Palliative Carer Workers Blogs
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Facebook Friends with a Dying Patient (Via NYTimes)
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If you want a better story about the potential for social media to be another tool for connecting people to each other, you won't have to look much further than Daniela Lamas' essay in the New York Times this past week.
As a medical resident she tells of a critically ill man using his laptop frequently in his ICU bed to update his Facebook status. Through a very simple exchange at the bedside, they became friends on Facebook, a new relationship which became much more complex.
The essay is short, but packs several difficult questions that Daniela elucidates very well in the essay. Read it and bring it to your team to see ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 14, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Three Excellent Blog Posts For our FieldEmail this article to a colleague.
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I couldn't wait until next month's palliative care grand rounds and so I had to post a link to each of these three wonderful blog posts to make sure you knew about them.
One from Joanne Kenen at The New Health Dialgoue from the New America Foundation:
In the article "This is Why We Need Palliative Care" Joanne comments on an article in the journal Health Affairs called "Shock Me, Tube Me, Line Me." An exceprt from her post:
End of life, he writes, can be done better. He’s correct. It can. "Give me a motorized wheelchair and a feeding tube if I need them, along with a tracheostomy to help me breathe and dialysis to fi...
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 14, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Palliative Care Grand Rounds 2.3 is up!Email this article to a colleague.
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Larry Beresford has posted a wonderful Palliative Care Grand Rounds on his blog hosted at Growth House. Thanks Larry for finding some great links! I especially like all the new blogs and posts about grieving and widowhood.
Go over to Larry's blog to see the best of what the blogosphere has to offer in all matters hospice and palliative care.
If you are interested to follow Palliative Care Grand Rounds you can also check out the PC Grand Rounds blog.
The host for April is Tim Cousounis at Palliative Care Success. Send him any blog posts you deem worthy for PC Grand Rounds. (Source: Pallimed: A Hospice & Palliative Medicine Blog)
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 9, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Fraudulent Pain Researcher ConvictedEmail this article to a colleague.
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Anesthesiologist Dr. Scott Reuben, a prominent pain researcher, has been convicted of falsifying medical research studies.
From BMJ article:
Dr Reuben’s published studies concerned use of multimodal analgesia (a combination of non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors) to manage pain after surgery. The US Department of Justice, which prosecuted him, said that his papers suggested that "multimodal analgesia would be as effective for pain, promote long-term healing, and avoid some of the side effects associated with opioid therapy."Sadly, he's authored 21 papers in the last 15 years per the BM...
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 9, 2010 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs
Implantable Cardiac Defibrillators- Hospice Role in Deactivation?Email this article to a colleague.
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The Annals of Internal Medicine published a survey of hospices regarding their experience with patients who have implantable cardiac defibrillators. (See here for a brief explanation of these devices.)The survey, conducted by Dr. Nathan Goldstein and colleagues, was directed at hospice administrators with instructions for that person to speak with the clinical staff. Of the 414 hospices that responded (a little less than half of those surveyed), 97% reported having patient(s) with ICDs, 58% reported having at least one patient who was shocked in the last year, and 42% of patients had the device deactivated.Having a polic...
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 9, 2010 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs
Twitter, Blogs and the 2010 AAHPM HPNA Annual AssemblyEmail this article to a colleague.
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I had a wonderful time at the 2010 AAHPM / HPNA Annual Assembly in Boston this past week. Meeting new people, seeing good friends, and learning a few new tricks along the way.
One of the prevalent themes in many of my conversations was social media, particularly blogs (the new AAHPM blog, GeriPal and Pallimed) and Twitter. The Social Media in Palliative Care Communities talk was an apparent success given we got 24 survey responses, expected only 10 people to come at the 7am session that had a compressed promotion timeline, but we had over 140 people, standing room only. There ARE people who like social ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 7, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Pallimed Readers Task: What did you learn from the Annual Assembly?Email this article to a colleague.
