MedWorm: Palliative Carer Workers

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...

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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....

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: ---------------------------------------------------------------------- ...

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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...

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 ...

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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)

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 ...

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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)

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

If you are a med ed geek like me, you L-O-V-E the Interactive Educational Exchange which has been a fun and exciting part of the Americal Academy of Hospice and Palliative Medicine (AAHPM) Annual Assembly for the past two years. It's not your ordinary concurrent session. No! Instead, you listen to a quick overview of the different presentations and then you zip around to learn more about the ones that you find most intriguing. I have always come away with at least one interesting idea to try or tweek to fit my teaching style and audience. So... if you're students are yawning, you can A) buy them coffee or B) go to the Interactive Educational Exchange on March 9th, 2012 from 3:30 to 5:00 pm. �...

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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...

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)

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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...

"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...

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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...

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)

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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...

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 ...

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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...

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...

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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...

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 ...

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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