MedWorm: Palliative Carer Workers

The Fault In Ours Stars (TFIOS): An Insightful Depiction Of Teens Living With Serious Illness

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 08 May 2013 04:00:00 +0100

I have to confess that even though I am a grown woman I seem to like many young adult –teenage books (I am still seventeen at heart). I am frequently asking my daughter and nieces about books they enjoyed when I’m looking for something to read. So far the books I have read include some teenage love stories happening in a futuristic dystopia in which the main characters are at risk of dying because of being in a arena fighting other children like in the hunger games; or being at risk of getting injured while performing difficult stunts like jumping from a train like in the divergent series. The Fault in Ours Stars (TFIOS) by John Green is also about teens who fall in love and who are actually dying because they both have cancer. The book is narrated from the perspective of Ha...

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The Fault In Our Stars (TFIOS): An Insightful Depiction Of Teens Living With Serious Illness

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 08 May 2013 04:00:00 +0100

I have to confess that even though I am a grown woman I seem to like many young adult–teenage books (I am still seventeen at heart). I am frequently asking my daughter and nieces about books they enjoyed when I’m looking for something to read. So far the books I have read include some teenage love stories happening in a futuristic dystopia in which the main characters are at risk of dying because of being in a arena fighting other children like in the hunger games; or being at risk of getting injured while performing difficult stunts like jumping from a train like in the divergent series. The Fault in Our Stars (TFIOS) by John Green is also about teens who fall in love and who are actually dying because they both have cancer. The book is narrated from the perspective of Hazel La...

What to do after the patient is made comfort measures only (CMO)

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 08 May 2013 04:00:00 +0100

Discussion: Deciding to focus only on comfort is a major transition point for patients, families and health care providers. After making this decision, most families are not sure what comes next. They look to health care providers to reassure them that they are doing the right thing and to ensure that their loved one does not suffer and that they are prepared for the next few days. The following questions should guide one’s action after a patient is made CMO: 1. Are the patient’s symptoms adequately treated/prevented? A standardized comfort measures only order sheet can optimize symptom management in CMO patients. It reminds clinicians that: a. All medications and laboratory tests that do not promote comfort should be discontinued. b. &n...

Relief From Death Anxiety: In Your Medicine Cabinet Already?

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 05 May 2013 04:00:00 +0100

The radio show Wait, Wait....Don't Tell Me! has a weekly segment called "Bluff the Listener" during which a caller listens to three unbelievable stories and then guess which one of the three is actually true. Much to my surprise, this week's "true" (yet unbelievable) story is about evidence that acetaminophen might relieve existential angst. (Here's a direct link to the audio segment.) Julius Axelrod (Source: National Institutes of Health) Really? Good ole' Tylenol might relieve bothersome thoughts about the ultimate threat to our existence? How could I not investigate this further, if only because the report threatens any conception I have of this meek anti-pyretic/analgesic. The title of the study from Psychological Science piqued my intrigue: "The Common Pain of S...

Lung Cancer Guidelines With No Mention of Palliative Care?

Pallimed: A Hospice and Palliative Medicine Blog — Thu, 02 May 2013 04:00:00 +0100

(Ed. - Welcome Mr. John Hennessy to the Pallimed family. His background in executive leadership of oncology programs brings a potential outsiders perspective to Pallimed. Thankfully he is a strong ally and champion for hospice and palliative care as you will see from his first post. Great to have you here John. - Christian) Disappointed…frustrated…we’ve all been there. My most vivid memories are of birthdays at home, when books and socks were unwrapped rather than remote control model airplanes and car keys. It wasn’t my birthday this week, but my daily e-mails usually include a gift or two. This week, it came from the National Comprehensive Cancer Network (NCCN) in the form of a link to the 2013 NCCN Guidelines for Patients for Non-Small Cell Lung Cancer (...

Raising Palliative Care Awareness Through Film Screeenings

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 01 May 2013 04:00:00 +0100

(Ed. - Can you believe it another new author! Please welcome Paul Tatum @doctatum, a family medicine physician board certified in geriatrics and palliative care who practices medicine in at the University of Missouri in Columbia. Paul is no stranger to blogging and also posts at Geripal. Please welcome him to Pallimed! - Christian) When I strike up conversation on the airplane and discussion turns to palliative medicine, the response tends to be either one of a blank stare and question about what is palliative medicine or a knowing smile and a ready story about how hospice and palliative medicine made a difference in the life of a loved one. I love the stories and they reinvigorate me. But to help the public with the questioning, blank stares, we still have a...

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Transdermal Granisetron for Refractory Nausea and Vomiting

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 01 May 2013 04:00:00 +0100

Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and muscarinic receptors. Of particular interest is its antagonism of 5HT2 receptors which are located in the vomiting center and are not well targeted by other traditional antiemeti...

Pallimed Case Conferences is Moving (Here)

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 01 May 2013 04:00:00 +0100

Editorial decisions and challenges in upkeep will mean Pallimed: Case Conferences will be moving over the next year to the main Pallimed website (www.pallimed.org). The first case is already (re-)published: Transdermal Granisetron for Refractory Nausea and Vomiting When the Case Conference blog was first started in 2008, there was always hope to find an editor to oversee it, but early collaborations ultimately did not facilitate stable editorial leadership. The aim to use cases to illustrate important teaching points in palliative care is still an important one. The University of Pittsburgh Palliative Care Department has graciously allowed us to continue to be a publishing venue for their excellent teaching cases. We are hopeful to see more open access case based public...

2013 TEDMED Report: What ideas could we help spread?

Pallimed: A Hospice and Palliative Medicine Blog — Fri, 26 Apr 2013 04:00:00 +0100

(Ed. - Please welcome another new blogger to Pallimed, Earl Quijada, MD (@equijada). Earl is a hospice and palliative care doctor in the Inland Empire of California. I first met Earl on Twitter and later at the 2011 AAHPM Assembly in Vancouver and I am very excited he is now a Pallimed contributor! - Sinclair) I know I’m not supposed to say this but I’ll say it once - we’re not a death denying society. I’m starting to learn about death in nonclinical settings. My mind is opening and I’m stoked. I just returned from 2013 TEDMED where the opening salvo encouraged me to drop my palliative care persona, make intellectual and emotional connections, and ask many questions. I was then immersed in thousands of disparate ideas. Imagine my feeling when I realized that I don’t under...

What's Your Vision of End of Life Care?

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 24 Apr 2013 04:00:00 +0100

(Ed. - Today's post is the first from Renee Berry @rfberry at Pallimed who is a digital media specialist with a strong passion and extensive knowledge about hospice and pallaitive medicine. Renee and I co-host the weekly hospice and palliative medicine tweetchat on Wednesday nights (along with Alicia Bloom). We are excited to have her input on the recent TEDMED conference where End of Life issues were featured. - Sinclair) I noticed an interesting conversation starting on Twitter last week about an illustration drawn as a part of TEDMED's great challenges. TEDMED is an annual conference dedicated to breakthrough thinking in health and medicine. While it is independent of the original TED conference which brings people together from the technology, education and design fie...

Pallimed Blog Updates

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 24 Apr 2013 04:00:00 +0100

I'm sure some of you are surprised to see you email boxes filling up with Pallimed posts again. Since coming back from the AAHPM/HPNA Annual Assembly we have been busily working on a few projects behind the scenes as we look to the future of this website. Energizing the base We had a great meeting of Pallimed contributors in New Orleans during the New Orleans meeting in March. There were many fresh commitments from some of our key contributors, and you can see that both Lyle Fettig and Suzana Makowski have started writing again. The conversations sparked a energy which made all of us realize how satisfying, fun and important it is to talk about hospice and palliative medicine. Adding new bloggers We already have two new contributors this week and there are a few more in line...

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Prevention and Palliation: Together Forever

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 15 Apr 2013 04:00:00 +0100

What do the following patients have in common? A 45 year old man who has a 60 pack-year history develops lung cancer and is diagnosed at an advanced stage.* A 33 year old woman with post-traumatic stress disorder who has been drinking since the age of ten and develops fulminant hepatic failure. An 82 year old man ends up in the surgical intensive care unit after a self-inflicted gunshot wound three months after his wife of 60 years dies. The mother of a 55 year old woman with morbid obesity, obstructive sleep apnea, and pulmonary hypertension laments that the park nearby isn't safe for people to use. All four patients are candidates for palliative care. All of them also have potentially preventable illnesses. When I see patients like this, I sometimes ponder their plight fr...

How Does Physician Assisted Dying Work? Beyond philosophy and rhetoric

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 10 Apr 2013 04:00:00 +0100

The New England Journal of Medicine released an article this week on the experience of implementing a Death with Dignity program in Washington at a University based Cancer Center. In the Fall of 2008, the voters of Washington State passed the Death with Dignity act allowing for the legal practice of prescribing medications for the self-administration by a person with a terminal illness with the goal of ending their life. This can be described using a variety of briefer terms: physician-assisted suicide, physician-assisted death, medically hastened death and others. (For the record it is not technically euthanasia since that describes an act where a health care professional adminsters medication. And that is illegal in the United States.) In the NEJM article the authors refer use the term p...

End of Life in the News: Where are all the Palliative Care Teams?