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It is so wonderful to be able to drink in from the fountain of knowledge and networking that is the 2010 AAHPM / HPNA Annual Assembly, but it is also important to share that knowledge with your co-workers. Since 2006 when the University of Kansas Palliative Care Fellowship (in conjunction with Kansas City Hospice & Palliative Care) started we have had two hours of review scheduled in place of the usual lectures. This serves a purpose for further discussion about important points from the meeting amongst the attendees but even more critical the passing of knowledge to those who could not attend. Why sh...
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 7, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Medicare Beneficiaries and Three Year Mortality After ICU StayEmail this article to a colleague.
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This study proves that mechanically ventilated older patients who have a "good" acute prognosis are still faced with a future of uncertainty with more than half having a high burden of comorbidities, close to half requiring recurrent hospitalization in the first year, and close to 6/10 dying in the subsequent three years.The results are difficult to apply to an individual patient. A previously healthy 70 year old patient who survives mechanical ventilation for pneumonia obviously has a different prognosis than a 70 year old who has end stage renal disease, CHF, and diabetes who survives mechanical ventilation for line seps...
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 7, 2010 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs
Symptoms, Suffering, Parents and Pediatric Palliative Care in End-Stage Cancer, Part 1Email this article to a colleague.
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This study interviews 141 subjects, with concomitant medical record review. Data presented included: Reported Experience with Hastening Death (HD) The 4 Questions: "During your child's end-of-life care period, did you or a family member ever consider asking someone on the care team to give him/her or give you or the family member medications to intentionally end his/her life?” "When your child was receiving end-of-life care, did you or a family member ever discuss intentionally ending his/her life?" "Did you or a family member ask someone on your child's care team to give him/her medications or to give you or the fa...
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 3, 2010 Category: Palliative Carer Workers Authors: Brian McMichael, M.D. Source Type: blogs
Social Networking and the #AAHPM Board Meeting - 1st DayEmail this article to a colleague.
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You can expect a few more emails this week as we blog frequently from the AAHPM/HPNA Annual Assembly giving you updates on all the interesting things going on in Boston.
I'll get to the board meeting review in a second.
First I have to tell a story about how important it is for our community to talk on planes. Do you talk to your neighbors on planes? I try to make a habit of at least introducing myself and finding out the names of the other people in my row. I just think it is cordial. And I have learned from experience that those people who want to talk will easily open up which may lead to some g...
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 2, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Pallimed Related AAHPM Events: Twitter, Social Media, Party, Arts and MoreEmail this article to a colleague.
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Hooray the AAHPM/HPNA Annual Assembly week is finally here. Before you stop checking the internet so much because you are at the Annual Assembly, here are a few Pallimed related events this week to check out while you are in Boston.
1) Twitter: Follow the action whether you are at the conference or not. Two good websites to keep open in your browser are TweetChat (better for those with Twitter Accounts) or What the Hashtag (better for those without a Twitter account...what are you waiting for?)
For those at the conference the official Twitter Hashtag is #HPMAssembly but many may also be using #AAHPM so if you...
Source: Pallimed: A Hospice & Palliative Medicine Blog - March 1, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
The Philadelphia Inquirer on Palliative Care; Keith Olbermann's FatherEmail this article to a colleague.
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The Philadelphia Inquirer enters our national end-of-life conversation this weekend with a tour-de-force that accurately portrays the reality of life and death in the American healthcare system as well as the potential of palliative care. The article describes the experiences of Mary Tole, a 74 year-old woman who spent 67 days in the hospital at Abington Memorial Hospital last fall (10 in the ICU and 57 on a ward). The palliative care team's crucial interactions with the patient and her family are detailed.***SPOILER ALERT****Mrs. Tole was admitted originally with delirium and falls. She had been previously healthy. After ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 28, 2010 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs
BONUS: List of Presentation Websites and SoftwareEmail this article to a colleague.
