Lunes 05/03/12 Semana del empleo

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& CULTUREFEBRUARY 25, 2012.

Why Doctors Die Differently
Careers in medicine have taught them the limits of treatment and the need to plan for the end

By KEN MURRAY
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient's five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.

What's unusual about doctors is not how much treatment they get compared with most Americans, but how little.
.Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again. He focused on spending time with his family. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn't spend much on him.

It's not something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

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.In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made "arrangements," as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

Unlike previous eras, when doctors simply did what they thought was best, our system is now based on what patients choose. Physicians really try to honor their patients' wishes, but when patients ask "What would you do?," we often avoid answering. We don't want to impose our views on the vulnerable.

The result is that more people receive futile "lifesaving" care, and fewer people die at home than did, say, 60 years ago. Nursing professor Karen Kehl, in an article called "Moving Toward Peace: An Analysis of the Concept of a Good Death," ranked the attributes of a graceful death, among them: being comfortable and in control, having a sense of closure, making the most of relationships and having family involved in care. Hospitals today provide few of these qualities.

Written directives can give patients far more control over how their lives end. But while most of us accept that taxes are inescapable, death is a much harder pill to swallow, which keeps the vast majority of Americans from making proper arrangements.

It doesn't have to be that way. Several years ago, at age 60, my older cousin Torch (born at home by the light of a flashlight, or torch) had a seizure. It turned out to be the result of lung cancer that had gone to his brain. We learned that with aggressive treatment, including three to five hospital visits a week for chemotherapy, he would live perhaps four months.

Torch was no doctor, but he knew that he wanted a life of quality, not just quantity. Ultimately, he decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months having fun together like we hadn't had in decades. We went to Disneyland, his first time, and we hung out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He had no serious pain, and he remained high-spirited.

One day, he didn't wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

As for me, my doctor has my choices on record. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like so many of my fellow doctors.

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A otro doctor lo diagnosticaron de un cancer al estomago, al dia siguiente cerro su practica y se fue a su casa, nunca puso un pie en el hospital, no chemo, no radiation, nada de nada.

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El gobierno de China anuncio que su target de crecimiento es el 7.5% para este anio, debido a la crisis en Europa que ha desacelerado sus exportaciones.

Recordar que una economia debe crecer mas del 7% para eliminar la pobreza.

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Los futures del Dow Jones 20 puntos a la baja.

Oil up 106.98

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Euro down 1.3195

[Victor VE]

RCZ

Cristal Project in Bongara has 211 mln. pounds of zinc

Lima, Mar. 04 (ANDINA). The Cristal Project, located in the zinc deposit Bongara in the department of Amazonas, has a total of 1.27 million tonnes of zinc oxides grading 7.5% and equaling over 211 million pounds of zinc, reported Sunday Canadian-based Rio Cristal.

Thomas Findley, President & CEO, said the company has filed a NI 43-101 Technical Report, which includes the company's first resource estimate on the property.

"We have only drilled 3% of the block of concessions that we control and we believe that we have significant opportunities to both expand the zinc oxide resource at the Cristal and Charlita Projects and to discover high grade zinc sulfides at our San Jose and Florida Projects," he said.

Findley explained during 2008 and 2011 the company drilled at total of 7,722 meters at Cristal and Charlita and in 2011 we drilled 1,417 meters at San Jose which is 12 kilometers south of Cristal.

"Results at Cristal were excellent and led to our being able to announce our first Measured and Indicated Resource. At Charlita we intersected zinc mineralization in six of fifteen holes. At San Jose, we drilled two holes and extensive zinc anomalies were intersected," he added.

"We now have an aggressive multi-part plan to continue exploring our Bongará Property which includes additional drilling at Cristal and Charlita to expand our oxide resource, additional drilling at San Jose to discover zinc sulfides; finalizing community agreements so that we can begin surface exploration and drilling at our Florida project; and expanded surface exploration in new areas of our concessions."


(END) LVT/LVT

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7:56 a.m. EST 03/05/12Treasurys
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Crude Oil 106.74 0.04 106.70
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Japanese Yen (USD/JPY) 81.35 81.81
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PMI compuesto zona euro cae a 49,3 en febrero
lunes 5 de marzo de 2012 07:16 GYT Imprimir [-] Texto [+]
LONDRES (Reuters) - La reducción del negocio en España e Italia arrastró al sector privado de la zona euro hacia la contracción el mes pasado, frustrando las esperanzas de que la región evite una nueva recesión, según un sondeo conocido el lunes.