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 09 Apr 2013 04:00:00 +0100

by Suzana Makowski By now, many of you may have heard or read Charles Ornstein,(@charlesornstein) a Pulitzer Prize-winning senior reporter, on NPR or in ProPublica on "How Mom’s Death Changed My Thinking About End-of-Life Care." He tells of his mother's final days in the hospital, after having aspirated during the placement of a naso-gastric tube that resulted in cardio-pulmonary arrest and subsequent days in the ICU. He speaks to the sense of being alone and the lack of guidance in the process of end-of-life decision-making. My heart dropped when hearing this story - for his (and his family's) loss, the difficulty of the process so clearly expressed, and for the haunting silence and void of palliative care throughout the care and in his stories. During the inter...

Basketball, The Presence of Suffering, and the Practice of Medicine

Pallimed: A Hospice and Palliative Medicine Blog — Thu, 04 Apr 2013 04:00:00 +0100

It's the first week of April, and we're on the verge of the penultimate games of the NCAA Basketball Tournaments. Since only four teams remain, chances are good that your favorite team is out of the tournament. As someone who has experienced that feeling 25 times over the years (but who's really counting?), I offer my condolences. To the few who still have a team in the tourney, condolences are pending for 75% of you. In honor of March Madness, I offer a challenge. Watch the video below and follow the narrator's instructions to count the number of times the team with the white shirts passes the ball. In medicine, the team with the white shirts passing the ball back and forth represents many of the activities of medicine. Look at all the energy which goes i...

Death Panels a Solution to Unwanted Intrusion at End of Life

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 01 Apr 2013 04:00:00 +0100

by Abe R Feaulx, Special Reporter When death is near, and no cure is available, more and more patients are turning to hospice to meet their end-of-life needs. To meet those needs, more and more hospice agencies are building hospice homes. These state-of-the-art facilities provide a place for patients to spend their final days, away from the commotion of the hospital or the dreariness of the nursing home. A hospice home is a free-standing facility designed to provide a private and comfortable setting where patients can die peacefully, often surrounded by friends and family. Yet many hospice homes are finding that privacy can be difficult to maintain, especially in the final hours. “We were sitting next to dad at the hospice home as he took his final breaths, and someone barged in to as...

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State of the Science from the 2013 AAHPM Annual Assembly

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 17 Mar 2013 04:00:00 +0100

The State of the Science plenary is one of my favorite traditions at the AAHPM Annual Assembly. This year, Jay Horton and Kim Johnson took the lead in presenting analyses of some of the previous year's most important hospice and palliative medicine research. For those attendees interested in seeing their slides again, you can find them here. Some of the research below further confirms our previous understanding of the state of the science (for instance, the studies on the low utility of feeding tubes in many circumstances). Other studies provide quality randomized controlled trial data on questions which have nagged our field but where previous RCT data are minimal or completely lacking (e.g. parenteral fluids near end of life and ketamine for cancer pain). We'd love t...

David and Debbie Oliver's AAHPM Plenary: Comforting Others While Living With Illness

Pallimed: A Hospice and Palliative Medicine Blog — Fri, 15 Mar 2013 04:00:00 +0100

One could write pages about David and Debbie Oliver's remarkable plenary presentation Friday at the American Academy of Hospice and Palliative Medicine Annual Assembly in New Orleans. David has stage IV nasopharyngeal carcinoma and has taken his cancer journey to the public. Before I go any further, I'll refer you to David's book, "Exit Strategy: Depriving Death of Its Strangeness," Paul Tatum's Interview with David at Geripal from August 2012, and below, see a clip from David's Cancer Videoblog in which he talks about cancer and palliative care. Of the many themes which arose from their presentation, I was especially struck by David's statements about the disclosure of his diagnosis to others and his frequent need to comfort the person receiving the news. Our culture s...

What The AAHPM Annual Assembly Means To Me

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 11 Mar 2013 04:00:00 +0100

I really love my field. Both sides hospice and palliative medicine. Both sides academic and community. Both sides profit/not for profit. Both sides friends and soon to be friends. Because to me they are not really sides or artificial tribes that exist because we humans really like to label things into groups. To me this is one whole big family and the Annual Assembly feels like a really good family reunion to me. Not the family reunion of TV or movie tropes where everyone dreads it, but the real type of family reunion where you see people you have not spoken with in a year or more, but you drop right into a regular conversation like you see each other every day. 2013 will be my 10th Annual Assembly in a row. I started in 2004 in Phoenix, AZ and have enjoyed each year more and...

7th Annual Pallimed and Geripal Gathering

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 11 Mar 2013 04:00:00 +0100

Are you excited about the AAHPM/HPNA/SWHPN 2013 Annual Assembly this week? I hope you or at least your colleagues are able to attend. We will be continuing the tradition of gathering readers and contributors to this blog and Geripal. It has grown over the years naturally and we are excited to meet other people you may only nknow by a screen name or email address. There will be a strong Pallimed contingent this year with Drew Rosielle, Lyle Fettig, Jeanette Ross, Holly Yang, Suzana Makowski, Thomas Quinn, and Amber Wollesen in attendance, so please rech out and say hello. We do have a date and time for the party - Thursday night starting around 9pm, so you have enough time to have dinner with colleagues and friends. But we don't exactly have a location...or locations.....

Prognosis: Weeks to Months – On the End of an Era at San Diego Hospice

Pallimed: A Hospice and Palliative Medicine Blog — Thu, 14 Feb 2013 05:00:00 +0100

On February 14th, 1977, a group of volunteers offered support to 10 patients who were nearing the end of life, and in doing so formed the foundation of what would grow into the largest academic hospice in the US – caring for upwards of 1000 patients each day at its peak, and training hundreds of hundreds of clinicians in the specialty of palliative care. Just a day shy of its 36th anniversary, it was announced that San Diego Hospice would be closing. As an alumnus of the fellowship program at San Diego, I am one of many who are grieving this news. I write here, not so much to share my grief, but rather to bring to light concerns that this announcement raises, to present questions on how the palliative care community (in its broadest sense – i.e. including hospice) should...

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PPS Trajectories in Hospice

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 27 Jan 2013 05:00:00 +0100

Functional status is all the rage in research these days, especially with the impending but often delayed roll out of ICD-10. Any seasoned hospice and palliative care (HPC) clinician will tell you how critical functional status is to understanding trajectories of patients as function has been part of our assessment for quite a long time. Most of us know functional assessments through the more clinical acronyms of ADL (Activities of Daily Living) and the PPS (Palliative Performance Status). On a whole HPC staff routinely use function as a key metric of prognostication, but we have not really had a lot of data that looked beyond PPS at admission. This week in the Journal of the American Geriatric Society, Pam Harris, Joan Teno, David Casarett and the CHOICE* group published...

Committee on Transforming End of Life Care is Incomplete

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 16 Jan 2013 05:00:00 +0100

In conclusion, I'm really glad the IOM is revisiting this issue after almost two decades. I have great confidence in the expertise of the committee so far, and expect great outcomes from the process. But if you think there needs to be a little bit more diversity now is your chance to give input. Reference: Summary table of different characteristics of the panel via Google Docs (Source: Pallimed: A Hospice and Palliative Medicine Blog)

The 2012 #HPM Year on Twitter

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 16 Jan 2013 05:00:00 +0100

Ed. - Please welcome the first Pallimed post by Dr. Jeannette Ross (@RossJeanette), a geriatrics and palliative medicine specialist from San Antonio, TX. I recently read a webpost called 20 Twitter Stats From 2012 noting some interesting statistic about the amounts of tweets thru the 2012 year, the most retweeted tweet (Obama’s victory tweet), the most followed twitter account (@ladygaga with 32 million+), and others. I was curious about what are the twitter statistics for our field as measured by the HPM hashtag. I went to the Symplur Healthcare Hasthtag Project and ran the #HPM 2012 analytics and did a little “research” of my own. So here are the top 10 twitter stats of the #HPM hashtag in 2012: There were 48,273 tweets sent using #HPM 67,869,558 Impressions* res...

Sendak: I cry a lot because they die and I can't stop them

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 06 Jan 2013 05:00:00 +0100

I'm always struck at the end of a year how much we pay tribute in words and video to those who have died in the prior year. Famous people always get the lion's share of the attention understandably as we focus on what they have achieved in their career. Rarely do we get to hear from them in the months leading up to their death about their fears and dreams. In September 2011, Maurice Sendak, noted children's author and illustrator was interviewed by Terry Gross for NPR's Fresh Air. During this interview, Sendak is very upfront with his mortality and what matters most to him as he has grown older and his health begins to decline. The whole interview is a gem, and I invite you all to sit down and find 45 minutes to be uninterrupted in listening to...

The Best Free Hospice and Palliative Care Info for your Inbox

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 06 Jan 2013 05:00:00 +0100

Are you drowning in information about hospice and palliative care? It seems like every day there is a new aggregator of articles, highlights and tweets. The criteria to the list below is: 1) The information must be primarily related to the clinical practice of hospice and/or palliative care, 2) The information must be able to land in one's inbox via email subscription, 3) The information must be available without paying for it directly or indirectly (membership), AND 3) The information should be posted with a regular frequency. And here is the list in alphabetical order: Blogs Hospice and Palliative Care Blog List Palliative Care Journals (all issues/articles open access) Supportive Oncology BMC Palliative Care Palliative Care Journals/Collections (Table of ...

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Integrated palliative care is suddenly all the rage

Pallimed: A Hospice and Palliative Medicine Blog — Thu, 29 Nov 2012 05:00:00 +0100

Last year an article by Thoonsen et al noted that early (they use the term 'proactive') palliative care "has hardly been addressed in the scientific literature." In 2012 there have been over a dozen papers (by my very informal and quick count) on this topic in both specialty (palliative care and oncology) and general medical journals. Both European and US-based journals are represented. They are an eclectic group, including retrospective studies, clinical trials, case studies, secondary analyses, and reviews. Some form of the term 'integration' (integrated, integrative) is commonly used as an adjective. Others seen are proactive, as noted above; concurrent; early or early access; prospective; comprehensive; and holistic. The focus varies: specific ...