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Here is a list of tools and sites I frequently use to make my presentations or might inspire you to stretch beyond your boundaries and increase your skill set. Check out the companion piece How to Give a Great Medical Presentation 2010.
Advice:
Duarte Blog: Nancy Duarte, writer of the book Slide:ology, who helped create the look (not the data) for An Inconceivable Truth. Great tips about slides and hot to make your talk memorable.
Six Minutes: Blog with links and best of features from all the best public speaking blogs. Covers preparing, making slides, and presenting. ****Highly rec: Weekly Best of...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 25, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
How to Give a Great Medical Presentation 2010Email this article to a colleague.
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This is the companion piece to Handy Hints for a National Meeting 2010. I always try to learn something about presentation skills from any talk I go to. If you have any of your pet peeves from presentations or helpful comments please add them below. You may also be interested in the list of key presentation software and websites.
Despite the frequent use of PowerPoint few people have ever been trained on how to use it effectively as part of a toolkit for presenting information. It is a tool to convey your message, much like a white board, a laser pointer, a flip chart, your verbal tone, your appearance, ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 25, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Demerol is Not Bad, It Treats Shivering.Email this article to a colleague.
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Image via WikipediaIf you have spent anytime with a palliative care team in a hospital you will know of their efforts to essentially blacklist Demerol (meperidine) from use in the hospital. Some hospitals have removed it or restricted it from the formulary all together. In medical culture, demerol has been a go to opioid peri-OR and mostly favored by surgeons. The drug has been purported to be less likely to cause billiary spasm, but this seems to be impacted more by cultural inertia in medicine and bench evidence and not clinical results.
But with the growth of induced hypothermia protocols in resuscita...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 25, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Last Chance for Pallimed Street Team-Look for the P!Email this article to a colleague.
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I am mailing out the Pallimed Street team kits in time for the AAHPM/HPNA Annual Assembly on Tuesday, so if you want to help out let me know soon by shooting me an email at ctsinclair@gmail.com. Right now we have over 20 people who have volunteered to hand out Pallimed 'P' Stickers at the assembly to wear on your name badge.
In case you forgot what the kit includes:
A set of 20 Pallimed 'P' Stickers
A set of 20 Pallimed business cards
2 5x7" mini posters
A Pallimed Prize Pledge sheet
A special treat for you (non-edible)
The support has been great so far! Thanks for making our advertising budget stretch further than it eve...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 21, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Handy Hints for a National Meeting 2010Email this article to a colleague.
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With the AAHPM Annual Assembly coming up, I will post the 7th edition of Handy Hints for a National Meeting. Later this week I will feature How to Give a Great Presentation, 3nd edition.
General
* If you are bringing family or a significant other, spend some time with them.
* Bring business cards, lots of them. Make sure they have your email on them. If they don’t, write your email a number of the cards so when you hand them out, you are not trying to find a pen to add it.
* When receiving a business card, immediately write down the topic of interest you were discussing with that person. If the time isn't right, then do...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 21, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
2/3 of the truthEmail this article to a colleague.
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1)
NEJM has an editorial discussing withholding information from patients. It's a practical, casual discussion of 1) the fact that in real life we withhold information from patients all the time (e.g. don't go into all the details as they can be confusing, overwhelming, or superfluous), and 2) the fact that we decide all the time to withhold certain major pieces information out of a desire to protect the patient emotionally. It's the latter that is the real issue (e.g. not talking with a leukemic patient about their abnormal MCV is not a problem; withholding from them their relapse is), and this is a reasoned discussion of...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 21, 2010 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
Latest 'Coping With Cancer' publicationsEmail this article to a colleague.
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This study looks at patient reports of spiritual support from their medical team, and pastoral care utilization, and finds that those are associated with more hospice utilization, and less aggressive EOL care, even among religious copers.
