Category Archives: Transplantation & Donation

Over-the-counter pills left out of FDA acetaminophen limits

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By Jeff Gerth and T. Christian Miller
ProPublica

January 16, 2014 – Earlier this week, the U.S. Food and Drug Administration urged health care providers to stop writing prescriptions for pain relievers containing more than 325 milligrams of acetaminophen, the active ingredient in Tylenol.

The agency’s announcement was aimed primarily at popular prescription medicines that combine acetaminophen with a more powerful opioid such as hydrocodone.

Agency officials said they had determined that “there are no available data” to show that the benefits of having more than 325 milligrams of acetaminophen in a single pill outweighed the risks from taking too much of the drug. Continue reading

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Illustration of the lungs in blue

GOP lawmakers press Sebelius to help child awaiting lung transplant

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Sebelius

By Mary Agnes Carey

A child in desperate need of a lung transplant clinging to life. Long waiting lists of patients who need organs and too few donors to meet the demand.  Rules that govern who gets what life-saving organs – and when.

Department of Health and Human Services Secretary Kathleen Sebelius had to confront all those issues on Tuesday when Republican lawmakers asked her repeatedly why she would not use her authority to make sure a 10-year-old Pennsylvania girl gets a lung transplant that could save her life.

Sarah Murnaghan, who is suffering from end-stage cystic fibrosis, needs a lung transplant or will die in two to three weeks.

Current organ donation rules make her ineligible for an adult lung and there are fewer children’s lungs that come available.  She has been on a waiting list since 2011, according to published reports.

The Organ Procurement and Transplantation Network, whose duties include collecting and managing scientific data about organ donation, says that nearly 1,700 people nationwide are waiting for lung transplants.

Price

Price

Rep. Tom Price, R-Ga., drilled Sebelius about the situation during a Capitol Hill hearing on the HHS budget Tuesday. Murnaghan cannot get the transplant she needs “because of an arbitrary rule that if you’re not 12 years old, you’re not eligible to receive an adult lung,” said Price, who is a physician.  “Madam Secretary, I would urge you this week to let that lung transplant move forward … It simply takes your signature.”

Sebelius said she has spoken with the girl’s mother and “can’t imagine anything more agonizing” than what the family is going through.

Sebelius said about 40 very seriously ill people in Pennsylvania over the age of 12 also are waiting for a lung transplant, as are three other extremely sick children in the same Philadelphia hospital as Murnaghan.

“I would suggest that the rules that are in place and are reviewed on a regular basis are there because the worst of all worlds, in my mind, would be to have some individual picks who lives and who dies,” she said. “I think you’d want a process guided by medical science and medical experts.”

That answer didn’t satisify Rep. Lou Barletta, R-Pa.

“Why do we have such bullcrap around this place and we have the chance to save someone’s life. … Why wouldn’t we do this?” he asked.

While Sebelius has ordered a review of transplant rules to analyze their fairness, “a study will take over a year [and] this young lady will be dead,” Price said at the House Education and the Workforce Committee hearing.

After the hearing, Sebelius told reporters that HHS lawyers “very much disagree that there is any ability for an individual to reach in” and change the current organ rules.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Dr. Ruth McDonald

Ruth McDonald has been appointed pediatrician-in-chief at Seattle Children’s

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Dr. Ruth McDonald has been appointed pediatrician-in-chief at Seattle Children’s Hospital.

Dr. McDonald, a pediatric nephrologist, has been with Seattle Children’s for 19 years, most recently as medical director of Ambulatory Services where she focused on improving communications and aligning hospital and clinic needs with the needs of referring physicians.

Continuing to enhance such communications will become part of Dr. McDonald’s responsibilities in her new pediatrician-in-chief role, hospital officials said.

Dr. McDonald is also an at-large member of the Children’s University Medical Group Board of Directors and chairs the group’s Clinical Practice Committee.

Dr. McDonald also serves as principal investigator in many multicenter research studies on pediatric renal transplantation. Additionally, she serves on the pediatric nephrology sub-board of the American Board of Pediatrics.