Increased Focus on Hospice Reform

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 07 Nov 2012 05:00:00 +0100

Do you hear the drums in the distance? They are beating louder and growing closer. The New England Journal of Medicine published a brief Perspective, "Growing Pains for Medicare Hospice Benefit," on the current Federal funding dilemma of the increasing hospice budget (Open Access PDF). David G Stevenson, PhD from Harvard Medical School, Department of Health Care Policy, gives a good summary of the financial foundation for the Medicare Hospice Benefit, and outlines the challenges with a longer national average length of stay, uncertain prognostication and trying to achieve budget neutral payment reform. Unfortunately the solutions proposed are quite complex and far from evolved. Accountable Care Organizations, concurrent care models, and bundled payments won’t be main...

Voting on Physician Assisted Suicide

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 07 Nov 2012 05:00:00 +0100

*UPDATE 11/7/12 9:45am ET: Prop 2 was defeated 51-49%, so PAS/DWD will not be legal in the state of Massachusetts.* Aren’t we all glad that is over! With all the attention on the Presidential race, it was easy to lose sight of some key issues which could have a large impact for palliative care providers. It was surprising how little national attention was given to Massachusetts Prop 2 on legalizing physician-assisted suicide (PAS) in the run up to the election. I was expecting this to even become part of the debates since the connection between health care and Massachusetts was obviously in play. Part of my reluctance to blog on the topic in the past month may have been related to an irrational fear of ‘death panel’ language creeping up again on the national scene....

World Hospice and Palliative Care Day 2012

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 14 Oct 2012 04:00:00 +0100

Happy World Hospice and Palliative Care Day everyone! Photo via Abaconda (cc) via Flickr I just wanted to mark this day, October 13th, 2012, as events happened all over the world to recognize our field and bring attention to the patients and families we care for. Events occured internationally and in the United States. On the international version of ehospice.com website, it reported that the WHO estimates that "24 million adults require palliative care at the end of life each year... Despite this growing need, 42% of countries still have no identified hospice and palliative care service, while 80% of people live in countries with little to no access to medication for the treatment of moderate to severe pain." There are so many patient who need us to advocate a...

Hospice and Palliative Haiku

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 23 Sep 2012 04:00:00 +0100

Photo by Flick user Isidro Cea While we often go to great lengths to explain what hospice and palliative care is about to families, patients and our peers, it is important to find the beauty in simplicity. Haiku are a great exercise in editing and restraint in conveying your message with brevity and density. On Twitter I happened to come across this haiku from an ER nurseHelping people die.Enemas and Foley caths.Things I've been thanked for.Jason Hautala is the ER nurse/author who recently published a book, Haiku Stat! compiling some of his best and most poignant work. The article in Emergency Medicine News explains that this act of creation is really an avenue to channel the emotions, frustrations and difficulties he and his colleagues see in the ER. I...

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Nominations to the IOM Committee on Transforming End-of-Life Care

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 23 Sep 2012 04:00:00 +0100

The Institute of Medicine is searching for experts in the scientific, technical, and medical professions to be considered for a study committee titled “Committee on Transforming End-of-Life Care.” Nominations are due Monday, September 24, 2012. The overall objective of the project is to advance policies to improve the care that individuals and families receive at the end of life through alignment with individual values and preferences and to stimulate a national conversation with individuals, families, and communities on improving the way we approach death. Specifically, the IOM committee will: review progress since the landmark 1997 IOM report Approaching Death: Improving Care at the End of Life, assess challenges and opportunities, and examine ways to integrate end-of-life...

2012 Sojourns Awards from The Cambia Health Foundation

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 19 Sep 2012 04:00:00 +0100

Whenever peers in your field are recognized for their hard work and dedication it is really reason for us all to celebrate the growth and increasing attention for the hospice and palliative care fields. Of course one would expect one's own representative organizations like HPNA, NHPCO, CAPC, and AAHPM to participate in celebrations of achievement, but it is even more important when groups outside our own tribe begin to share in the accolades. The Cambia Health Foundation is holding the 2012 Sojourns Awards today in Seattle, WA to recognize five clinicians holding the flag for quality of life and symptom control for those with serious illness. The Sojourns Award was created in 2007 to recognize palliative care regional leaders in Washington, Oregon, Idaho and Utah....

TEDMED: The 20 Great Challenges of Health and Medicine

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 12 Sep 2012 04:00:00 +0100

I wanted to bring to the attention of the Pallimed community that TEDMED is sponsoring a series of discussions on a new interactive minisite: The 20 Great Challenges of Health and Medicine. The purpose of the series is to elicit multiple perspectives and interaction with thought leaders on some of the large, complex problems in health in medicine that effect us all. One of the first 6 online discussions active right now is on The Caregiver Crisis. "Coming soon" will be an online discussion on Coming to Grips with End-of-Life Care. It is interesting to note that so far the only TEDMED presentation that has been explicitly about EOL decision-making is this one by Alexandra Drane, the driving force behind Engage With Grace...

A New Day for Pallimed

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 12 Sep 2012 04:00:00 +0100

Hi remember us? Just your friendly neighborhood hospice and palliative medicine blog. Yes we have been quiet for almost three months. And even before that we were slowing down in our posts. But I think that needs to change. And it will start to change now. Pallimed has been a labor of love since its inception. No ad revenue, no grants, no donations, just some after hours writing on topics which we the writers thought were interesting. We were part of a very early growth in specialty medicine blogs and became a pretty strong voice. But then the time to write posts seemed to disappear, it was easier to just tweet a link, and many other good informational sources started appearing. We have heard many stories from all of you about how seeing th...

Pet Hospice

Death Maiden — Wed, 29 Aug 2012 04:00:00 +0100

I have had to put two of my cats to sleep during the course of the past 10 years. Both of these decisions were terribly difficult and painful. In one case, I felt I let my cat Orange Kitty live too long and she suffered too much. My heart still aches remembering her walking a few steps, collapsing and urinating all over herself. She was such a dignified cat. I can't imagine that was how she would have wanted to die. In the other case, I still sometimes worry that I put my cat Ebony to sleep too soon. He wasn't eating and was moving very slowly, especially attempting to lay down and get back up. The vet told me he was in renal failure and he would not take to having fluids infused subcutaneously, as my previous cat had. For fear he would progress to the condition that Orange Kitty had, I ha...

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ACA, Supreme Court, Politics and Hospice

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 27 Jun 2012 04:00:00 +0100

I love prognostication as a research topic and a clinical skill, and I have been thinking a lot about the future for hospice as it relates to the impending decision by SCOTUS on the Affordable Care Act. Most people in hospice are aware of the new Medicare rule for Face to Face (F2F) visits that started in January 2011 for patients on service beyond the second benefit period (usually 180 days.) Many of you would be surprised to know the new rule was part of the Affordable Care Act. So one thought crossed my mind as I heard talking heads drone on about the decision: If ACA is struck down in its entirety will the Face to Face provision go away? If the ACA is deemed unconstitutional as a whole, F2F may disappear for a while, but my guess is F2F would likely come back in some...

Accurate Portrayal of a Hospice Nurse?

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 27 Jun 2012 04:00:00 +0100

Is it just me or is it really hard to portray what hospice nurses do to the rest of the world? I recall seeing this Johnson and Johnson public service announcement last year, but was recently reminded about it during this week's #hpm Tweetchat. Maybe you have seen it on TV, but for those of you who have not seen it yet here you go: (email subscribers click the link to this story to go to the website) A transcript of the PSA for those who have YouTube blocked from work: I'm a hospice nurse. Berta Olson is my patient. I spend long hours with her, checking her heart rate, administering her medication, and just making her comfortable. One night Berta told me about a tradition in Denmark. When a person dies, she said, someone must open the window so the soul can depart. I...

Time Magazine teaches us How to Die

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 11 Jun 2012 04:00:00 +0100

Some of you may have caught the stark red cover of Time magazine last week with the bold white font and minimalist design, which let you know lurking within those pages was a story that would let you know “How to Die.” (Subscription required) Now as you may recall, Time magazine was recently lauded/lambasted for the breast feeding cover featuring a 3 year old on his mother’s breast. So initially I thought this was Time magazine jumping into sensationalism again to increase magazine sales, but then on further thought would people really be stampeding the newsstands for this subject? Upon reading the tagline “What I learned from the Last Days of My Mom and Dad,” the concept of the article became more clear. I have been noticing in the past year the increasing atte...

Pallimed's 7th Anniversary

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 11 Jun 2012 04:00:00 +0100

While we are a bit quieter than we used to be when we started we are still here and blogging. At nearly 1200 posts, this past week marked the 7th Anniversary of Pallimed (Jun 8, 2012). No need to recount the beginnings since you can read that in other anniversary posts (linked below). But I just wanted to take a moment to mark the passage of time. Thanks for being here with us readers and sharing these posts. As the current editor I still have grand plans for what Pallimed can be, but little things add up and it makes it hard to keep pushing for a vision when so many other priorities come first. We always love to hear feedback from readers so please share with us your thoughts in a comment or by email to christian@pallimed.org. 2006 - 1st Anniversary 2007 - 2nd Anniv...