Loggers, E., Maciejewski, P., Paulk, E., DeSanto-Madeya, S., Nilsson, M., Viswanath, K., Wright, A., Balboni, T., Temel, J., Stieglitz, H., Block, S., Prigerson, H. (2009). Racial Differences in Predictors of Intensive End-of-Life Care in Patients With Advanced Cancer Journal of Clinical Oncology, 27 (33), 5559-5564 DOI: 10.1200/JCO.2009.22.4733
Mack, J., Weeks, J., Wright, A., Block, ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 21, 2010 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
AAHPM has a Blog!Email this article to a colleague.
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The AAHPM has a blog! The AAHPM has a blog!
www.aahpmblog.org
This has been in the works for a while and I am very glad to see it! I am hoping this will be a great new way for the Academy to interact with members and non-members to help grow awareness about hospice and palliative medicine. Go over and say hello! (Source: Pallimed: A Hospice & Palliative Medicine Blog)
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 15, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Pallimed? There's an App for That!Email this article to a colleague.
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Can't always get to a computer to get to Pallimed? Well now iPhone (and iTounch and iPad) users have an option to read Pallimed and Pallimed: Arts and Humanities (including comments to both blogs) with the very first Pallimed FREE iPhone app.
The FREE Pallimed app gives you one-click access to the blog content without any of the extra sidebar content that could make browsing the site via a smartphone a bit difficult. You can even post a comment via the iPhone app. There are two bugs we have found so far and we are working to get them hashed out (can't email author nor email the blog post).
We even ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 15, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Twitter for Medical Professionals: 11 Uses in 9 StepsEmail this article to a colleague.
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Twitter really had a big year in 2009, but some of the shine may appear to be wearing off. Sure you have seen it on your preferred 24/7 news channel and everyone and every organization seems to want you to follow them on Twitter (or be a fan on Facebook). But Twitter is still a important force in information dissemination and therefore medical professionals and organizations need to be aware of how this tool can work best for one's information gathering and disseminating practices.
First let's get a few things out of the way
Saying Twitter, Tweet, Re-Tweet, Tweeple or Tw-(insert word here) sounds stupid. It w...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 15, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Twitter for the 2010 AAHPM/HPNA Annual AssemblyEmail this article to a colleague.
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In 2009, the Annual Assembly of the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA) became the first demonstration of multi-user use of Twitter at a major medical conference. Part of this was a nice coincidence of events: Twitter was growing in popularity in early 2009, I had just become more comfortable with Twitter after a few months of use, smartphone apps for Twitter became more powerful allowing for non desktop use of the platform.
Some basic stats from 2009's AAHPM/HPNA Annual Assembly:
Tweets During the Conference (Tue 3/24-Sat 3/28 ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 15, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
January 2010 Digest of Pallimed: Arts & HumanitiesEmail this article to a colleague.
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For those of you who do not stray to far from the main blog, here is a quick summary of the posts from January 2010 Pallimed: Arts & Humanities blog by Amy Clarkson, MD and Amber Wollesen, MD.
Death and Harry Potter
Amber reviews the multiple themes around death in the popular series of the boy wizard.
I Still Do: Loving and Living with Alzheimer's Dementia
Amy discusses a writer/photographer's first hand account of watching her husband succumb to Alzheimer's. The author even commented on the post!
Iris
Amber talks about the 2001 film and palliative care themes around the sense of time in a chronic illness.
...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 12, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
New Pallimed Feature: Guest PostsEmail this article to a colleague.
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Since Drew is taking a little time off to play HGTV, I wanted to welcome our first guest blogger, Brian McMichael, MD, a Physical Medicine and Rehabilitation resident with a keen interest in palliative medicine. He has spent some quality time crafting wonderful comments to Pallimed and GeriPal, so we decided to invite him to guest post on Pallimed.
If you are interested in posting on an occasional basis to Pallimed, please email Drew and Christian (our emails are all over this blog) and we will fill you in on the requirements/details. If you have read Pallimed you understand the basic approach and topics we li...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 12, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Pallimed 2010 Street Team Enthusiasts Needed!Email this article to a colleague.
