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Chinese-style Steamed Whole Fish

Ingredients

750 g whole snapper, scaled, cleaned and gutted
1 leaf nappa cabbage, cut into 4 squares
1/4 cup chicken broth
1/4 cup Chinese cooking wine
1/4 cup ginger julienne
2 teaspoons white sugar
3-1/2 tablespoons light soy sauce
1/4 teaspoon sesame oil
1/3 cup green shallot julienne
1/4 cup peanut oil
1/2 bunch coriander, leaves only
small pinch ground white pepper

Method

  1. Pat fish dry and place on a chopping board. With a sharp knife, make three diagonal slits into the side of the fish, then score in the opposite direction to make a diamond pattern. Turn the fish over and repeat on the other side.
  2. Bring a large steamer pot of water to the boil. Arrange cabbage squares in a shallow heatproof bowl, and place fish on top. Pour combined stock and wine over fish, then sprinkle the fish with half the ginger, avoiding the head.
  3. Place bowl inside steamer basket over boiling water, put lid on steamer and steam for 10-12 minutes or until fish is cooked. The flesh should be white through to the bone, which will be exposed by the cuts. If flesh is still translucent, replace lid firmly and steam for another minute or so.
  4. Remove steamer basket from steamer, then carefully remove the bowl from the steamer basket. Sprinkle sugar evenly over fish, avoiding the head. Drizzle fish with combined soy sauce and sesame oil, and sprinkle with remaining ginger and half the shallots.
  5. In a small pot, heat peanut oil until it reaches smoking point. (This is the most important point of the dish — the oil must be hot enough to ‘scald’ the ginger and shallots.) Slowly and carefully drizzle hot oil over fish. Garnish with remaining shallots, plus coriander and pepper, and serve hot.

Source: Kylie Kwong

What Is a ‘Good Death’?

Discussions must go way beyond treatments and deal with the patient’s sense of peace, experts say.

At the end of their lives, most people want peace, as little pain as possible, and some control over how they die, a new research review finds.

Researchers said the study gives some sense of how people typically define a “good death.”

For those facing a terminal illness, it seems that what matters most is control over the dying process — being home rather than in hospital, for instance — being pain-free, and having their emotional and spiritual needs met.

And for their families, the hopes are largely the same, according to the review of an international array of studies on “successful dying.”

The findings were published in the American Journal of Geriatric Psychiatry.

Yet, experts said, when it comes to caring for terminally ill patients, doctors often focus the discussion on treatments — which ones are wanted, which ones are not.

“That’s important, but we have to go way beyond that,” said Dr. Dilip Jeste, the senior researcher on the study and director of the Stein Institute for Research on Aging at the University of California San Diego School of Medicine.

“The take-home, to me, is that we really need to talk to patients about the dying process,” Jeste said.

Often, he noted, the subject is seen as “taboo,” by doctors, family members and even patients themselves.

“Even if patients want to talk about it,” Jeste said, “they may be afraid to bring it up with their families, because they don’t want to upset them.”

Because of that, Jeste said, he’s found that patients often “feel relieved” when their health providers broach the subject.

It’s true that “advance care planning” for people with serious illnesses often focuses on treatments, agreed Dr. R. Sean Morrison, who directs the Herzberg Palliative Care Institute at Mount Sinai Icahn School of Medicine, in New York City.

So a patient, for instance, will make decisions about whether he wants doctors to try to prolong his life by using a mechanical ventilator when he can’t breathe on his own, or feeding tube when he can’t eat.

“What this study tells us is, that’s not actually what’s most important to patients and families,” said Morrison, who was not involved in the research.

Instead, he said, they care more about what the remainder of their life will look like — and not just the final days.

According to Morrison, end-of-life discussions — whether they’re between patients and doctors, or among family members — should focus on a person’s values.

“Who are you as person? What’s truly important to you? How do you define a good quality of life?” Morrison said. “If someone says spirituality or religion is important to them, for instance, I better make sure a chaplain is involved at some point.”

For the review, Jeste’s team pulled together 36 international studies looking at patients’, families’ and healthcare providers’ views on “successful” dying. Patients ranged in age, but were elderly on average; most often, they had advanced cancer, heart failure, lung disease or AIDS.