Alemania, la economía más sana del bloque, seguía expandiéndose aunque a un ritmo menor, mientras que la actividad económica en Francia se estancó. Sin embargo, las perspectivas francesas para los próximos meses han mejorado.

El PMI compuesto, que mide la actividad manufacturera y de servicios, cedió a 49,3 en febrero frente a un anuncio original de 49,7 y por debajo de la lectura de enero de 50,4.

"En este momento, nuestras estimaciones son que el PIB de la región se habrá reducido un 0,1 por ciento en los tres primeros meses del año", expresó Chris Williamson, economista jefe de Markit.

Un sondeo de Reuters el mes pasado pronosticó una contracción de la economía de la zona euro del 0,2 por ciento en el trimestre actual, lo que provocaría la segunda recesión en tres años.

"La debilidad persistente en países como Italia y España también aplacará el crecimiento en otros países de la zona euro que normalmente dependen del comercio dentro de la región, restringiendo las recuperaciones en Alemania, Francia y otros países del norte", agregó Williamson.

El sector de servicios de España empeoró significativamente en el mes pasado, según los datos de PMI conocidos el lunes, mientras que el negocio en Italia registró su noveno mes seguido de descenso.

(Reporte de Andy Bruce. Traducido por la Redacción de Madrid; editado por Carlos Aliaga vía Mesa Santiago)

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Sector servicios China toca máximo 4 meses en febrero: PMI HSBC
lunes 5 de marzo de 2012 05:56 GYT Imprimir [-] Texto [+]
PEKIN (Reuters) - El sector de servicios de China operó en febrero a su ritmo más rápido en cuatro meses, aunque muy por debajo de su tendencia de largo plazo pese a un salto en el crecimiento de nuevos negocios a un máximo en ocho meses, mostró el lunes una encuesta del sector privado a gerentes de compras.

La lectura, que proporciona una muestra de las condiciones en las empresas que van desde restaurantes hasta bancos, contrasta con un reporte oficial el sábado que indicó que el sector se está contrayendo.

El índice chino de gerentes de compras (PMI, por su sigla en inglés) del sector de servicios elaborado por HSBC subió a un 53,9 en febrero estacionalmente ajustado desde 52,5 en enero, muy por encima de la marca de 50 que delimita la expansión y contracción.

"A pesar de esto, los proveedores de servicios reportaron una modesta tasa de creación de empleo, y nuevamente expresaron una confianza por debajo de la tendencia sobre las perspectivas de negocio a corto plazo", dijo en un comunicado el proveedor de datos británico Markit, que recopiló el índice.

En la superficie, la encuesta de HSBC marcó un repunte sólido en el pujante sector terciario de China. Pero Markit inyectó una advertencia acerca de los hallazgos, teniendo en cuenta que el alza de nuevos pedidos también fue mucho menor que el promedio de la serie.

"El crecimiento en las actividades de servicios alcanzó su mayor ritmo en cuatro meses, gracias a un aumento notable en los nuevos negocios. Esto ayudó a elevar las nuevas contrataciones y las expectativas de negocios", dijo Qu Hongbin, economista jefe para China y co-director de investigación económica en Asia de HSBC, en un comunicado que acompaña a los datos.

La encuesta indicó que las empresas de servicios continuaron contratando nuevo personal en respuesta a las cargas de trabajo crecientes, con el sub-índice que mide la creación de empleos subiendo en febrero respecto a enero. El nivel de nuevos negocios previstos por los encuestados subió a un máximo en cuatro meses.

El alza en los precios de los insumos alcanzó en febrero un máximo de tres meses, con los consultados citando como sus principales impulsores a mayores costos de combustibles y ligados con mano de obra. Pero el último aumento fue más lento que el promedio de la serie a largo plazo.

La lectura del índice principal en el sondeo de HSBC mostró una imagen muy distinta a la del PMI oficial de servicios.

Este registró una contracción del sector con una lectura de 48,4 en febrero -su nivel más bajo en un año- contra el 52,9 de enero.

La Oficina Nacional de Estadísticas de China dijo en un comunicado en su página web que la debilidad en la demanda de servicios de cara al feriado del Año Nuevo Lunar fue responsable de la caída.

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http://online.wsj.com/public/page/espanol-inicio.html