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As we get closer to the AAHPM/HPNA Annual Assembly in Boston (March 3-6, 2010), we will again be calling on Pallimed readers to help spread the word about Pallimed and medical blogging. Believe it or not there are some people out there who think blogs are just for political slams, celebrity gossip, and watching videos of my kids performing magic tricks. But as you know a blog can be a place for serious discussions about vital issues to good clinical practice, public opinion of hospice and palliative medicine and occasionally a funny quip.
This offer is open to any Pallimed reader who wants to grow the knowledg...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 12, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Tube ‘em & Move ‘em: The Data SetEmail this article to a colleague.
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Greetings. This is my first guest-post on Pallimed; I’m hoping it won’t be my last. I had envisioned a cleverer debut, elucidating my inclination to HPM vis-à-vis my bio, as a non-traditional (read mid-life-crisis-old) entrant to medicine, and my specialty (PMR by way of EM). However, Drew is taking a hiatus and the article I’m posting on now fell into my lap while still printing-press warm. So, thanks to Drew, Christian and to the entire Pallimed Editorial Board for the encouragement and invitation. On to Pallimed…
Drew just posted 'It just changes the complications' covering an ethnographic study that appeared i...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 11, 2010 Category: Palliative Carer Workers Authors: Brian McMichael, M.D. Source Type: blogs
Brief editor's noteEmail this article to a colleague.
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I am in the process of preparing my house for sale, and for the next few weeks/month will be spending all my free time cleaning, recycling, painting, and worrying, and don't plan on posting again during that time. I have another couple posts written, which I've scheduled for a couple weeks from now, but that's it. I will be at AAHPM in Boston, and hope to see many of you there. Come to the happy hour and say Hi, or just grab me if you run into me. --Drew. (Source: Pallimed: A Hospice & Palliative Medicine Blog)
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 8, 2010 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
'It just changes the complications'Email this article to a colleague.
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Archives of Internal Medicine recently had a study about the influence of nursing home culture on rates of tube feeding of patients with advanced dementia. This is a qualitative/ethnographic study of two NH in South Carolina, both within the same region, and both selected because one had very high rates of TF of patients with dementia (41%) and one had a low rate (11%) (they note the high one was actually the 4th highest in the region - the other 3 wouldn't participate in the study).The researchers observed care in the NH (how mealtimes are structured, who does what, etc.) and interviewed multiple providers at each site (n...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 8, 2010 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
Descartes & Captain PikeEmail this article to a colleague.
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This study is builds on that, and the authors describe identifying one subject who could answer yes/no questions via fMRI.Let me explain. First, the proof of principle. They had 16 healthy subjects imagine either playing tennis or walking around a familiar environment imaging what they'd see: reliably in these subjects these tasks would cause predictable, and predictably different, activity seen on fMRI (e.g. in the supplemental motor cortex for the motor task and in the parahippocampal gyrus for the spatial task). Then they told the subjects that they were to answer yes/no questions by, for instance, imagining the motor ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 8, 2010 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
AAHPM Social Media Workgroup at the Annual AssemblyEmail this article to a colleague.
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A new session has been added to the AAHPM/HPNA Annual Assembly in Boston, MA on Friday March 5th from 7-8:15am. Bloggers from Pallimed and GeriPal have been invited to give a interactive workshop on social media in hospice and palliative care. The panel and abstract is listed below. It is not in any of the current material and has been developed in just the past few weeks. We are planning on presenting for the first 30 minutes and then opening it up to the group for questions.
If you are interested in going, no need to RSVP, but if you want to help direct the content please feel free to fill...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 2, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Social Events at the AAHPM/HPNA 2010 Annual Assembly in BostonEmail this article to a colleague.
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One of the best things about the AAHPM/HPNA Annual Assembly is the chance to see old friends and meet new ones. No better time for this then after a full day of conferences. But many times there may be conflicting events on a particular night. So before you hear about any other events and RSVP to them, you need to know about the Annual Pallimed Party.
