practitioner, Elevated Cardiac Troponins–Not Always an Acute Coronary Syndrome, explains that cardiac enzymes, such as troponins, are a very sensitive laboratory test. In the Emergency Department, most patients with chest pain, shortness of breath, and associated symptoms are tested for elevated cardiac enzymes. However, when interpreting the test, it is important to remember that these enzymes are elevated when there is myocardial cell injury, but does not determine the mechanism of injury. The article discusses that there are many common causes of a cardiac troponin leak.

By Ellen T. Thatcher, GNP-C, CHPN
Ellen T. Thatcher, GNP-C, CHPN, is a certified geriatric, hospice, and palliative care nurse practitioner and community hospice care coordinator at the Bay Pines VA Healthcare System in Bay Pines, Florida.

I love having my Pomeranian, Margaret, at work with me because I seem to have a better day when she’s with me. She’s allowed on the Hospice Unit and in our Community Living Center; the veterans absolutely love her. However, because of policy, she’s not allowed in the acute or intensive care areas.  

By Jorge Ruiz, MD; and Allen D. Andrade, MD
Jorge Ruiz, MD, is the director of the Laboratory of E-learning and Multimedia Research and the associate director for Education and Evaluation. Allen D. Andrade, MD, is the associate director of the Laboratory of E-learning and Multimedia Research and GRECC Investigator, and both are at the Geriatric Research, Education, and Clinical Center (GRECC), Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida.

Adherence to self-management behaviors is linked to better health care outcomes in patients with chronic illness. Despite the benefits, however, nonadherence remains a significant problem. Though interventions to improve adherence to self-management behaviors have shown some success, in most cases these interventions are resource intensive and may not be available to most patients. Computer-based interventions may constitute cost-effective ways to improve access to evidence-based self-management. We have seen that avatars (digital representations of people) are widely used in Internet environments to facilitate social interactions and communication. Compared with a computer program without avatars, one with an avatar could establish a relationship with a participant that is more engaging, persuasive, and long-term.

By Ellen T. Thatcher, GNP-C, CHPN
Ellen T. Thatcher, GNP-C, CHPN is a certified geriatric, hospice, and palliative care nurse practitioner and community hospice care coordinator at the Bay Pines VA Healthcare System in Bay Pines, Florida. 

We often hear experiences that are metaphoric. (http://www.fedprac.com/Article.aspx?ArticleId=Uccpqfs5dug=.)The dying person may report seeing an angel, a deceased relative, or a deceased beloved pet from the past, or talk about going on a trip. Oftentimes they may do busy work, pick at the air, or look like they’re pulling a rope or packing. Sometimes they become restless, get a burst of energy, try to get out of bed and possibly fall. When questioned, they often talk about their metaphoric experience.

By Jorge Ruiz, MD; and Allen D. Andrade, MD
Jorge Ruiz, MD is director of the Laboratory of E-learning and Multimedia Research and associate director for Education and Evaluation. Allen D. Andrade, MD is associate director of the Laboratory of E-learning and Multimedia Research and GRECC Investigator and both are at the Geriatric Research, Education, and Clinical Center (GRECC), Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida.

Can an avatar that resembles you influence your behavior? There is growing evidence suggesting just that. Manipulating an avatar’s appearance to resemble an individual is now possible. Jeremy Bailenson at Stanford University found that college students reported increases in exercise 24 hours after viewing an avatar resembling them exercising. We investigated whether these findings translate into physical activity gains in sedentary, overweight veterans. We objectively assessed veterans’ levels of physical activity with accelerometers. We randomly assigned them into 1 of 3 groups: viewing an avatar that looked like them exercising, another viewing an avatar of another person exercising, and a third to watch a static figure exercising. Veterans who viewed an avatar resembling themselves exercising significantly improved their physical activity 1 week after the intervention. (http://www.ncbi.nlm.nih.gov/pubmed/22357026)

By Editor-in-Chief James V. Felicetta, MD

James V. Felicetta, MD is Editor-in-Chief for Federal Practitioner; chairman of the Department of Medicine at the Phoenix VA Health Care System in Phoenix, Arizona; professor of medicine at the University of Arizona in Phoenix, Arizona; and Governor-Select, Arizona Chapter, American College of Physicians. 
 

On behalf of all of us at Federal Practitioner, I’m delighted to welcome you to our exciting new blog! We believe the blog will be an important mechanism for allowing all of us to become more interconnected and interactive with one another. We will have members of our Editorial Advisory Association and our journal authors who already have blogging experience get us started with some provocative postings.