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Hospice Nurses Are So Important

Pallimed: A Hospice and Palliative Medicine Blog — Thu, 10 May 2012 04:00:00 +0100

Me with Ruth Hancock out side of KBR* As many of you in health care are probably familiar, this week is National Nurse's Week capped by National Nurse's Day on Saturday May 12th, the birthday of Florence Nightingale. Most health care organizations do small things to recognize the important role nurses fill, but after this week it goes back to the regular grind. Since completing a hospice and palliative medicine fellowship, I have been privileged to work alongside fantastic nurses who have been wonderful teachers, mentors, clinicians, and leaders. I am especially reminded because in the past two weeks I have had several interactions with nurses from my past education and work experiences. These chance meetings reinforced how indebted I am to the many hospice nurses who h...

Fellowship Match: Geriatrics in, Palliative Medicine up Next?

Pallimed: A Hospice and Palliative Medicine Blog — Fri, 04 May 2012 04:00:00 +0100

[Ed. note: This post is a reimagining of a post at Geripal. Same facts - some simliar sentences - wholly different approach.] This week the American Geriatric Society is holding their annual meeting and they announced they will now do a fellowship match starting with the 2014 academic year. This is huge news for geriatrics since they have been without a match since they were first officially recognized by the ACGME in 1988. It also serves as an important benchmark for palliative medicine fellowships. Why is this important news? Both fellowships have a lot in common and hopefully directors at geriatrics programs can work with their HPM colleagues to accelerate working through the complexities of getting a HPM match. We have seen posts on GeriPal and Pallimed about the frustrati...

Blogs to Boards: Question 8

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 01 May 2012 04:00:00 +0100

Discussion:Show/hide Discussion Answer and Discussion: The correct answer is A. KEY POINTS Opioid neurotoxicity in the setting of renal failure/azotemia is the most likely answer. Morphine metabolites build up disproportionately in the setting of renal failure. Morphine 3-glucoronide is a neurostimulant that can lead to agitated delirium, myoclonus, hyperalgesia, and even seizures. Morphine and hydromorphone are the most common culprits. Morphine 6-glucoronide is a metabolite that is active on the mu-opioid receptor, and thus is not a major player in terms of inducing agitated neurotoxicity. Fentanyl does not have the same metabolites and thus has a lower risk of agitated neurotoxicity. Since there are no active metabolites that build up in renal failure, it is the safest of the “...

What is the right age for kids to go to a funeral?

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 01 May 2012 04:00:00 +0100

If you have worked in hospice for a few weeks or health care for a few years you will probably come across this question at some point. What is the right age to take children* to a funeral? This question is asked of everyone involved with the care of the patient not just the social worker or chaplain who you might think are natural targets for such a question. Deeper underneath this question are ones that children may naturally have about illness, death and dying. And of course these may be questions the parent do not feel ready to answer, thus the solicitation of guidance. You can break down the basic answers in a couple of categories that all have their pros and cons. No. Absolutely no! - Obviously this answer doesn't take into account any of the unique aspects noted ...

Facebook adds Organ Donor Status

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 01 May 2012 04:00:00 +0100

As you may have heard Facebook is going public as early as next week. In a curious (or expected) show of goodwill and an attempt to make use of Google's (slightly ironic) mantra "Don't be evil," Facebook CEO Mark Zuckerberg announced that today you can add your organ donor status to your Facebook profile. This will be an interesting social experiment in the wild to see if organ donation could go viral. Palliative care clinicians will all recognize the issue with a shortage of potential organs for those in need. We talk to patients and families all the time that are holding on to hope for a possible transplant. One quality measure as you can see from the picture above is the link to actual state registries. Could something like this work for advance dire...

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How Not To Get Frozen In Carbonite Against Your Wishes

Pallimed: A Hospice and Palliative Medicine Blog — Thu, 12 Apr 2012 04:00:00 +0100

Some 2nd year medical students from my institution (University of Minnesota Medical School) created this remarkable and hilarious video about, well, a Gundersen-La Crosse-style advance care planning project which takes place in the Star Wars universe. You get to witness the horrors of receiving medical treatments against one's wishes (hint: it's from Episode III). Hat tip to Dr. Jim Pacala for letting us know about this. (It's good quality except the sound quality can be fuzzy - it's best viewed with good speakers.) (Source: Pallimed: A Hospice and Palliative Medicine Blog)

National Health Care Decisions Day 2012

Pallimed: A Hospice and Palliative Medicine Blog — Thu, 12 Apr 2012 04:00:00 +0100

Yes it is that time of year again. If the weather is starting to get nice and there are a few storms coming through your area it must be Spring and that means Taxes right? Well yes there is April 15th where we have to pay our taxes. But more importantly to the hospice and palliative medicine community is National Healthcare Decisions Day (US) and National Advance Care Planning Day (Canada) on Monday April 16th. 2012 marks the 5th year of NHDD, an initiative spearheaded by Nathan Kottkamp, a partner at McGuire Woods law firm in Virginia. He is living proof of the famous Margaret Mead quote, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." I have had the pleasure of working with Nathan in 2011 ...

Blogs to Boards: Question 6

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 09 Apr 2012 04:00:00 +0100

Blogs to Boards: Question 4

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 02 Apr 2012 04:00:00 +0100

Discussion:Show/hide Discussion Answer and Discussion: The correct answer is E. This patient has had multiple types of nausea, however currently her major nausea type seems to be vestibular. She may have developed an otolith while dehydrated. Some chemotherapeutic agents are ototoxic and can cause vestibular symptoms including hearing loss, tinnitus, vertigo/nausea. She also has had chemotherapy induced nausea, as well as diabetic gastroparsis. For the boards, probably the default choice for nausea will be D2 blockers, however there are certain types of nausea for which D2 blockers are not the best choice. a) Ondansetron and the other ‘-setrons’ are HT3 receptor blockers and have excellent evidence for the treatment of chemotherapy induced nausea, and post-operative nausea. Whi...

ACGMC Announces New Fellowship Requirements for Hospice, Palliative Medicine & Puppies Training

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 01 Apr 2012 04:00:00 +0100

Leaders of the APRIL-FUL showing good bedside manner FOR IMMEDIATE RELEASE: ACGMC and AVMA COE announce new requirements for fellowships in Hospice, Palliative Medicine and Puppies Chicago, April 1, 2012. by Abe R Feaulx, Pallimed Special Reporter In a joint news conference, representatives of the Accreditation Council for Graduate Medical Comedy (ACGMC) and the Alaskan Veterinary Medical Association Accreditation Council on Comedy (AVMA COC) outlined new requirements for accreditation of fellowships in Hospice, Palliative Care and Pupplies (HPCP). As many of you will recall last April 2011, the Association of Palliative Realists Interested in Looking For Unified Language (APRIL-FUL) declared the new name for the field "Hospice, Palliative Care and Puppies." Explaining the histo...

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Generalissimo Francisco Franco gets an LVAD

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 01 Apr 2012 04:00:00 +0100

Last Saturday night, live, special correspondent to Weekend Update, Chevy Chase, filed this report on a story that he has been covering since 1975. To the cheers of supporters, aides to Generalissimo Francisco Franco announced that the Generalissimo has received a left ventricular assist device, also known by the abbreviation, LVAD. The procedure was performed at an undisclosed location. At this time, it is uncertain how this development will ultimately affect the Generalissimo's fate. Aides declined to comment on whether the Generalissimo would be placed on a heart transplant list. At this time Generalissimo Francisco Franco is not dead. Stay tuned for further updates. (Source: Pallimed: A Hospice and Palliative Medicine Blog)

Hospice Doctor Admits This Work is Very Sad

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 01 Apr 2012 04:00:00 +0100

April 1, 2012 by Abe R Feaulx, Pallimed Special Reporter On a cross-country plane flight, Dr. Arya Kidenmee finally admitted to her seatmate, an unabashedly handsome young shower curtain salesman, what the public has known all this time. "I finally had to tell him that hospice work is very sad. I'm not sure why people in hospice and palliative care always say it is rewarding. We have meetings every week where we just sit and cry the entire time, it is absolutely emotionally paralyzing to try and help people with advanced illness." When reached for comment, seatmate Brock Montgomery noted, "I knew it. I run into people in health care all the time and people who work for hospice always appear so friendly and outgoing, but I knew there could not be anything rewarding in helping...

Blogs to Boards: Question 2

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 26 Mar 2012 04:00:00 +0100

Discussion:Show/hide Discussion Answer and Discussion: The correct answer is A a) The patient likely has opioid induced constipation (OIC). Methylnaltrexone is a mu-opioid receptor antagonist and is related to naloxone. After ruling out bowel obstruction, fecal impaction and any other abdominal process, you give methylnaltrexone at 0.15mg/kg subcutaneously, usually 8 (patients < 136lbs) or 12 mg (patients over 136lbs). About 60 percent of patients will have a BM in under 4 hours. Usually within 30 minutes of the first dose. Number needed to treat was 2.2 (pretty darn good). One barrier is cost. At $48 per 8mg dose this is a costly way to manage constipation. b) While controlling abdominal pain is important relieving the cause of the abdominal pain takes precedence. Opio...