This will be the 4th year we have had a gathering and this year it will be even better because Eric Widera and Alex Smith from GeriPal have decided to join us for the first ever Pallimed/GeriPal Gathering.
Sadly Drew will not be with us this year as ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 2, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Best of January 2010 Posts & CommentsEmail this article to a colleague.
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Most Viewed Posts from January 2010
1. Palliative Care Grand Rounds Vol. 2.1
2. Catholic Directives on Artificial Hydration and Nutrition
3. Paradoxes in Advanced Care Planning
4. Judy Chamberlin, Hospice Patient & Blogger Died January 16th
5. Overdose in Patients Prescribed Chronic Opioid Therapy
Most Commented on Posts from January 2010
1. What is the Role of Palliative Care in Haiti After the Earthquake? - 11 comments
2. Paradoxes in Advanced Care Planning - 9 comments
3. Palliative Care Grand Rounds Vol. 2.1 - 8 comments
4. Outpatient Rotations to Methadone - 6 comments
Multiple other posts with 2-3 comments
B...
Source: Pallimed: A Hospice & Palliative Medicine Blog - February 2, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Morphine Concentrated Liquid Receives FDA ApprovalEmail this article to a colleague.
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Image via WikipediaThe FDA has approved Roxane Laboratories to make concentrated (20mg/ml) morphine liquid for the administration in opioid tolerant patients with moderate to severe acute and chronic pain.
Others have covered this story including GeriPal, NHPCO (Member-protected link - Why?), and CAPC. Obviously the hospice and palliative care online communities are welcoming this news given liquid concentrated morphine is an essential tool in good symptom control, especially for patients in the last few weeks of life when swallowing becomes more difficult.
Interestingly, the FDA Press Release says at the en...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 28, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
'First is the widespread and deeply held desire not to be dead...'Email this article to a colleague.
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It looks like JAMA has closed their series 'Perspectives on Care at the Close of Life,' which we covered extensively the last year, and started a new one 'Care of the Aging Patient.' There have already been two so far, but in addition this week's issue has a 'Clinician's Corner' piece about a patient with cardiac cachexia and hospice care. Thus, a JAMA update today.
1)
First, the Clinician's Corner piece. The case begins succinctly: Mrs H is an 86-year-old retired health care professional and grandmother with severe cardiac cachexia. She is considering the best way to have her life end. The case goes on to describe a pati...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 28, 2010 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
Outpatient rotations to methadoneEmail this article to a colleague.
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This study is a retrospective chart review of a single center's (MD Anderson) experience with this. The paper includes data about patients initiated on methadone (as the first strong opioid), but I'll focus on the rotation data here. The patients (N=89, mean age 58, median baseline oral morphine equivalent daily dose [MEDD] of 100 mg) were rotated to methadone as outpatients, and had median first follow up at 13 days, and second at 37 days. The rotation protocol is not specified in great detail (and they imply there is not a set protocol for this group - instead more of general parameters that are adjusted based on the phy...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 28, 2010 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
What is the Role of Palliative Care in Haiti After the Earthquake?Email this article to a colleague.
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In hearing about all the tragedy and occasional stories of hope and amazement with the recent earthquake in Haiti, I have been wondering about the role for a hospice/palliative care philosophy in the treatment of those injured and killed during and after the earthquake. Locally, I have not heard of any hospice or palliative care staff taking leave of work to embark to Haiti. (And if anyone does know of someone with a palliative background who has recently gone to Haiti I would love to interview him/her for Pallimed.)I have also considered how my skill set might be best applied if I myself had decided to go to Haiti with th...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 26, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Historical Pallimed: January 2006Email this article to a colleague.
