When Is It Appropriate to Order an Ionized Calcium?

When is it appropriate to order an ionized calcium?

Convincing evidence demonstrates that ionized calcium and not total calcium is the physiologically relevant component of blood calcium. Direct measurement of ionized calcium, however, is limited by difficulties in accurate analysis, lack of standardization, and need for special handling, all resulting in increased cost; therefore, strategies have been developed to estimate ionized calcium from ...

Refusal of Therapy: When Is It Appropriate?

I n our last issue, I talked about care in the context of end of life, in particular the expense and futility of care given in the last months of life or when patients are facing an incurable condition. I believe that it is entirely appropriate to refuse care or decline aggressive therapies at the end of life. Recently, the news has been full of reports detailing the story of Cassandra Fortin, ...

Mitral valve surgery: when is it appropriate?

Mitral regurgitation (MR) is a frequent complication of end-stage cardiomyopathy. Historically, these patients were managed either medically or with mitral valve replacement, both associated with poor outcomes. We studied 150 patients with cardiomyopathy and severe MR who were managed with mitral reconstruction. One hundred fifty patients with 4+ MR, left ventricular ejection fractions of 8%-24...

Providing hope in terminal cancer: when is it appropriate and when is it not?

Hope is essential in the face of terminal cancer. Generally in Western societies, patients and their families prefer their doctor to engage them in transparent, realistic, authoritative, empathic and open communication about the diagnosis and prognosis of cancer but this topic is not well studied in the Asian context. With the exponential increase in information about cancer and the many permut...

when appropriate statistical analysis is dismissed