Dr. Mark Del Beccaro, former pediatrician-in-chief, has moved into his new position as vice president of medical affairs at Seattle Children’s.

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Hospitals seek patients on Google, Facebook

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By Phil Galewitz
KHN Staff Writer

This story was produced in collaboration with 

When the University of Pennsylvania Health System sought new patients for its lung transplant service last year, it turned to Facebook and Google.

Google ad for transplants at Penn.

The results of the $20,000 advertising campaign on the websites exceeded administrators’ expectations.

During a few weeks in August and September, more than 4,600 people clicked on the ads and 36 people made appointments for consultations.

One of those is now on the hospital’s lung transplant waiting list, and several others are being evaluated, hospital officials say. While the response may seem small, each transplant brings in about $100,000 in revenue.

“We wanted to test the theory of how successful a digital marketing campaign could be,” said Suzanne Sawyer, the health system’s chief marketing officer.

“It was like looking for a needle in a haystack,” she said, noting only about 60 lung transplants are done each year in Philadelphia, where the health system is based.

Penn is one of a small, but growing number of hospitals taking their advertising campaigns to Facebook, Google and other websites.

Fewer than 150 of the nation’s 6,000 hospitals use Google and Facebook to market services, estimates Rob Grant, executive vice president of eVariant, a Simsbury, Ct.-based hospital consulting firm.

He and other experts predict the numbers will rise as more see the value of highly targeted campaigns that enable them to track results.

“People are seeking out information online, and we wanted to meet people where they are looking for things,” said Tim McGuire, customer research and relationships manager for Greenville Hospital System in South Carolina, which is also using digital marketing.

Hospitals are hardly the only businesses using social media to advertise.  But at a time of mounting concern about wasteful health spending, critics question an approach that is “about revenue generation, not about improving health,” in the words of Elliott Fisher, director of the Center for Population Health at The Dartmouth Institute for Health Policy and Clinical Practice.

Facebook Users May Be Unnerved

“It saddens me to see an academic medical center go down this road,” said Dr. H. Gilbert Welch, an expert on the dangers of medical screening and author of the book, Overdiagnosed: Making People Sick In The Pursuit Of Health. “People should have a healthy skepticism and recognize these ads for what they are: efforts at persuasion … that are likely to be unbalanced.”

44 percent of Facebook users said they would never click an ad and 30 percent “strongly distrust” Facebook with their personal information.

Some health care experts suggest Facebook or Google users may also be unnerved to see ads for hospital services appear on their screens while they catch up with friends and family, because of information they may have shared or searched for.

“I don’t want Facebook to know what essentially are my medical needs,” said Gerard Anderson, director of the Center for Hospital Finance and Management at the Johns Hopkins Center For Global Health.

study by London-based digital marketing agency, Greenlight, released in May on the eve of Facebook’s initial public offering found 44 percent of its users said they would never click an ad and 30 percent “strongly distrust” Facebook with their personal information.

Hospital executives say the strategy benefits patients, as well as providers.

“Some may see it as an intrusion of privacy, but others say it’s about delivering content that is more relevant to me,” said Chris Boyer, director of digital marketing and communications at Inova Health System, based in Falls Church, Va.

Last year, he said, Inova advertised weight loss programs on Facebook for three months at a cost of about $1,500.

Nearly 300 people clicked its online ad and 30 people registered for a free weight-loss seminar.

Seven of those ended up having weight loss surgery, which helped the hospital make a $20,700 profit on that surgery in the second quarter of 2011.

The goal was not to channel people towards surgery, he added, but to provide them access to a full range of weight loss services.

‘We Walk A Fine Line’

Boyer said that Inova paid to place ads on the Facebook pages of users in the hospital’s market area who were between the ages of 35 and 55.  The hospital did not target people based on information in their Facebook status updates. “We walk a fine line when we do this kind of advertising,” he said.

For Inova, Google has been a more effective advertising vehicle than Facebook, Boyer said, but both have brought in new patients.

With Google, the hospital bid for search terms such as “bariatric” or “weight loss,” and when people from the hospital’s market area did a search, an ad showed up next to their search results. Inova paid a fee each time someone clicked on their ad. Google users can be targeted by zip code, city or state.