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Now that Pallimed is embarking on the 5th calendar year of existence, we thought it would provide a good opportunity to look back at some of the older blog posts. This will be a monthly column and for the first month we will look at January of 2006. Back when it was at pallimed.blogspot.com. Back when the colors were blue and sea foam green. Back when Twitter did not exist (March 2006 for you trivia hounds). Back when the only people reading were Drew and me. Well to be honest I was doing most of the reading and Drew was doing most of the writing since he out-posted me 19 to 3.So here are some highlights from Pallimed circ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 26, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Overdose in Patients Prescribed Chronic Opioid TherapyEmail this article to a colleague.
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The rate of overdose in patients who have been prescribed chronic opioid therapy is not known and neither is the relationship between the prescribed dose and the risk of overdose. The Annals of Internal Medicine published a cohort study which attempts to provide more data on this question in a population of patients with chronic, non-cancer related pain (unfortunately entitled Opioid Prescriptions for Chronic Pain and Overdose). It's funded by the National Institute of Drug Abuse.The cohort is derived from the CONSORT (Consortium to Study Opioid Risks and Trends) study with all subjects belonging to the Group Health Cooper...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 25, 2010 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs
Judy Chamberlin, Hospice Patient & Blogger Died January 16thEmail this article to a colleague.
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Judy Chamberlin who openly blogged about her experiences as a hospice patient died Saturday January 16th, 2010 at her home in Massachusetts. Her blog started in December 2008 and she shared many great stories about her difficulties with COPD, interactions with her hospice team, and a few interactions with the Boston Globe.
She and her blog were featured here at Pallimed in December 2009. Her story will be featured on NPR's Morning Edition Tuesday morning.
She expressed concern for the lack of a voice for the hospice patient often being supplanted by the family or friends or medical staff. We at Pa...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 18, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Pallimed Prize for Hospitals AnnouncementEmail this article to a colleague.
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Sometimes great challenges need great support to be overcome. Palliative care services in hospitals are overshadowed in marketing efforts by other revenue producing, prestige enhancing, feel-good medical 'product lines.' We have all seen the billboards and magazine/newspaper inserts touting the newest technology, doctors and nurses with the best smiles and vague proclamations that nothing bad could ever happen to you at 'Our Medical Center.' The same hospital administrations and staff who praise the good work of the palliative care internally would likely turn pale at the thought of trying to promote qual...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 18, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
JCO round-upEmail this article to a colleague.
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This study involved outpatients with aggressive brain cancers (n=50, mean age in 50s, over 3/4 rated their current health status as good or better, about 50% reported they would not want CPR at baseline) who were randomly assigned to either a verbal description of advanced cancer and different treatment options or that plus a short video showing the different treatment options in real life. Advanced cancer "was defined to participants as being "very sick" in a situation where they may or may not be able to speak for themselves" (as far as I can tell no discussion of time-based prognosis or inevitability of death). The trea...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 11, 2010 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
Paradoxes in advance care planningEmail this article to a colleague.
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Journal of Clinical Oncology has a paper on cancer patients' attitudes about discussing advance directives. The study is posited as a follow up to one published 10 years ago which suggested that cancer patients did not want to discuss ADs with their oncologists. The data come from a prospective study involving all patients consecutively admitted to an academic hospital's inpatient oncology service over several months; patients (N=75, mean age 51 years, 23% African American; the majority had hematologic malignancies) were interviewed about AD completion and preferences.41% of patients reported having completed an AD (all we...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 11, 2010 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
Palliative Care Grand Rounds Vol 2.1Email this article to a colleague.
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This article has been on my 'to blog' pile yet has never gotten screen time. DoctorRW makes points about the culture shift towards more aggressive pain control by physicians as a result of marketing (illegal and legal), regulation (via JCAHO and other orgs), and a changing public expectation. This is also a time of rapid growth in the palliative care field, which he did not mention in his article and I wonder what role does hospice and palliative care play in this highly complex system. Daily we strive to break down barriers to appropriate opioid use, but is there collateral damage to the community from i...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 6, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Welcome listeners from the Walt Bodine Show!Email this article to a colleague.