Blogs to Boards - AAHPM 2012

Pallimed: A Hospice and Palliative Medicine Blog — Thu, 08 Mar 2012 05:00:00 +0100

For those who attended our blogs to boards session - here is the link to the PDF's(please email christian@pallimed.org if you have difficulty with it)http://www.tagmydoc.com/dl/go8DS/43P (Password needed)If you didn't get the chance to attend, don't fret. We plan to post a question a week on both GeriPal and Pallimed to get everyone ready of the 2012 palliative care boards. (Source: Pallimed: A Hospice and Palliative Medicine Blog)

The 3rd Annual Pallimed/GeriPal Meet-and-Greet at the AAHPM/HPNA Annual Assembly

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 07 Mar 2012 05:00:00 +0100

As seen on GeriPal...It is on - the 3rd annual Pallimed/GeriPal Meet-and-Greet during the AAHPM / HPNA Annual Assembly!Desktop BackgroundsThis year's party will be held at the Tarantula Billiards Bar and Grill on Thursday, March 8th. We will plan to start around 9:30 PM. We are working on reserving the four Billiards tables in the back, so look for us there.Tarantula Billiards Bar and Grill is one block away from the convention center. The address is 1520 Stout St. Denver, CO.The party is open to all, so drop on by. (Source: Pallimed: A Hospice and Palliative Medicine Blog)

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More Echoes of Temel et al.

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 08 Feb 2012 05:00:00 +0100

This week the American Society of Clinical Oncology (ASCO) published a new Provisional Clinical Opinion (PCO) as an early release article online, The Integration of Palliative Care into Standard Oncology Care. Seven published RCTs formed the basis of the "Panel’s expert consensus that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden."The Oncology Report published a background piece on this PCO, which highlights the impetus of this paradigmatic shift in comprehensive cancer care as the Temel et al., article in the NEJM in July 2010. Pallimed contributors have posted more or less directly on the reverberations here, here, here, here, here, here and most recently here, wh...

Drug Shortages in the US and Abroad

Pallimed: A Hospice and Palliative Medicine Blog — Fri, 03 Feb 2012 05:00:00 +0100

World Cancer Day is February 4th, and in honor of this day, I'm posting about a critical issue we have written about on Pallimed before... access to medications. There are three developments in the last few days I think are worth knowing about... by NASA's Marshall Space Flight Center by Phil McIver 1) The Life Before Death feature film premiered in Singapore on February 1st. This movie about the international pain crisis accompanies 50 short films (33 have been released on YouTube so far), a one-hour TV documentary (not yet released), and two advocacy websites (here and here). If you are interested in hosting a screening of the feature film in your area, click here. (Previous related posts are here, here...

The Prognostic Frame of Healthcare for Older Adults (and Everyone Else)

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 16 Jan 2012 05:00:00 +0100

I have a 1 in 542 chance of dying in the next year. In other words, for every 542 men who are the same age as me, one will die in 2012. For those of us who survive until 2017, the probability of death during that year will be 1 in 364. This probability will increase fairly predictably over the years. Gompertz Law of human mortality suggests that the rate doubles every eight years. Supposedly, this law stands the test of time and across populations. I'm certain actuarialists routinely figure out probabilities that a man my age will become seriously ill or disabled as well. Statistics put mathematical meat onto a mild, chronic anxiety about dying or becoming ill. It's something that most of us feel and I don't trust people who say that they don't have any anxiety about it. Source: Meander...

The Alignment of HPM and Oncology: Palliative Care Influence on Chemotherapy Use in Metastatic NSCLC

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 02 Jan 2012 05:00:00 +0100

In this study, patients receiving the palliative care intervention were free from IV chemo 24 days longer at the end of life and received 14 days more of hospice which doesn’t add up to 2.7 months. Avoidance of toxic chemo near the end of life and provision of supportive hospice likely play a role, but in the shadows, there appears to be a survival benefit which is unrelated to chemo avoidance or hospice. Improved symptom control and psychological well-being, perhaps? In Temel et al, the primary outcome was improved QOL 12 weeks after initiation of the intervention. While we are talking about the study being underpowered, I do have to point out that there was a statistically insignificant trend towards the palliative care group ha...

Christopher Hitchens: Dying as an Atheist

Pallimed: A Hospice and Palliative Medicine Blog — Fri, 16 Dec 2011 05:00:00 +0100

Image credit: Wikipedia Christopher Hitchens, noted author and philosopher died December 15, 2011 leaving behind many essays, books, and other writings as well as contributing to several lectures, ethics/religion debates, and TV talk shows. His acerbic style often ruffled feathers as he attacked religious dogmatism. As one of the most famous outspoken atheists of this era, his thoughts on being diagnosed with an incurable disease would be a powerful insight into how atheists might approach illness and death. Where others might retreat from the public spotlight, Hitchens attacked his cancer through writing. As a doctor caring for patients facing their own mortality, understanding their spirituality becomes an important part of caring for the whole person....

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Palliative Drug Shortages

Pallimed: A Hospice and Palliative Medicine Blog — Fri, 16 Dec 2011 05:00:00 +0100

There was a time when I heard about chemo shortages, and I thought that must really force some tough choices for patients and physicians. But thankfully (I thought) drug shortages for generic non cutting edge medications that have been around for a long time like the ones commonly used for symptom control would probably be relatively immune. But in the past 2 weeks I began hearing rumblings from our pharmacists about a possible shortage of IV lorazepam. As I researched this more it appears to be a much bigger problem. It wasn't just local or even regional but national. Thanks to the American Society of Health System Pharmacist (ASHP) website I could find out lots of info that is up to date on the supply chain of key meds for hospice patients....

Engage With Grace 2011: Occupy With Grace

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 23 Nov 2011 05:00:00 +0100

For the past few years at Thanksgiving, Pallimed donates a blog post to Engage With Grace, a movement to encourage a new tradition of using the family time during this American fall tradition to get families talking about what is important to them. This is a movement you can easily get behind in person if you are an advocate for good patient centered health care, which you likely are if you are reading this blog. So donate your blog, Facebook update, Twitter account (#EWG) to Engage With Grace this holiday weekend. And then put your money where your mouth is and bring it up yourself while your family is together. Here is the this year's post from the Alexandra Drane and the Engage With Grace Team: ---------------------------------------------------------------------- ...

A Better Kind of Care

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 16 Nov 2011 05:00:00 +0100

Paul White, shown here at a chemotherapy session with his daughter Laurie Alexander.(Essdras M Suarez/Globe Staff) In a July 24th article, A Better Kind of Care, The Boston Globe journalist Kathleen Burge introduced readers to Paul White, a successful owner of an engineering and manufacturing business, a man with a wife, two adult daughters, five granddaughters, and stage IV renal cell carcinoma. He had beat the odds repeatedly, having survived over seven years since the discovery of metastases. Despite availing himself of surgery, every new advancement in chemotherapy and participating in a clinical trial, his cancer was implacably progressing. Contemplating starting on what might be the last chemotherapeutic agent, he had also started seeing Dr. Vicki Jackson, Director of the Palliative ...

"I Am a Doctor Working in Palliative Care. Ask Me Anything."

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 15 Nov 2011 05:00:00 +0100

The social news website Reddit advertises itself as the "Front Page of the Internet." The site might as well be called "Procrastination Grand Central" (based on my experience). For those unfamiliar with the site, Reddit relies on a simple upvote/downvote system which brings popular stories/posts to the top of the page. Once you click on a post, you will notice many comments which are once again ordered based on popularity. One can also search the site based on keywords. A lot of the stuff posted on the site is, well, junk... but there is enough good stuff to keep you occupied if you aren't not careful. by Eva B One of the "subreddits" on the site is entitled "IAMA," which doubles for "I am a" and "ask me anything." Several posts strike me as notable. For instance, see "...

REMS education comment period

Pallimed: A Hospice and Palliative Medicine Blog — Fri, 11 Nov 2011 05:00:00 +0100

The FDA has opened a comment period, closing December 7, on it's just-released draft "Blueprint for Prescriber Continuing Education Program." The accompanying request-for-comment states that "The central component of the Opioid REMS program is an education program for prescribers and patients." If you've missed the previous discussion of opioid REMS, see Drew's blogs here and here and especially Stew Leavitt's extensive analysis last April.The actual REMS stuff that has come out so far has not been as draconian as some had feared when first announced. The education Blueprint is pretty benign and pretty much (what should be) standard of care for almost any medication: the prescriber should know about the medications' potential negative effects, take them into consideration in prescribing an...

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Patient-centered care

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 08 Nov 2011 05:00:00 +0100

Discussion Paper, a new IOM series. Patient-Centered Cancer Treatment Planning: Improving the Quality of Oncology Care is the report of a workshop (Feb 28 – Mar 1, 2011) jointly sponsored by the National Coalition for Cancer Survivorship and IOM. Both of these publications grew out of the IOM emphasis on patient-centered care that was highlighted in the 2001 consensus report, Crossing the Quality Chasm: A New Health System for the 21st Century. In that report patient-centeredness was identified as one of six key characteristics of quality care.Patients are the “ultimate stakeholders” in an increasingly complex delivery system, often with poor coordination and unclear roles. “The effectiveness of patient-clinician communication can be as important as that of a diagnostic or treatmen...

Serious vs. Chronic vs. Life-limiting vs. Advanced vs. Terminal

Pallimed: A Hospice and Palliative Medicine Blog — Fri, 04 Nov 2011 04:00:00 +0100

This article is worth a glance and I have encountered some similar issues in my clinical work. Certainly I do not discourage this type of advocacy. I remember from my residency being exposed to several rheumatologists who practiced medicine using a biopsychosocial philosophy. I'm sure that many of them would welcome greater interdisciplinary involvement. Perhaps palliative care's greatest benefit for these patients would be more indirect than seeing every patient. System-wide educational and quality improvement palliative care initiatives may be where the value is for these patients. How would you recommend that a palliative care team handle this type of request for an evaluation? Here are some possible options: I would schedule the patient for an appointment ...

Most Days I Clamor for POLST

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 30 Oct 2011 04:00:00 +0100

Helen Kao at Geripal recently wrote a thoughtful post which highlights some of the flaws in the California POLST form. It's worth a read and I agree with her comments. (And even though I use "POLST" here, I agree with her thoughts on using "POST" instead.) For jurisdictions which are considering the establishment of POLST, it is important to consider the experience of other states as new forms are designed and legislation is drafted. I live in one of the many states which is in the process of developing a program. In spite of the weaknesses of forms currently in use in other places, PO(L)ST/MO(L)ST remains a very helpful tool with new research continuing to back its utility. For instance, consider a recent study published in the Journal of the American Geriatrics Society which...

The Death of Steve Jobs: In Medias Res

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 30 Oct 2011 04:00:00 +0100

The illness and death of the iconic Steve Jobs have stimulated much conversation both online and off. I won't rehash that now. In case you missed it, NYT published the eulogy delivered by Steve's sister, Mona Simpson, who is a novelist and English professor. "One time when Steve had contracted a tenacious pneumonia his doctor forbid everything — even ice. We were in a standard I.C.U. unit. Steve, who generally disliked cutting in line or dropping his own name, confessed that this once, he’d like to be treated a little specially. I told him: Steve, this is special treatment. He leaned over to me, and said: “I want it to be a little more special.” Intubated, when he couldn’t talk, he asked for a notepad. He sketched devices to hold an iPad in a hospital bed. He designed new fluid ...

Innovation Advisors Program

Pallimed: A Hospice and Palliative Medicine Blog — Fri, 28 Oct 2011 04:00:00 +0100

Attention! Palliative Care advocacy opportunity! Do you want to get palliative care on the health care agenda? Are you interested in healthcare innovations? Please consider applying for the Innovation Advisors Program with the Center for Medicare and Medicaid Innovations (CMMI). Deadline for applications November 15, 2011. Check it out!!! http://innovations.cms.gov/innovation-advisors-program/ (Source: Pallimed: A Hospice and Palliative Medicine Blog)

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What caught my eye in Twitter this week (10/28/11)

Pallimed: A Hospice and Palliative Medicine Blog — Fri, 28 Oct 2011 04:00:00 +0100

(From http://www.thedesignwork.com/) What follows are a few of the things of the interesting things that went by me on Twitter this week (most recent on top). If you don't tweet, no worries, I removed the hashtags (those pesky # signs). I did leave in the @ signs for those of you who do tweet so you can see who the tweets came from and to give proper credit, but I included who they are in parentheses if it wasn't really obvious. Let me know if you like having the tweets cherry-picked for you. (Disclaimer: I don't read all the tweets in Twitter, so you are getting some of the select few I found interesting enough to retweet/repeat.) Congrats to Dr. Anthony Back of Seattle Cancer Care Alliance for Sojourns Award! http://bit.ly/tAnzWU *Well-deserve...

Oncology Patients in the Emergency Department

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 19 Oct 2011 04:00:00 +0100

by john cowper Dusting off the Blogger account and checking in...... JCO published a population-based snapshot that looks at the characteristics of patients with cancer who visited emergency departments in North Carolina during 2008. Lung cancer was the most common cancer identified in visits by a significant margin while breast, prostate, and colorectal cancer were each identifed in a smaller number of visits. Patients with lung cancer were more likely to be admitted to the hospital with a total of 63% of all ED visits for patients with cancer resulting in an admission. The top three complaints included pain, dyspnea, and gastrointestinal complaints. More ED visits occurred during night and weekend hours than regular office hours. Few brief thoughts/questions to ponder: What percentage ...

The New Language of Medicine

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 19 Oct 2011 04:00:00 +0100

NEJM published a perspective piece where the author briefly describes recent evolution of certain terms within medicine which may resonate with you. "Patients are no longer patients, but rather “customers” or “consumers.” Doctors and nurses have been transmuted into “providers.” These descriptors have been widely adopted in the media, medical journals, and even on clinical rounds. Yet the terms are not synonymous. The word “patient” comes from patiens, meaning suffering or bearing an affliction. Doctor is derived from docere, meaning to teach, and nurse from nutrire, to nurture. These terms have been used for more than three centuries." "The words “consumer” and “provider” are reductionist; they ignore the essential psychological, spiritual, and humanistic dimensio...

Oligometastatic Lung Cancer

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 19 Oct 2011 04:00:00 +0100

NEJM presents a case of a man found to have a primary lung cancer and a solitary brain metastasis. The discussion regarding management of the patient is noteworthy, especially the possible role of surgery and a brief discussion regarding the use of tyrosine kinase inhibitors. The palliative care consultant should be aware of the available case series which suggest that a minority of patients might have a longer survival than what is usually expected in patients with brain mets. (See Table 1 in the article.) In the case series, patients received aggressive surgical intervention for the brain met and aggressive attempt at locoregional control of the primary cancer. The article provides some guidance for selection of appropriate patients for aggressive disease-based manage...

NPR Series on Aging and End of Life: Hospice and Palliative Care in Prison Population

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 19 Oct 2011 04:00:00 +0100

The NPR show Tell Me More has a week long series on issues surrounding aging and end of life. Today, the show highlighted the documentary Serving Life about care provided to inmates at Angola Penitentiary in Louisiana. The documentary aired this summer on the Oprah Winfrey Network. Also, see this recent perspective piece from Annals of Internal Medicine which addresses the issue of compassionate release of prisoners near the end of life. Pallimed has featured stories on palliative care in prisons previously (see search results for "prison" here). (Source: Pallimed: A Hospice and Palliative Medicine Blog)

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The Fellowship Quest With No Match, or O Brother, Where Are We?

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 31 Jul 2011 23:00:00 +0100

Update: In the vast palliative care social media echo chamber, Eric Widera over at the GeriPal has provided the 2 to a 1-2 post combination on the problems of applicant/learners in the current state-of-the-fellowships. Please be sure to pop on over and check it out.------------------------------------------------------------------------------------------------Eric Widera over at GeriPal posted in April about changes in the National Resident Matching Program (NRMP) timeline for medical subspecialty fellowships, and the implications for Hospice & Palliative Medicine (HPM) and Geriatrics.I'd like to talk about our Match-less HPM fellowship application process, from one applicant's perspective.Photography by Ken Goldberg. From “Tele-Twister” CC 2004. Some rights reserved.So, there I am...

Call for Submissions to the 3rd Annual AAHPM Interactive Educational Exchange!

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 24 Jul 2011 23:00:00 +0100

LIFE Before Death Short Films - Week 10 of 50!

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 24 Jul 2011 23:00:00 +0100

Each week for 50 weeks, there will be a short documentary film about the international crisis in untreated pain. We've already made it through the first 10 weeks so far! This is a part of a larger project entitled LIFE Before Death which includes a full-length documentary film as well (see Christian’s earlier post Movie Trailer Premiere: LIFE Before Death). Whether you are interested in watching about Opiophobia or debate the question of Torture in Health Care, you can catch up at TreatThePain.com. You can also download the videos for advocacy and training work at the Life Before Death website (the topic of two previous Pallimed posts here and here). If you are interested in some blog posts on individual short films, Dr. James Cleary, Director of the Pain...

Denosumab, palifermin, and the costs of supportive cancer care

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 18 Jul 2011 23:00:00 +0100

I've been following the emergence of denosumab as a preventive therapy for skeletal related events in patients with bone metastases, and thought I'd write about it. Denosumab is a monoclonal antibody therapy which binds RANK-ligand, leading to osteoclast inhibition, decreased bone turnover, and presumably its salutary effects in preventing fractures and other skeletal related events (this glowing editorial on denosumab gives a nice/brief overview of its mechanism of action - the image is from this editorial.) There have been several publications the last half-year in Journal of Clinical Oncology (breast cancer study here; myeloma & non-breast, non-prostate cancer study here) all showing that denosumab is non-inferior to zoledronic acid in preventing skeletal related events....

Increasing Palliative Care Awareness - the 2011 CAPC Public Opinion Research

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 28 Jun 2011 23:00:00 +0100

Palliative Care still befuddles many people when they first hear the term. Even after seeing it people may feel like the many blind scientists touching different parts of an elephant. Historically we have described to people what palliative care is on our terms as the experts who provide it. Looking at many organizations definition of palliative care they have not been made based on public opinion and understanding. The Center to Advance Palliative Care (CAPC) with support from the American Cancer Society Action Network commissioned a study of public opinions on palliative care, but now the question is what can we do with this new information. Before I get any further on my opinion of the key findings, I need to tell you to take 15 minutes and read the actual report.&nb...

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The New York Times Takes on the Issue of Rising Hospice Costs

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 28 Jun 2011 23:00:00 +0100

This week the New York Times talks about the rising costs of providing hospice care in America with a particularly juicy hook about a nearly $25 million whistle-blower settlement against an Alabama hospice. From there it talks about the focus of some hospices to seek patients who are likely to have longer lengths of stay, like dementia and stroke. One research analyst even goes as far to say "It's a lucrative business, at least under the current reimbursement system." They also feature an inspector general report that documentation for hospice patients in nursing homes was lacking. Not a good start from a newspaper that has actually been quite kind to hospice in the past. The rest of the article goes on to discuss the various fixes including every hospice me...

"I'm taking care of him...but not really." - The dying patient in intensive care

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 18 Jun 2011 23:00:00 +0100

Discussion Should Occur Before Death The Power of Love: Going to Dialysis Hell and Back Leave your thoughts here but also go to Happy Hospitalist's blog and leave comments there because it is pretty popular and our thoughts might get to people outside our normal blogging circles (Source: Pallimed: A Hospice and Palliative Medicine Blog)

Did Hospice Have the Biggest Impact on American Health Care?