Both Google and Facebook customers can limit advertisers’ use of their personal information by changing their privacy settings.

Despite early success, Boyer said that online advertising makes up only about 7 percent of Inova’s media spending. Unlike broadcast ads or billboards, online buys enable a hospital to track who responds to the ad and what they spend at the hospital as a result.

Penn, meanwhile, is expanding its social media presence since targeting its transplant ads at people 35 and older who “liked” a lung transplant advocacy group.  The ads began running a few months after Temple University in Philadelphia temporarily shut its transplant program. Temple, which has since resumed the program, declined to comment on its competitor’s strategy.

As of June 1, Penn had about 60 people on its lung transplant list, where they wait to be matched with organs that meet their specific tissue type, among other criteria.

“In the past, most of our lung transplant patients have been referred to us from community-based physicians,” said Sawyer, the marketing chief.  “We now see that individuals are actively searching for options, and some are self-referring for evaluations.”

Penn officials were so encouraged by the results, she added, that they have put together a dozen other digital marketing campaigns, promoting fertility services and proton therapy for prostate cancer, among other services.

“It is a more responsible use of a hospital’s limited resources than using expensive mass media advertising,” Sawyer said.


This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Diagram showing how a donated kidney is implanted in the human body

Living kidney donation: Free seminar, April 24

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Diagram showing how a donated kidney is implanted in the human bodySeminar Living Kidney Donation April 24 at First Hill Campus

A free educational seminar about living kidney donation will be held Tuesday, April 24 from 6:30-8:30 p.m. in Glaser Auditorium on Swedish Medical Center’s First Hill campus (747 Broadway, first floor).

At the two-hour seminar Swedish Organ Transplant’s living kidney donor team will talk about the living kidney donor process.

Speakers will include:

  • Phillip Chapman, M.D. – Living kidney donor surgeon
  • Nelson Goes, M.D. – Nephrologist
  • Diane Gould, R.N. – Living donor clinical transplant coordinator
  • Kathy Otis, M.S.W. – Medical social worker
  • A living donor
  • Moderator Marquis Hart, M.D. – Organ transplant surgeon and medical director of Swedish Organ Transplant

After the team members speak, a panel of two or three living kidney donors will discuss their personal experience with being a living donor, followed by a question-and-answer period.

Light refreshments will be served.

Registration for this free seminar is required.

To RSVP, contact Dwayne Biles at 206-215-2913 or via dwayne.biles@swedish.org.

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Close Up on an intensive care unit's heart monitor.

Cutting through ICU confusion

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Amy Sutton, Contributing Writer
Health Behavior News Service 

Family snapshot of Jim Young and his children sitting on a sofa.

Jim Young and his children

In January 2010, after beginning treatment for chronic Lyme disease, 53-year-old Jim Young lost significant weight and struggled to breathe.

Doctors admitted him to a private room in the hospital, but within 15 hours, his wife Erica Kosal received a call about his imminent transfer to the intensive care unit (ICU).

The first time seeing him in the ICU came as a shock to Kosal, 42, a college professor. “I can remember he was hooked up to all kind of machines. He looked so deflated. He was out of it and really sleepy and confused. He didn’t look like the same person and I wasn’t prepared for that,” Kosal said.

Several days after giving birth in 2003, marketing agency owner Ann Albergotti, then 35, woke to a throbbing headache and temporary blindness.

After doctors diagnosed her with a stroke in the ER, she spent 5 days in the ICU. Her nurses and doctors kept her and her family well informed: “I knew what was happening, what was going to happen and why,” Albergotti said.

But when her 76-year-old mother was admitted to the ICU last year for a collapsed lung, the flow of information between staff and family didn’t run so smoothly.

“When her condition worsened, it happened overnight and at a time when the family had left for the night to return in the early morning. We didn’t find out what happened until our return and we had specifically asked that if her condition changed while we were away, that we get a call. That was upsetting,” Albergotti said.

Like Young and Albergotti, every year more than 5 million people in the United States spend time in intensive care units for acute injuries or life-threatening illnesses.

For patients, family members and friends, the ICU experience is often emotional and confusing.

Who’s Who in the ICU

If you or a loved one is in the ICU (sometimes referred to as critical care), you’ll come in contact with a variety of medical professionals. Here’s a brief who’s who:

Intensivist:

Doctors who diagnose ICU patients and direct their care and treatment are called intensivists. These physicians, also called critical care doctors, have specialty and subspecialty training in treating critically injured and ill patients. Intensivists usually work in the ICU full-time.

 ICU nurse/critical care nurse:

ICU nurses implement the intensivist’s plan of care. They monitor the patient, assess pain, administer medications, and perform tasks such as placing tubes and managing ventilators and dialysis. They also work closely with families, explaining the patient’s condition and care.

Nurse manager:

The nursing unit manager, or charge nurse, oversees the nursing care in the ICU and assists the nurses when necessary.

Specialty physician:

“Whatever the patient’s primary sickness is, those doctors will be there in addition to the primary critical care doctor,” Adalja said. Inside the ICU, you may see other specialists, such as gastroenterologists, surgeons, neurologists and infectious disease doctors.

Pharmacist:

Pharmacists prescribe medicine dosages for ICU patients. Like intensivists, ICU pharmacists have specialty training in prescribing medicines for critically ill and injured patients.

Therapist:

Several types of therapists work with the critical care team. Respiratory therapists help ICU staff monitor the patient’s breathing. Physical therapists work to minimize permanent disabilities. Occupational therapists in the ICU help reduce patient’s disability at work and at home.

Social worker:

Families in the ICU may benefit from talking to a clinical social worker (sometimes called a case manager), a person trained to help with communication between medical team members and family. An ICU social worker may offer emotional support, provide referrals to community resources, assist with the transition out of the ICU and help families navigate the end-of-life decision making process.

Clergy/chaplains:

Hospital clergy members provide emotional and spiritual support to ICU patients and their families. Some ICUs have their own dedicated chaplains; others have a hospital chaplain that serves patients and family in all hospital units.

The Sickest Patients

Close Up on an intensive care unit's heart monitor.

Photo by Hamma

If you’ve ever visited a family member or friend in the ICU, your stomach sick with fear and worry, you may have wondered — why the ICU? Why not some other hospital unit?

“ICUs take care of the sickest patients in the hospital,” said Amesh A. Adalja, MD, FACP, a clinical assistant professor in the department of critical care medicine at the University of Pittsburgh Medical Center.

People who’ve experienced heart attacks, strokes, surgical complications and severe respiratory problems receive care in the ICU. The ICU also provides trauma care for those who’ve been severely injured in automobile accidents or from gunshot wounds, fires, falls or industrial accidents.

What sets the ICU — sometimes referred to as the critical care unit — apart from the emergency department or other hospital units is that ICU patients require continuous monitoring and sometimes, advanced machinery to support their life functions.

For example, a patient whose kidney function is impaired may receive intermittent dialysis in other areas of the hospital. But a patient who needs dialysis around the clock requires ICU care.

Patients who need regular suctioning of the respiratory tract, who require a ventilator to help them breathe or who need infusions of medicines to keep their blood pressure stable are other examples of those requiring ICU monitoring.

The ICU also differs from other hospital units in its much lower ratio of nurses to patients. ICU nurses typically care for only one or two patients. In other areas of the hospital, nurses may be responsible for six or more patients.

Not all ICUs are created equal, and the size of the hospital you’re visiting plays a role in the type of ICU environment you’ll experience. Smaller hospitals may have only one ICU that takes all types of patients.

In larger hospitals, there may be multiple ICUs, each specializing in a certain type of critical illness, such as stroke or cardiac or thoracic surgery.

How the ICU looks also varies from hospital to hospital and unit to unit. In general, though, ICUs tend to be more open, compared to other areas of the hospital. ICU “rooms” may not have a door, they may be enclosed only on three sides, or the door or room may be transparent so that staff can more easily monitor patients by sight from a central desk.