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If you are visiting Pallimed for the first time after hearing about us on the Walt Bodine Show (NPR radio station KCUR out of Kansas City, Missouri), I would encourage you to look around at a few of our sections to get a better feel of what we write about here.
About Pallimed
Our Arts & Humanities blog
Lists of other hospice and palliative medicine related blogs
For the caller who called in after me asking about finding time to do the blog and if we are giving our skills/knowledge away or if we are compensated, I can answer those here since I won't be able to call back in since the show is now over.
Finding time to ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 4, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
Catholic Directives on Artificial Nutrition and HydrationEmail this article to a colleague.
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In November of 2009, the United States Council of Catholic Bishops voted to approve and update the Ethical and Religious Directives for Catholic Health Care Services. Some of the wording changes have begun to worry some in health care about how to handle delicate discussions in Catholic health care facilities that may be caring for patients wishing to forego artificial nutrition and hydration. The most vocal group thus far is Compassion & Choices. The NHPCO, AAHPM and HPNA have been relatively silent on this matter either way to my knowledge.
The section on End of Life starts on page 29 and begins wi...
Source: Pallimed: A Hospice & Palliative Medicine Blog - January 4, 2010 Category: Palliative Carer Workers Authors: Christian Sinclair, MD Source Type: blogs
A few more from the NYTEmail this article to a colleague.
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A few more articles, to round out my inter-holiday week of posting about NYT articles to do with end of life care:1. Last week was an article challenging the idea that more money spent at the end of life does not improve outcomes (ie the Dartmouth Atlas data on Medicare spending). It specifically looks at some data from Los Angeles area hospitals to do with congestive heart failure patients which indicates that those hospitals which spent the most on heart failure patients had the lowest mortality rates. What I found most notable about this was that it addresses to an extent the very important issue of comparing mortality ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - December 29, 2009 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
NYT on Palliative SedationEmail this article to a colleague.
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This Sunday's New York Times had a front page/below the fold article on 'palliative sedation' (which as of last night was still the #1 most emailed article according to their website). It is a long, confusing article, & I'm still trying to figure out what I think of it. Like most newspaper articles about things like this it gets some things it gets spot on, while others I found deeply troubling.The article tells the stories of several dying patients and their families, as well as interviews with palliative care physicians and other clinicians. The overarching theme of the article seems to be that 'PS' is controversial ...
Source: Pallimed: A Hospice & Palliative Medicine Blog - December 29, 2009 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs
The Breadth of Hope, Selling Hope, and More on Quelling ThanatophobiaEmail this article to a colleague.
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The holidays are upon us, a new year is approaching, and hope abounds. Three prominent articles touch on the topic of hope in patients with life threatening illnesses.Pediatric palliative care physician Dr. Chris Feudtner from the Children's Hospital of Philadelphia discusses the breadth of hope in pediatric patients and their families in his recent NEJM perspective article. The essay speaks for itself but here's a succinct passage that I especially appreciated:"...when clinicians discuss the prospect of delivering bad news to patients or their families, we often speak imperatively about not "taking away" or "killing" or "...
Source: Pallimed: A Hospice & Palliative Medicine Blog - December 21, 2009 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs
The Breadth of Hope, Selling Hope, and Quelling Thanatophobia in the Name of Healthcare ReformEmail this article to a colleague.
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The holidays are upon us, a new year is approaching, and hope abounds. Three prominent articles touch on the topic of hope in patients with life threatening illnesses.Pediatric palliative care physician Dr. Chris Feudtner from the Children's Hospital of Philadelphia discusses the breadth of hope in pediatric patients and their families in his recent NEJM perspective article. The essay speaks for itself but here's a succinct passage that I especially appreciated:"...when clinicians discuss the prospect of delivering bad news to patients or their families, we often speak imperatively about not "taking away" or "killing" or "...
Source: Pallimed: A Hospice & Palliative Medicine Blog - December 21, 2009 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs