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 18 Jun 2011 23:00:00 +0100

First of all let me say, vote now if you want 'Hospice Care' to win.* Many of you have probably heard in the past 2 months about the Modern Healthcare 35th Anniversary "Big Impact" Tournament from other hospice advocates imploring you to vote. I have advocated for it on Facebook and Twitter, but until now I had not really thought it important enough to dedicate a blog post on the subject. Frankly what does winning this online tournament mean? Clearly there is no prize money and if there was you would get your cut after me. So is this about bragging rights? Who would we regale with our great stories about besting Patient Safety Advocacy in the second round? I think these are important questions that go beyond winning a popularity contest. If hospice cha...

Congratulations to GeriPal on Two Year Blogiversary!

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 18 Jun 2011 23:00:00 +0100

A hearty congratulations to Eric Widera and Alex Smith and the rest of the GeriPal team for reaching their two year milestone. They have created a wonderful site where geriatrics and palliative care are discussed passionately and their reach is extending the field. GeriPal has become a major influence in just two short years because of hard work and their dedication. And if you are thinking, "Gee GeriPal and Pallimed do a great job of independently covering hospice and palliative medicine issues, so there is no other need for a new blog"...you would be selling yourself short. We need more writers out there. Be the next Pallimed, or GeriPal! And when you start your blog come tell me, and we will help spotlight your best writing. And remember there are pl...

Routine Palliative Medicine Consults for VAD Destination Therapy

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 15 Jun 2011 23:00:00 +0100

In this month's issue of the Mayo Clinic Proceedings is the first article reporting on a case series with inclusion of palliative medicine (PM) consultations as a routine, integrated part of pre-op or early post-op care for patients receiving ventricular assist device (VAD) as destination therapy (DT). Both Drew and Holly have posted previously on Pallimed about VAD DT. The Mayo Clinic is a nationally and internationally recognized tertiary and quaternary referral center. As such, beyond the ordinarily sick patients, the Mayo Clinic treats some extremely sick patients, patients who come to be cured, as well as patients who are a mixture of both. The Mayo Clinic recently performed its 100th heart translpant, and they having been implanting VADs as both bridge therapy and as DT. As such, t...

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"If I've got 6 months to live, I want to know so I can party"

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 11 Jun 2011 23:00:00 +0100

Journal of Supportive Oncology recently published the results of a pilot trial of an evidence-based decision aid for patients with metastatic cancer (free full-text available here, as always with JSO papers). This was a small, single cancer center study of 27 patients with metastatic solid tumors (mean age 63 years, 56% African American, with a mixture of metastatic breast, colon, lung, and hormone refractory prostate cancers). All patients at the center (it's not clear how the patients were identified - if this was a consecutive vs a convenience sample, etc.) who were potentially eligible were referred to the study after approval of their oncologist. The primary oncologist or oncology nurse could decline allowing the patient being enrolled due to concerns the patient would h...

Responding to Cancer Care Costs: Palliative Care Community - Get Ready

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 11 Jun 2011 23:00:00 +0100

Last year, about this time, the New England Journal of Medicine (NEJM) rocked the world of Oncologists and Palliative Care Specialists, publishing an article about how early palliative care interventions not only add to quality of life, but also length of life. This year, NEJM published an equally provocative piece, a "Sounding Board" article that addresses the need to curve the cost of cancer care. Get ready Palliative Care colleagues to respond once again. The anticipated growth in cost of cancer care is hard to fathom: rising from $104 billion in 2006, to possibly $173 billion in 2020. That is more than many countries entire GDP - (Indonesia's GDP is $174 billion, Thailand's is $132 billion.) To prevent bankrupting the US healthcare system, Oncologists will face the challenge of how to...

Pallimed's 6th Anniversary

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 07 Jun 2011 23:00:00 +0100

Today is the 6th anniversary of Pallimed and while we had a great beginning of the year you may have noticed that it has been pretty quiet around here lately. You do not have to worry, we are not going away, but I think all of us here were keeping busy in so many other parts of our lives that Pallimed took a bit of a back seat to other priorities. Finding balance is something we try to help our patients and families acheive and of course self-care is something we stress to our peers and trainees as well. The good news: in the month off, the hospice and palliative medicine world of blogs and social media did just fine. So we are glad to be in a cultural ecosystem that allows for these breaks every once in a while. In fact now that we are back from our unannounced hiatus, I want to challeng...

Palliative Care Grand Rounds June 2011

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 07 Jun 2011 23:00:00 +0100

Palliative Care Grand Rounds is back after a brief hiatus. Thanks to last month's host Tim Cousounis for restarting PCGR with a bang. Let's jump right into the best of the blogs featuring hospice and palliative care from the last month. Melissa Sweet from Australia blogs for Croakey (the health care blog of the site Crikey). She recently featured Palliative Care Australia and their efforts to develop a national consensus statement on palliative care. From the first post a larger discussion on the use of social media to help palliative care grow in Australia led to a second post. (Found via @GroundSwellAus) Blog posts written from personal experience are so helpful in understanding how health care is experienced from the other side of the Electronic Med...

What Happens when the Patient Stops Fighting Cancer?

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 14 May 2011 23:00:00 +0100

On December 23, 1971, President Richard Nixon declared "war on cancer", signing the National Cancer Act into law. This law significantly strengthened the National Cancer Institute, giving it more autonomy within the NIH and more funding. Earlier in 1971, baseball Hall of Famer Harmon Killebrew (nicknamed "The Killer" for his slugging prowess) finished his 18th season in the major leagues. That year, he won the Lou Gehrig Memorial Award which is given to players who emulate Gehrig's character both on and off the field. At the age of 35 and 36, Killebrew still produced excellent statistics playing for the Minnesota Twins in 1971 and 1972 before his production fell off in the years before his retirement in 1975. A few days ago, I was looking for the latest scores when I found t...

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Pallimed Contest #2: Teleconference with Joan Halifax Roshi and Metta Institute.

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 26 Apr 2011 23:00:00 +0100

We are fortunate enough to have two back to back contests to give our loyal Pallimed readers. We just announced our winners of our first contest and now if you were not able to go to Chicago you can enter this next contest, because you can just stay home. The Metta Institute is giving two lucky Pallimed readers a complimentary individual registration for their May 3rd teleconference "Being with Dying" with Joan Halifax Roshi, a Zen priest, Founder and Co-Abbot of the Upaya Zen Center (Twitter: @UpayaZen) . The teleconference will focus on "Being with Dying" and the essential role of compassion in caregiving. She has worked in the area of death and dying for over thirty year and has been a keynote speaker at NHPCO and AAHPM national conferences. The cost of the teleconference is $25...

2011 World Congress Correspondent Selected!

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 26 Apr 2011 23:00:00 +0100

Thanks to all who emailed in to win. We have our winner to for one complimentary pass for a Pallimed reader to attend this meeting June 22-24th in Chicago. Congratulations to Holly Kirkland Walsh, FNP, GN, who will attend and report back to us on what she learned from the summit. The alternates should Holly not be able to attend have been notified by email. If you did not receive an email then you didn't win this time. But no worries we will have others. (Source: Pallimed: A Hospice and Palliative Medicine Blog)

The Unspoken - Short Film About Father-Son Communication

Pallimed: A Hospice and Palliative Medicine Blog — Tue, 26 Apr 2011 23:00:00 +0100

"Dad...this film is all the things I need you to hear." This short film is a perfect fit for today's world filled with distractions and...hey what's that shiny object over there. Sorry. This 4 minute film titled "THE UNSPOKEN" from Jason van Genderen was the runner up at Tropfest Australia 2011 and is more powerful than even a Hallmark commercial, more heartfelt then a torch song, and evidence that we are capable of appreciating people before they are dead and gone. Congratulations to Jason on his recognition and thank you for giving so many people an example of what 4 minutes of talking can accomplish. And as always check out the 81 comments and counting on YouTube for some insight in to how this affects people. Some examples: Thank you for this. My dad has been battlin...

Chemotherapy complications round-up...neuropathy,

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 23 Apr 2011 23:00:00 +0100

A few recent studies about mitigating chemotherapy complications have caught my eye and bear mentioning. The first couple are about neurotoxic complications of chemotherapy. I've been seeing a lot of patients who have had quite severe problems from (usually chronic) peripheral neuropathies related to their chemotherapy. At least occasionally these complications are devastating - leading to very difficult to manage, disabling pain. I haven't seen this confirmed in the literature, not that I've gone looking, but my sense is that these sorts of complications are becoming more and more common, perhaps in part to expanding use of taxane-based chemotherapy, and other newer neuropathic agents like bortezomib. Despite this, there are no proven (ie, in well designed, controlled trials) analg...

Feeling grumpy about opioids

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 20 Apr 2011 23:00:00 +0100

As it's been noted on the blog before, it's safe to say we are in the midst of a transition towards increasing restrictions on our ability to prescribe opioids to our patients, although the nature of these restrictions are really just emerging**. All of this is, of course, in response to the horrifying epidemic of prescription opioid abuse - see this recent New York Times piece for a bone-chilling description of prescription opioid abuse in Appalachia. Which is not to say that some of the recent high-profile scholarly publications on the risks of chronic opioid therapy make me very, very grumpy, at least how they are interpreted in the headlines and editorial page. I've really appreciated Stewart Leavitt's ongoing, critical discussion of these publications (and the larger...