“Compared to other areas of the hospital, ICUs are also busier, faster, with a large number of people and lots of equipment around each bed. There is also more ambient noise than in many other hospital areas from things like monitors, ventilators and other medical devices,” said Linda Bell, MSN, RN, a clinical practice specialist with the American Association of Critical-Care Nurses.

Putting Family at Ease

Most of the time, patients admitted to the ICU come from other areas of the hospital. Like Erica Kosal, family members may receive a call from emergency services or another hospital unit letting them know their loved one is being transferred to the ICU.

“They’re stressed, so it’s important to put them at ease. We try to give them an overall picture of what’s going on with the patient,” said Michael Bergman, MD, director of the ICU at University Hospital of Brooklyn at Long Island College.

When families first get to the ICU, the nursing staff typically explains what will happen at the patient’s bedside, what type of monitoring they’re on and what the plan of care will be, said Barbara Maffia, RN, ICU Nurse Manager at University Hospital of Brooklyn at Long Island College. Nurses in the ICU may also ask the family whether the patient has a health care proxy, a person to make medical decisions for them.

Bergman points out that ICUs are stressful environments for both family members and medical staff. “In other hospital units, doctors may know the patient’s diagnosis before the patient is treated. In the ICUs, the diagnostic process goes on while treatment goes on. In ICUs, if the patient is sick, a lot of times we don’t have all the answers of what’s going on. You’re trying to stabilize blood pressure, fluid status and other issues while trying to figure out what caused all this,” said Dr. Bergman.

Keeping Family and Friends Informed

For some people, a phone-tree is an efficient way to pass along information (one person calls three people with updates, who each call three others, etc.) But for many, there’s no longer a need for a phone tree: the families of today’s ICU patients can easily keep out-of-town friends and family informed by creating a simple blog-style, privacy-protected patient website. Family members can update everyone on the patient’s condition at once, share photos and receive messages of support. Try these free resources:

Seeing Your Loved One

Finding out your loved one is in the ICU is difficult. Seeing your loved one in the ICU environment often proves startling and upsetting. Though this experience is usually emotional, knowing what to expect may help you remain strong when first arriving.

Your loved one’s appearance may have changed drastically from the last time you saw him or her. ICU patients may have bruising because of blood tests, clotting problems or injury. Many patients in the ICU experience facial swelling due to medications or from injury. The patient may have tubes in his or her nose or mouth. You may see bandages to help hold tubes in place. Your loved one may need a catheter to collect urine or a temporary or permanent opening in the stomach to collect urine and stool.

If you’re visiting someone in the ICU, don’t be surprised if you’re asked to leave during certain medical procedures, such as central or intravenous line placement or catheterization. The medical staff informs family of the need for these procedures beforehand, but encourages them to step away from the patient’s room—but with good reason.

“You may think that they’re being put through discomfort when they’re not. These procedures can be quite traumatic for families to watch,” and having family members in the room can cause added stress for medical personnel performing the procedures, Bergman said.

The aftereffects of certain procedures, such as breathing tube insertion, can cause pain in the throat, making speech difficult. In addition, fluctuations in body fluids and chemicals in the blood can interfere with a person’s cognitive ability, making it difficult to think clearly or talk.

Finally, the medicines used to manage the pain associated with critical illness may cause big changes in how your loved one talks and acts, causing disorientation, hostility or confusion.

Managing pain is an important aspect of ICU care for critically ill patients. “Many patients have pain, discomfort or agitation, either because of illness or because of the procedures being done. ICU teams put a great emphasis on relieving pain and discomfort,” Bergman said. Patients in ICU may receive analgesics, or pain-relieving medications, as well as sedatives to reduce anxiety.

As part of ICU care, nurses reassess pain regularly and administer medications as necessary. But if you notice distinct changes in your loved one’s personality or feel that the patient looks uncomfortable, it doesn’t hurt to advocate for your loved one. You should approach the ICU nurse, and say “to me, she looks uncomfortable,” Bergman said.