Overall, the researchers found 11 “core themes” that consistently came up across the studies.

For patients, the most common themes were: control over their dying process; being free of pain; spiritual and emotional well-being; and a sense of life being “complete” — which meant having a chance to say good-bye to their loved ones, and feeling that they’d lived “well.”

For the most part, families had the same priorities.

Doctors and other health care providers, meanwhile, valued pain control and patients’ preferences for where and how they died. But they put less emphasis on the existential — like patients’ sense of life completion and spirituality.

To Morrison, the findings offer a “roadmap” for doctors to use in end-of-life discussions. “This essentially gives them a list of core themes that really matter to patients,” he said.

Still, Morrison stressed, any end-of-life discussion has to be highly individual. And he suggested it start when a patient is diagnosed with a disease that is likely terminal.

“Everybody is different,” he said. “We all have to understand and be able to talk about what we value. If it’s important to you to stay at home, tell your doctor you want the type of care that will help you remain at home.”

Jeste agreed. “Ultimately, well-being is defined by the dying person,” he said. “We talk all the time about ‘personalized medicine.’ That has to extend to the end of life. ‘Successful’ dying is an extension of successful living.”

Source: U.S. Department of Health and Human Services

In Pictures: Sushi Burger

‘Revolutionary Future’ for Contact Lenses – Drug Delivery, Disease Monitoring and More

Imagine contact lenses that can deliver medicines directly to the eye, slow progression of nearsightedness in children, or monitor glucose levels in patients with diabetes. Those are some of the emerging advances in contact lens technology reported in the April special issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Wolters Kluwer.

The special issue on “Revolutionary Future Uses of Contact Lenses” presents original research and reviews on proposed new uses for contact lenses. Taking advantage of new materials and technologies, these ideas go far beyond the traditional use of contact lenses for vision correction, offering potential new treatments for eye diseases, along with new approaches to monitoring of medical conditions.

New Technologies Open Exciting New Uses for Contact Lenses

The special issue was assembled by an international expert panel, led by Lyndon Jones, PhD, FCOptom, of University of Waterloo, Ont., Canada. It features 13 papers on new and emerging applications–some still under development, some already available–for contact lens technology:

  • Slowing progression of myopia. With rising rates of nearsightedness (myopia) in children worldwide, there is growing interest in the use of contact lenses to prevent or slow progression of this vision defect. Two original research studies suggest that lasting reductions in myopia progression may be possible even with some currently available contact lenses. In the future, lens designs developed specifically for this purpose may be even more effective.
  • Drug and stem cell delivery. New technologies such as “molecular imprinting” have renewed interest in the possibility of using contact lenses to deliver medications directly to the eye over a period of days to weeks. While many challenges remain, this approach could lead to improved treatments for ocular diseases, achieving higher drug levels in the eye itself. Contact lenses are even being evaluated a new approach to stem cell therapy for patients with ocular surface diseases.
  • Contact lens ‘biosensors.’ New technologies may enable the development of contact lenses containing biosensors to monitor patient health. For example, a device to monitor changes in intraocular pressure in patients with or at risk of glaucoma is commercially available now. The special issue also includes a report on biosensing contact lenses that can measure glucose levels in the tear film of the eye, which may one day provide a new approach to continuous monitoring in patients with diabetes.
  • New approaches to vision correction. Meanwhile, researchers are still working on new designs to further improve vision correction with contact lenses. Studies in the special issue report promising results with new approaches to extending depth of vision for patients with aging-related vision loss (presbyopia) and benefits of “centrally red-tinted contact lenses” for patients with degenerative retinal diseases or extreme light sensitivity (photophobia).

Other technologies in earlier stages of development include accommodating contact lenses capable of changing change focus, “wearable displays” using contact lenses, and lenses with “photonic modulation” for treatment of seasonal affective disorder. “The advances in contact lens technology, especially imaging and new biocompatible materials, has made such possibilities a reality,” comments Anthony Adams, OD, PhD, Associate Editor of Optometry and Vision Science. “Researchers are already proposing solutions to the clinical and research challenges posed by these revolutionary new uses of contact lenses, going well beyond vision correction.”

Source: Wolters Kluwer Health


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