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Continued deficits in the evidence base for palliative care in oncology

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 20 Apr 2011 23:00:00 +0100

An unusual and sobering study on the state of the “palliative oncology literature” has recently been published online. Searching 6 bibliographic databases, this group from M.D. Anderson undertook a massive review of the palliative oncology literature, comparing from 2004 and 2009 the number of articles, proportion of all oncology articles, topics, and study designs. The paper begins by highlighting the familiar barriers to palliative care research: limited research funding, few personnel trained in palliative care research, difficulty in recruiting and retaining patients/subjects, methodologic issues. They also pointed out that there still isn’t a consensus taxonomy and classification system for palliative care literature (can you tell they had professional research librarians on th...

Correspondent Needed! - World Congress Leadership Summit on Hospice and Palliative Care

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 20 Apr 2011 23:00:00 +0100

In a previous blog I asked about coverage of some of the other main palliative care meetings as a new role for Pallimed. Hopefully many of you are already attending these meetings and if you are you are welcome to email me in advance and get your complimentary 'Pallimed Blogger Press Badge' in exchange for giving us a summary of what you learned while you were at the conference. Until now the Pallimed Blogger Press Badge really didn't hold much value beyond getting you into all the sw.iest clubs and a Pallimed/GeriPal Party if it was being held in your city. (They only happen once per year!) But now we are entering a new era... In an arrangement with the World Congress, they have given us one complimentary pass for a Pallimed reader to attend this meeting June 22-24th ...

A few pearls from ACP

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 16 Apr 2011 23:00:00 +0100

Earlier this month the 2011 ACP annual meeting was held in San Diego. In addition to escaping New England to Southern Cal in early April, I got to see old friends at San Diego Hospice, meet the fellows, and catch some pearls at the ACP meeting. I wish there were more of us there tweeting and blogging, because I could not catch all the talks I wanted to. Here are some of the articles highlighted in talks I attended that may be pertinent to our field: Updates of Ethics, Dr. Sha reviewed key articles/events in palliative care and ethics: The CDC takes a stand on distributive justice during influenza pandemics in allocating ventilatory support to patients. - Article: Manuel ME Pandemic Influenza: Implications for Preparation and Delivery of Critical Care Services J Intensiv...

National Healthcare Decisions Day - April 16, 2011

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 13 Apr 2011 23:00:00 +0100

This post is part of the 2011 Blog Rally for National Healthcare Decisions Day. If you have a blog please post it and leave it up on the front page through April 16th. -Ed. Rallying to Encourage and Empower Us All to Make Our Healthcare Decisions Now for the Unknown Later… College education. Career path. Relationships. Starting a family. Buying or selling a house. Vacations. Retirement. From the age that we’re old enough to understand, most of us are taught and accept that these are the markers in life that we plan for. However, there’s one key marker that’s all-too-often missing from this list: healthcare decision-making. Like planning for these other life events, planning for the time (or times) that we are unable to express our healthcare wishes is of the utmost importance. It...

Surgical Clinics of North America revisits Palliative Care

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 13 Apr 2011 23:00:00 +0100

I can't get enough of this month's Surgical Clinics of North America (April 2011). Thoughtfully presented, the entire issue creates a three dimensional view of palliative care in surgery. Dedicated to Jack Zimmerman, MD, FACS, who helped establish one of the first hospices in the US while Chief of Surgery at Church Home and Hospital in the 1970s, Surgical Clinics of North America presents a well-rounded and well-thought through collection of papers on Updates in Palliative Surgery. Geoffrey Dunn's introduction outlines the successes of our field, while also honestly presenting the challenges to its growth - from the limited research funding to the heated political arena, even daring to use the term "death panel." He generously credits our field with as being "a timely le...

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Morpheme Conference on New Media - Spots still available

Pallimed: A Hospice and Palliative Medicine Blog — Wed, 13 Apr 2011 23:00:00 +0100

As May 6th gets closer I wanted to remind you there are only a few slots left for our inaugural conference on New Media for Palliative Professionals. If you need a refresher I included information from a previous post on the conference. We hope to see some of you there for a fun weekend in Birmingham. Sign up soon before the last slots are taken! From the previous post --------------------- I am very excited to announce the first ever Morpheme Conference May 6-8th, 2011 to help palliative professionals from any discipline work with new media and creative writing. This project got started back in the Fall of 2010 at the AAHPM Board Meeting when Amos Bailey approached me to talk blogging. We began discussing his experiences writing on his blog about gardening and my work wit...

Movie Trailer Premiere: LIFE Before Death:

Pallimed: A Hospice and Palliative Medicine Blog — Sun, 10 Apr 2011 23:00:00 +0100

The problem of pain and suffering is important in the developed world. Most of us work through these challenges daily, but a much larger problem exists on the international level with few countries having access to effective opioids, pain relief and palliative care expertise to the level we have in the United States and Canada. Efforts like the Foundation for Hospices in Sub-Saharan Africa and international educational efforts via programs like San Diego Hospice are ways that the palliative care community is reaching beyond our work locally. Sadly most of these programs are under-recognized and do not get the level of support needed for the scope of the problem. Sometimes you need to do something a little more confrontational to get th...

NHPCO Management and Leadership Conference 2011

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 04 Apr 2011 23:00:00 +0100

After Hill Day is over, NHPCO will be hosting their 26th Management and Leadership Conference at the nearby Gaylord National Conference Center. Just in time for the end of the Cherry Blossom Festival! I have never been to the MLC before but have been to the Clinical Team Conference a few years ago. This session looks to be much more about the administrative issues as opposed to the medical-clincal aspects of the AAHPM and NHPCO CTC conference. I am only able to go for the Friday sessions, but after looking over the sessions this past week I see many more topics that I would be interested in. Reading through many of them I am reminded of the absence of a voice in the blogosphere since Hospice Guy at Hospice Blog left in 2009. We don't have anyone really coverin...

NHPCO (Virtual) Hill Day 2011

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 04 Apr 2011 23:00:00 +0100

The National Hospice and Palliative Care Organization and it's sister organization the Hospice Action Network are hosting Hill Day in Washington DC on April 6th where they lead hospice advocates from all over the country in meeting with government representatives to talk about the role for hospice in the continuum of our nation's health care delivery system. They bring the stories and the data to appeal to both sides of the political brain and are meeting with both major parties. The events started today with strategy sessions to make sure the advocates were prepared with the facts and how to make the most effective use of their time. I have never attended Hill Day but would invite anyone who is attending this year or the past to write a guest post for Pallimed to recount you...

Slate Survey on Mourning and Loss

Pallimed: A Hospice and Palliative Medicine Blog — Mon, 04 Apr 2011 23:00:00 +0100

Meghan O'Rourke wrote a great series of articles on grief for Slate Magazine in 2009 that will soon be part of a newly published book, The Long Goodbye. The articles were featured on Pallimed when they first appeared and a worthy read when you get a few moments. At the end of March, Slate published a survey asking about grief experiences. 30 questions with plenty of open ended answers. The post already has plenty of comments which seems ripe for a dissertation or at least a letter to the editor. Wondering what type of research this would be and why no one is publishing 'Qualitative analysis of readers comments to online article about grief.' Regardless...I just wanted to point this out to say there are good journalistic sources out there tackling the tough is...

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Inpatient Rehab Improves Functional Status in Asthenic Cancer Patients

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 02 Apr 2011 23:00:00 +0100

This study sought to compare functional outcomes in asthenic patients with hematologic malignancies with those of asthenic patients with solid tumors after inpatient rehabilitation.Their hypothesis was that asthenic patients with hematologic malignancies were less likely than patients with solid tumors to make functional improvement after rehabilitation. This was a retrospective chart review of 60 asthenic cancer patients (30 consecutive patients with solid tumors and 30 consecutive patients with hematologic malignancies) who completed inpatient rehabilitation at a comprehensive cancer center between October 2005 and October 2007. Patients in whom the admitting physiatrist determined asthenia to be the main cause for admission to the rehabilitation unit were included in this study. Patient...

Hope you liked the April Fool's Posts

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 02 Apr 2011 23:00:00 +0100

Hopefully many of you realized the 5 posts on April 1 were of the joking variety. QuickMed Inc. Launches New Palliative Service: Scoops of Compassion Reluctant Oncologist Finally Embraces Alternative Medicine Three additional specialty boards are long shot to co-sponsor Hospice and Palliative Medicine BREAKING NEWS: Specialty now known as Hospice, Palliative Care and Puppies New Demonstration Project Proposed for CMS by Fringe Medical Group Thanks to Drew, Suzana, Brian, Lyle, Holly for their contributions (in no particular order). And a big thanks to Abe R Feaulx for his crack reporting. We may ask him back next year. Interestingly, I had some comment son Facebook about a dermatology doctor who is doing his palliative care fellowship, the effective ...

Palliative Care Grand Rounds to Return this Week

Pallimed: A Hospice and Palliative Medicine Blog — Sat, 02 Apr 2011 23:00:00 +0100

Palliative Care Grand Rounds has been on hiatus for the past few months but will be coming back strong with the best of blog posts on hospice and palliative medicine. This is a great way to showcase all the different voices out there and hopefully to encourage more people to participate with the ongoing recognition for their efforts. Stay tuned for the new debut this Wednesday! If you blog and are interested in hosting please email christian@pallimed.org to sign up for an upcoming month. (Source: Pallimed: A Hospice and Palliative Medicine Blog)

New Demonstration Project Proposed for CMS by Fringe Medical Group