A Family Affair

When it comes to family member visitation in the ICU, the policies vary from hospital to hospital and from unit to unit. Nurses often have some discretion to either expand or limit family access, but generally any adult who wants to visit during visiting hours will be allowed to, Adalja said.

In the busy ICU environment, family members may feel that getting the answers to their questions is a challenge.

However, visitation by children under the age of 14 on adult ICUs is nearly always limited because of potential psychological effects and the infection risk, Bell said.

Bergman noted that his ICU limits patient visitation in the morning, when nurses and physicians are busiest assessing pain levels, performing procedures and administering medications.

In the busy ICU environment, family members may feel that getting the answers to their questions is a challenge. Bell recommends designating a single family member to act as the conduit for information for the rest of the family who is prepared to write down questions they may have to discuss with the clinical team at a convenient time. Critical care is full of jargon, so stopping a doctor to politely ask, “What does that mean?” is a useful strategy to get answers to your questions, Bergman said.

While you’re visiting your loved one in the ICU, it’s easy to feel helpless among the medical machinery and highly trained staff. But Bell notes that patients may benefit from the touch and assistance of friends and family.

“They might also want to ask if it’s okay for them to help with some of the routine care, things like combing hair, swabbing the mouth, massaging or putting lotion on the arms or legs,” Bell said.

To help ease Young’s ICU recovery, Kosal brought in photos of their children and a special pillow for him to use after his tracheostomy. Both Young and his daughter designated a special stuffed animal that they could hold when missing each other, Kosal said.

In the wake of stress and worry that invariably accompanies a loved one’s ICU stay, don’t neglect your own needs. “The hard part for family members will come when the patient is discharged and in need of additional care at home. So it is vitally important that family members take time to eat, rest and take care of their personal needs,” Bell said.

Photo of the ICU monitor by Hamma

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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Photo: Sigurd Decroos

The Gift of Giving: How One Living Donor Can Start a Chain of Transplants

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Photo: Sigurd Decroos

With the demand for transplants far surpassing the supply of donated organs, new and innovative ideas are essential to helping thousands of patients.

Connie Davis, M.D., professor of UW Medicine and director of Kidney Care and Transplantation Services at UW Medical Center, explains how organ transplantation works and how just one living donor can start a chain of transplants!

This event series is co-sponsored with UW Medicine. It is free, and everyone is welcome.

Photo by Sigurd Decroos

Registration is not required.

Where:

  • Seattle Central Library, 1000 Fourth Ave., Downtown.

When:

  • Wednesday, November 3, 2010, 6:30 – 8pm

Contact Info: Central Library 206-386-4636 or Ask a Librarian!

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Morning Report: Seattle, regional and national health stories in the news

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Fighting hunger and obesity at the same time

The Obama administration intends to use federal food assistance programs to improve the nutrition of the poor, the Washington Post reports.

Obesity is a growing health problem with one in four Americans now being dangerously overweight and one in three children being either overweight or obese.

Research, including work being done at the University of Washington in Seattle, has linked poverty and obesity. 

But there are skeptics, the Post’s Jane Black reports, “Public health advocates have long hoped to link food assistance to good nutrition. To the anti-hunger lobby, however, mandating what kind of food needy people should eat is impractical and smacks of paternalism. It would be impossible, they say, to determine which of the 50,000-plus products in the grocery store should be classified as healthful.”

To learn more: 

Sunnyside teen honored posthumously for organ donation

A Sunnyside teen whose tissues and organs were donated after he died in an automobile accident last October is one of 34 organ donors who will be honored in the Rose Parade this New Year’s Day in Pasadena, California, writes Yakima Herald Republic reporter Ross Courtney in an AP story appearing in the  Seattle Post-Intelligencer.

To learn more: 

How a team of firefighters that wouldn’t quit saved a man’s life

In today’s Seattle Post-Intelligencer, reporter Casey McNerthney tells how a team of North Highline Fire District firefighters worked for more than an hour to restart a man’s heart after he had a cardiac arrest. 

“Rescuers took turns at CPR until their arms burned,” McNerthney writes. “The man suffering cardiac arrest on the kitchen floor was clinically dead….”

To learn more:

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