MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'ethics/law'. Sun, 18 Oct 2009 17:39:46 +0100 http://www.medworm.com/index.php?rid=2678743&cid=t_100064_122_f&fid=34736&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FChannelN-PodcastsPoweredByOdiogo%2F%7E3%2Fw9_9xSrvffk%2Fneurolaw.html The Brain and the Law An overview of neuroethics and neurolaw that covers a lot of ground, from Phineas Gage to comas. Ways that the brain controls behaviour, issues of responsibility and accountability in the legal system, decision making, recidivism and rehabilitation, predicting violence, the hype and reality of fMRI lie detectors and the implicit association test (IAT), and more. Mentions a clinical trial that’s testing neurofeedback for controlling cravings. Fast-paced and accessible talk, via @lawneuro and @hoteit, from the @RSAevents Vision lectures. (Source: Channel N) Channel N blogs http://www.medworm.com/rss/comments.php?id=2678743 Fri, 07 Aug 2009 03:00:33 +0100 2678743 http://www.medworm.com/index.php?rid=2598219&cid=t_100064_87_f&fid=34902&url=http%3A%2F%2Fwww.futurepundit.com%2Farchives%2F006364.html Okay folks, what do you make of this? Some people do not feel tempted to lie. CAMBRIDGE, Mass. – A new study of the cognitive processes involved with honesty suggests... (Source: FuturePundit) FuturePundit blogs http://www.medworm.com/rss/comments.php?id=2598219 Sun, 12 Jul 2009 23:00:00 +0100 2598219 http://www.medworm.com/index.php?rid=2553188&cid=t_100064_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2FEOHO-pcg--Q%2F The federal court stepped in to ban the genetically modified alfalfa produced by Monsanto Co., pending a thorough review of the crop’s impact on the environment. The ruling by the 9th U.S. Circuit Court of Appeals on Wednesday leaves Creve Coeur-based Monsanto with two options. It can appeal the case to the U.S. Supreme Court or hope for regulatory approval after the Agriculture Department completes a comprehensive environmental review. (stltoday.com) Environmental groups and alfalfa-seed farmers sued the government in 2007 over its decision to release GM alfalfa without reviewing how the crop can potentially affect the environment. According to this news, the case marks the “first time a thorough environmental review has been required for regulatory approval of a genetically modified... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=2553188 Mon, 29 Jun 2009 00:22:01 +0100 2553188 http://www.medworm.com/index.php?rid=2349270&cid=t_100064_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2FXOOoMmh_tyA%2F Next-generation technologies are exploding so rapidly in genomics and personalized medicine that the NIH want to help jump-start experiments that will answer some of the bioethical concerns that rose along with the era. Image: Newscom More than 200 grants could receive up to $1 million each from the stimulus funds that were earmarked for the National Institutes of Health’ Challenge Grants program. Ten bioethics-focused programs address issues relating to the commerce of direct-to-consumer genetic tests; ethical issue posed by nanomedicine, tissue engineering and similar emerging technologies; and informed consent issues as medical records become electronic. Genomics becomes an even hotter topic as the NIH requests for more advances and developments of new methods and technologies. The wa... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=2349270 Wed, 15 Apr 2009 03:28:00 +0100 2349270 http://www.medworm.com/index.php?rid=2260153&cid=t_100064_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2FyROCp-aZhY8%2F I got this off Senator John McCain’s Twitter (yes, he now tweets). Over the last few days, the Arizona lawmaker has been tweeting his version of “The Top Porkiest Projects” in the Omnibus spending bill. Here are science/genetics projects that Sen. McCain consider earmarks or pork-barrel: “$819, 000 for catfish genetics research in Alabama” “$1,427,250 for genetic improvements of switchgrass - I thought switchgrass genes were pretty good already, guess I was wrong.” “$1 million for mormon cricket control in Utah - is that the species of cricket or a game played by the brits?” “$650,000 for beaver management in North Carolina and Mississippi” “$250,000 to enhance research on Ice Seal populations” “$209,000 to improve blueberry production and efficiency in GA”... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=2260153 Fri, 06 Mar 2009 12:20:00 +0100 2260153 http://www.medworm.com/index.php?rid=2241054&cid=t_100064_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2F1KfFWCW6aO4%2F I got this off Senator John McCain’s Twitter (yes, he now tweets). Over the last few days, the Arizona lawmaker has been tweeting his version of “The Top Porkiest Projects” in the Omnibus spending bill. Here are science/genetics projects that Sen. McCain consider earmarks or pork-barrel: “$819, 000 for catfish genetics research in Alabama” “$1,427,250 for genetic improvements of switchgrass - I thought switchgrass genes were pretty good already, guess I was wrong.” “$1 million for mormon cricket control in Utah - is that the species of cricket or a game played by the brits?” “$650,000 for beaver management in North Carolina and Mississippi” “$250,000 to enhance research on Ice Seal populations” “$209,000 to improve blueberry production and efficiency in GA”... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=2241054 Fri, 06 Mar 2009 12:20:00 +0100 2241054 http://www.medworm.com/index.php?rid=2205278&cid=t_100064_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2F4dINQeqvWN8%2F I don’t know about the people working at the NIH, but I was giddy about the NIH funding from Obama’s stimulus plan. Anyone who has worked at the institute knows how each dollar from the taxpayers is stretched to accomplish lofty goals for better health and innovative research. So it’s no surprise that the $10.4 billion funding is met with anticipation and excitement, and questions about how exactly will the funds be disbursed. Acting Director Raynard Kington answered that question in a statement this week - NIH will fund applications that are already on hand and expected to make progress in the next few years. Applications that have been judged for merit but did not receive awards last year due to lack of funds will finally get thei due this year. NIH will focus on preserving and... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=2205278 Sun, 22 Feb 2009 08:42:54 +0100 2205278 http://www.medworm.com/index.php?rid=2200623&cid=t_100064_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2F3PfAqxjTbi8%2F The current Obama administration is putting plenty of attention on HEALTH, and I’m not talking about health care and insurance, although hopefully we’ll have good news on those fronts in the next four years. What I’m talking about are money and heads of offices – two factors that dictate how U.S. research in genetics and health will be conducted and approached in the next four years. This week, when President Obama signed the Economic Recovery Act, the NIH got $10 billion in funds for research, medical education and patient care. Another $19 billion went to a health information technology initiative for creating electronic medical records. In the political front, who is going to replace Daschle as candidate for the Health and Human Services Secretary? The Wall Street Journal writ... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=2200623 Fri, 20 Feb 2009 05:49:00 +0100 2200623 http://www.medworm.com/index.php?rid=2200624&cid=t_100064_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2FvDJgd9vaGjg%2F Just these past weeks I read about three articles about misconduct of postdoctoral fellows and research scientists. The first was from a UCLA professor who falsified data on cancer treatment research, and used the data for grants and a publication. In 2005, Mai Nguyen was barred from conducting research for three years, but she has since published 10 articles under her married name, and continues to teach at UCLA. The second misconduct came from a UCSF postdoctoral fellow who changed her own data files (36 files!) and changed images from another researcher’s experiments. None of Nima Afshar’s results were published anywhere, and she is nowhere to be found at the time the report came out last week. The latest was from an NIH postdoctoral fellow who changed gel images to get the desire... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=2200624 Thu, 19 Feb 2009 05:04:00 +0100 2200624 http://www.medworm.com/index.php?rid=2167710&cid=t_100064_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2FBMAUEKAU-uQ%2F The new US Congress is quite busy this week with our (hopeful) economic package and new laws that need voting. Amendments are being changed left and right, but there are several laws that scientists might take particular interest in.   Senate passed an amendment increasing National Institutes of Health funds by additional $6.5 billion, on top of the $3.5 billion already included in the bill. What this means for the NIH: more opportunities for research, funding for grants, and new jobs created for scientists and staff. The House re-opened the debate limiting the open-access policy of the NIH. The current NIH policy requires all NIH-funded investigators to submit versions of their manuscript to public databases within a year of publication. The current debate is whether open-access neg... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=2167710 Fri, 06 Feb 2009 11:07:22 +0100 2167710 http://www.medworm.com/index.php?rid=2027051&cid=t_100064_87_f&fid=34902&url=http%3A%2F%2Fwww.futurepundit.com%2Farchives%2F005781.html Neuroscience catches up with Fyodor Dostoevsky. When someone is accused of committing a crime, it is the responsibility of impartial third parties, generally jurors and judges, to determine if that... (Source: FuturePundit) FuturePundit blogs http://www.medworm.com/rss/comments.php?id=2027051 Thu, 11 Dec 2008 05:00:00 +0100 2027051 http://www.medworm.com/index.php?rid=1930290&cid=t_100064_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2FIFbwFQYEgUQ%2F With all the growing excitement, hype and inquiry surrounding personal genome testing, I was wondering when the National Institute of Health would join the fun. With a $600,000 grant from the NHRGI, the Genetics and Public Policy Center of Johns Hopkins will begin conducting studies to understand the new direct-to-consumer genetic testing industry. And it’s about time. Tags: direct-to-consumer, gene testing, genetics and public policy, nhgri, research, riskShare This (Source: Genetics and Health) Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=1930290 Mon, 03 Nov 2008 23:49:36 +0100 1930290 http://www.medworm.com/index.php?rid=1709138&cid=t_100064_87_f&fid=34902&url=http%3A%2F%2Fwww.futurepundit.com%2Farchives%2F005458.html If you can't stand for some people to have more than others then you'll be miserable. Sure glad I'm tolerant of rich people. To add some ammo to these explanations,... (Source: FuturePundit) FuturePundit blogs http://www.medworm.com/rss/comments.php?id=1709138 Sun, 17 Aug 2008 04:00:00 +0100 1709138 http://www.medworm.com/index.php?rid=1618060&cid=t_100064_87_f&fid=34902&url=http%3A%2F%2Fwww.futurepundit.com%2Farchives%2F005359.html University of Chicago researchers find that while undergoing functional magnetic resonance imaging (fMRI) brain scans children 7 to 12 show similar patterns of brain activity to adults when watching animated... (Source: FuturePundit) FuturePundit blogs http://www.medworm.com/rss/comments.php?id=1618060 Sun, 13 Jul 2008 04:00:00 +0100 1618060 http://www.medworm.com/index.php?rid=800027&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F08%2Fdutch-nicu-at-end-of-life-tidbits.html The July issue of Pediatrics has an article about NICU decision making for terminally ill newborns. In the past few years there has been a bit of a media sensation because of the Dutch tackling the very tough issue of medicines and technology potentially prolonging the life or death of newborns that are unlikely to survive. It started when a NICU in the Netherlands came up with euthanasia guidelines for terminally ill newborns. For most readers of Pallimed, it should be well known that euthanasia and physician-assisted suicide are considered legal and acceptable medical practice in the Netherlands. I give credit to Dr. Verhagen and his colleagues in studying end-of-life decision making in the NICU. This is an area that palliative care has really not addressed as a profession in a systemati... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=800027 Wed, 15 Aug 2007 03:45:00 +0100 800027 http://www.medworm.com/index.php?rid=786689&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F08%2Fno-drugs-for-you-per-fda.html An appeals court decision in DC has setup the potential for a very important Supreme Court hearing on the rights of the terminally ill. The court ruled 8-2 against the Abagail Alliance which supports the rights for dying patients to get access to experimental medications. The FDA is opposed to this measure. The finding by the judges stated that the constitution does not guarantee access to experimental drugs that have not been studied enough to be deemed safe and effective. (Read the court brief here.)One of the cases cited in support of the decision was Washington v. Glucksberg, which is the Supreme Court Decision on the right to assisted suicide case from 1997, that challenged the Oregon law on PAS. The basic result from that decision was no federal/constitutional right exists but that t... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=786689 Wed, 08 Aug 2007 02:13:00 +0100 786689 http://www.medworm.com/index.php?rid=761451&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F07%2Fprognosticating-cat-nejm-covers-hospice.html The New England Journal of Medicine is on a roll with relevant hospice & palliative medicine content lately. This week they have 4 key hospice related pieces, an audio piece and an article by one of the top prognostic researchers.Some of you may have stumbled upon Oscar the death-predicting cat via a NPR radio lead-in on Morning Edition, or in various newspapers. The human (animal?) interest story is about an anthropomorphized cat who appears to be able to prognosticate death within a few hours at a nursing facitily (Steere House) in Rhode Island. Can animals predict death? Like animals predict weather? or earthquakes? Should we fund more studies into Oscar and his animal breatheren? Or are we reading too much into his actions? There are plenty of biases that could be brought up here: reca... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=761451 Fri, 27 Jul 2007 02:40:00 +0100 761451 http://www.medworm.com/index.php?rid=757915&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F07%2Fketamine-steroids-katrina-caregivers.html Several things in brief...1)Pain Physician has a case based review on ketamine as an adjuvant for pain (free full-text available). Reviews the pharmacology and some of the data and provides very practical suggestions for its use. Good one for the teaching file.2)Supportive Care in Cancer has an interesting case series on using very high dose corticosteroids for palliation of dyspnea from malignant upper airway obstruction (in otherwise dying patients). The authors' argument is that this can be effective but very high doses need to be used (on the order of 40mg of IV dexamethasone daily).3)Some closure on the Hurricana Katrina physician murder charges: Dr. Anna Pou has been cleared of criminal charges after the grand jury failed to find evidence of a crime. AMA press-release here. The nurse... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=757915 Wed, 25 Jul 2007 18:43:00 +0100 757915 http://www.medworm.com/index.php?rid=752787&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F07%2Fnew-cpr-organ-donation-after-cardiac.html Newsweek: Back from the DeadThe cover of Newsweek has a man floating in a pool, with the caption "This Man Was Dead. He Isn't Anymore. How Science Is Bringing More Heart Attack Victims Back To Life." It is curious that the man is in a pose reminiscent of a cross, but alas this is not primarily a theological or graphic design blog so I will leave that for someone else to discuss.The focus of the news article is induced therapeutic hypothermia after cardiac arrest, which has shown promise in animal and human testing to improved recoveries from cardiac arrest and possibly shock and stroke victims (some primary medical articles: here, here and here). Given the focus on recovery, the article does a fair job covering it, but of course with any new whiz bang technology it is important to look at ... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=752787 Tue, 24 Jul 2007 03:36:00 +0100 752787 http://www.medworm.com/index.php?rid=728417&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F07%2Fopana-hastened-death-in-news.html How did I miss this?Did anyone else know about this?How come no one told me?Do you know about Opana aka oxymorphone?If you have not heard about oxymorphone and you count yourself as an expert in opioidology and palliative medicine, you should probably read Chamberlin et al's review of oral oxymorphone in the Annals of Pharmacotherapy. I stumbled across this medication initially in "Pain Medicine News" that shows up in my mailbox without me ever subscribing to it. Many of the articles in the last issue kept mentioning oxymorphone, and I thought I needed reading glasses, because I kept seeing 'oxycodone' or 'morphine' as I glanced over it. Luckily I work with a great hospital pharmacist who found this recent article.Some quick facts about oxymorphone:Approved by FDA: June 2006Brand Name: Opa... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=728417 Thu, 12 Jul 2007 02:39:00 +0100 728417 http://www.medworm.com/index.php?rid=723177&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F07%2Fsurrogates-advance-directives-and.html 1 picture, 3 related articles, 5 websites, and many thanks:1)First is an article about decision-making about life-support for adults without surrogate decision makers in Annals of Internal Medicine. This was a prospective, multicenter, US-based study looking at ICU patients who lacked decision-making capacity, a surrogate, or an advanced directive (data based on prospective surveys of ICU attendings). Of note, the researchers went to great lengths to ensure that their data would be untraceable to an individual patient and physician.Findings: of 3000 ICU admissions during the study period, 450 patients died and 5.5% of these (25 patients) deaths were of patients without a decision maker. Astonishingly, in 2 of the 7 institutions 25% of ICU deaths were in patients without surrogates. (This m... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=723177 Mon, 09 Jul 2007 21:45:00 +0100 723177 http://www.medworm.com/index.php?rid=698085&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F06%2Fpaging-dr-tmi-poppy-trade.html This study was well-designed and executed and the discussion section is a great read. It provides insight in how to look at the blurry lines among empathy and disclosure and boundaries and strengthening the clinician-patient relationship. I think these issues are very important for palliative care practitioners since it is so easy to make a quick connection with people by sharing any of your own losses, but ultimately it does turn the focus to us, and not to the patient or family. One technique if you are sharing something of your own experience, is you can always depersonalize it and mention "A patient/family that was in a similar situation thought this was important..." or whatever segue works best.But I guess that is sharing a little too much about myself!2)Nature is reporting a release... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=698085 Wed, 27 Jun 2007 02:29:00 +0100 698085 http://www.medworm.com/index.php?rid=686953&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F06%2Fopioids-opioids-opioids-cadavers.html 1)Anesthesia and Analgesia has an article urging medicine to conceptualize pain relief as a fundamental human right, and several editorials in response (one on improving access to analgesics worldwide; one on legal aspects of pain management; a general supporting editorial ; and a cautionary editorial warning of overuse of opioids to control chronic and postoperative pain). The main article is a comprehensive review at how and why pain is undertreated and the health and societal costs of this, and focuses a lot on international (WHO, etc.) efforts to improve pain relief. One sobering tidbit: 6 nations use 79% of the world's supply of morphine and 120 countries use virtually zero. (One assumes that in most of these countries the strong opioid of choice is nothing, and not Actiq or OxyCont... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=686953 Wed, 20 Jun 2007 22:37:00 +0100 686953 http://www.medworm.com/index.php?rid=674904&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F06%2Fdoctor-or-drug-pusher-in-ny-times.html This week's New York Times Sunday Magazine cover story is on criminal prosecutions of pain doctors for prescribing opioids. It is a long article which mostly focuses on a single case of a physician who certainly recklessly prescribed opioids for chronic pain - but for whom there's no evidence that he did it with any sort of intent other than to relieve pain (he wasn't running a prescription mill, conspiring to divert or otherwise distribute opioids, nor was he profiting from people misusing his prescriptions). The journalist more or less accuses the DEA/the Feds of reassuring physicians they won't be prosecuted unless they prescribe with criminal intent - knowingly prescribing opioids to be diverted or abused etc. (and not just recklessly but with analgesic intent which would be a matter f... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=674904 Sun, 17 Jun 2007 01:53:00 +0100 674904 http://www.medworm.com/index.php?rid=674906&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F06%2Fsurrogates-shakes-sedation-guidelines.html The recent issue of Archives of Internal Medicine has a number of articles with special significance to the palliative medicine field.The Physician-Surrogate Relationship by Dr. Torke is probably the first article I have seen that specifically addresses just the important role the surrogate plays in medical decision making. Nothing groundbreaking in the actual content of the article but it is groundbreaking in the fact that it addresses the issue of MD-surrogate relations at all. It lays out the relationship based on 4 key issues:Relationship BuildingDecision Making RolesExperience of the SurrogateMultiple SurrogatesOne thing that I did not find highlighted were the few studies out there that demonstrate surrogate decision making accuracy is not as high as society would hope for the amount... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=674906 Thu, 14 Jun 2007 03:57:00 +0100 674906 http://www.medworm.com/index.php?rid=660427&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F06%2Ffatigue-o-rama-at-asco-surgery-for-back.html Thanks to everyone at the CSPCP conference last week for being so friendly - particularly the Nova Scotian crew (DH & family, RH, PM) for your hospitality and generosity. Halifax, for those of you who are curious, is as lovely as billed (but watch out for hurricanes). I'm still re-orienting myself and so this is going to be a post of 'quickies.'1)ASCO occurred last week & Medscape reported on a session on new research on cancer-related fatigue. It's of course impossible to really get a sense for the quality of this research based on a reporter's summary of a conference session but the research presented suggested 1) ginseng may be helpful, 2) modafinil may be effective for chemobrain, 3) donepezil is not effective for fatigue.(Medscape articles usually require you to sign-up - it's free ho... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=660427 Wed, 06 Jun 2007 00:34:00 +0100 660427 http://www.medworm.com/index.php?rid=650729&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F05%2Fdrawbacks-of-pain-measurement-annas-on.html 1)Journal of Clinical Oncology has a wonderful 'art of oncology' piece written by a social worker about the 0-10 pain scale (free full-text appears to be available). It describes her experience being in severe pain in the hospital and, essentially, having her experience of pain, her suffering, erased by her care-providers' insistence on talking only about her pain rating. She has no complaints about her actual pain management - people took her seriously and treated her appropriately - it was the lack of engagement with her about her experience that she felt like the 0-10 scale engendered."Sometimes, consoling presence is the needed medication—something I did not find in reporting and noting scores of 0 to 10."She contrasts this with previous experiences with pain: "Before I had renal c... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=650729 Thu, 31 May 2007 02:03:00 +0100 650729 http://www.medworm.com/index.php?rid=611630&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F05%2Fdeceiving-patients-methylnaltrexone.html Happy belated Nurses’ Week for all of the nurses who follow the blog and those who love - or at least professionally admire - them. I am traveling through next week and this may be my last post until the last week of May. And yes, the fonts on this post are a little off - I can't figure out how to fix it.1)The most recent BMJ has an analysis about whether it’s ever moral for physicians to lie to patients. It actually, and without irony I think, presents a flowchart-type decision aide to help physicians make this decision. To the credit of the author the flowchart makes it highly unlikely that someone would conclude that it is permissible – the example below is the rather extreme circumstance in which the author concludes that it’s ok to lie. “A patient with a ruptured aortic aneu... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=611630 Thu, 17 May 2007 01:56:00 +0100 611630 http://www.medworm.com/index.php?rid=611632&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F05%2Fnetherlands-euthanasia-update-nejm.html This study demonstrated this happened less in 2005 (0.4%), and most times the physician spoke with the patient about this at an earlier time, or with the family, and often times with another physician.3) Opioids are not the medications of choice for hastening death. The great (public and medical) fear that titration of opioids for symptoms may hasten death is undermined by the fact that those who practice E/PAS in the Netherlands use medications such as neuromuscular relaxants more often than opiates. As I have been teaching students and residents lately: Opioids are powerful palliative medications to be understood and respected, not feared.Now this is not to say there are not very strong and cogent reasons against E/PAS, but in any reasonable debate about these practices we must reference... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=611632 Fri, 11 May 2007 04:00:00 +0100 611632 http://www.medworm.com/index.php?rid=599346&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F05%2Fvent-discontinuation-pleurodesis.html In no particular order: 1)Critical Care Clinics has an ethical review of discontinuation of mechanical ventilation at the end of life. It’s actually a rather free-wheeling review of the U.S. legal and ethical framework for withdrawal of life-prolonging treatments in the dying. It’s a good one for the teaching file. The same issue has a review of noninvasive ventilation (such as BiPap) which references its use in dying patients. “For the terminally ill patient, dyspnea is one of the most distressing and common symptoms. The most widely used treatment for this has been narcotics and anxiolytic medications. These medications are effective in relieving dyspnea, but they also have adverse effects. Noninvasive ventilation presents as an alternative measure to treat dyspnea; it can be ... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=599346 Tue, 08 May 2007 18:36:00 +0100 599346 http://www.medworm.com/index.php?rid=587328&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F05%2Fhospiceblog-hurwitz-update-lying-chemo.html 1) If you have not gone over to see HospiceGuy and his HospiceBlog (www.hospiceblog.org) you are missing out on some great posts. HospiceGuy is on a roll with some insight about the role of the chaplain in hospice, the NHPCO conference, hospice leadership and a quick overview of the Medicare Wage Index for 2008. On the wage index, the NHPCO also has a 5 page announcement (members only) boiled down to the parts that you need to know about.2) The verdict is in on the case of Dr. Hurwitz and he was found guilty of:“knowingly and intentionally” distributing drugs “outside the bounds of medical practice” and engaging in drug trafficking “as conventionally understood”? (via NY Times)Many good overviews below so I will not go into detail here but at least read one of these links becau... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=587328 Thu, 03 May 2007 15:25:00 +0100 587328 http://www.medworm.com/index.php?rid=568153&cid=t_100064_87_f&fid=34902&url=http%3A%2F%2Fwww.futurepundit.com%2Farchives%2F004209.html Brain scans show that psychopaths are not like the rest of us in how their brains work. Using functional magnetic resonance imaging (fMRI), researchers in the United States, Germany, and... (Source: FuturePundit) FuturePundit blogs http://www.medworm.com/rss/comments.php?id=568153 Wed, 25 Apr 2007 04:00:00 +0100 568153 http://www.medworm.com/index.php?rid=567919&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F04%2Fvideo-assisted-advance-care-planning.html 1)Archives of Internal Medicine has a couple notable articles. First is an intriguing one on using instructional videos in advance care planning for patients with dementia. 120 adult outpatients (median age 58, 70% women, over half non-white) who didn’t have family members with advanced dementia were given verbal information about advanced dementia and asked, essentially, if you were in this state would you want full, aggressive life prolonging care, less aggressive life prolonging care (hospitalization, antibiotics, etc. but no CPR, vent, or ICU level care), or comfort-only care? Then they were shown a video of a patient with advanced dementia being cared for (you can watch the clip here) and then were asked the same thing. After hearing a description of dementia, about half said the... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=567919 Tue, 24 Apr 2007 21:57:00 +0100 567919 http://www.medworm.com/index.php?rid=538988&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F04%2Fmedical-suicide-and-medical-futility.html The Washington Post and the USA Today ran articles in the past two days about very emotional and controversial issues in medicine. WaPo (or the Washington Post to those not in the know, as I was until today) covered the medical futility case in Texas where: A 17-month-old deaf, blind and terminally ill child on life support is the latest focus in an emotional fight against a Texas law that allows hospitals to withdraw care when a patient's ongoing treatment is declared "medically futile."The Texas Medical Futility law allows physicians with the support of the hospital to declare any treatment futile, and allow the patient/family unit 10 days to find another medical facility to care for them. If one is not found, the life-supporting treatment may be stopped. Or at least that is the way the ... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=538988 Thu, 12 Apr 2007 04:39:00 +0100 538988 http://www.medworm.com/index.php?rid=522599&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F04%2Fwithdrawing-life-sustaining-treatments.html 1)The current Neurology has the American Academy of Neurology's updated position statement on life sustaining treatment for patients without decision making capacity (no abstract; issue table of contents here). It is explicitly written in response to legislative efforts of the last few years (post-Schiavo) to restrict the rights of patients' families and physicians to stop artificial nutrition in incapacitated patients if it is decided that that is what the patient would want. To this end it reiterates the AAN's 1988 position that it is permissible to stop life-sustaining treatment (including artificial nutrition/hydration or ANH) in incapacitated patients if that is consistent with their wishes/in their best interest. Some nuggets:"[Recently] legislators in several states introduced bill... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=522599 Thu, 05 Apr 2007 00:37:00 +0100 522599 http://www.medworm.com/index.php?rid=500365&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F03%2Foregon-dwd-2006-report.html Oregon has released the 2006 annual report on the Death With Dignity Act. If you are not familiar with this report, the Department of Human Services reviews important data collected from physicians about how the physician-assisted suicide/death law is enacted. Particularly they collect demographics about the patients who receive prescriptions and track how the patients die (natural causes vs. taking the prescribed dose of barbiturate).During 2006, 65 prescriptions for lethal medications under the provisions of theDWDA were written (figure 1). Of these, 35 patients took the medications, 19 diedof their underlying disease, and 11 were alive at the end of 2006. In addition, 11patients with earlier prescriptions died from taking the medications, resulting in atotal of 46 DWDA deaths during 200... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=500365 Fri, 23 Mar 2007 03:39:00 +0100 500365 http://www.medworm.com/index.php?rid=490136&cid=t_100064_87_f&fid=34902&url=http%3A%2F%2Fwww.futurepundit.com%2Farchives%2F004139.html Since I'd pull the trigger I guess I already think like a Vulcan. Consider the following scenario: someone you know has AIDS and plans to infect others, some of whom... (Source: FuturePundit) FuturePundit blogs http://www.medworm.com/rss/comments.php?id=490136 Thu, 22 Mar 2007 04:00:00 +0100 490136 http://www.medworm.com/index.php?rid=484971&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F03%2Fethics-in-icu-prognosis-computers-to.html Many, many items in brief....1)Critical Care Medicine had a supplement in February about ethics in the ICU. Many articles here, including one on end of life ethics in the unit. It opens with this rather remarkable salvo:"Originally conceived and operated as short-term, life-saving vehicles for acutely ill or injured patients, modern intensive care units (ICUs) have expanded into entities that care also for chronically, although seriously, ill people; in fact, ICUs often become repositories for patients who have little or no chance for survival. Sophisticated technology frequently takes on a life of its own; the sheer momentum of processes inherent to ICUs may prevent healthcare providers from taking a step back to make well-considered decisions, especially at the end of a human life."The r... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=484971 Wed, 21 Mar 2007 02:16:00 +0100 484971 http://www.medworm.com/index.php?rid=474466&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F03%2Fsometimes-lot-of-good-stuff-comes-our.html Sometimes a lot of good stuff comes our way here at Pallimed but we just don't have time to get to a full commentary but we want to bring what we feel is important issues to the readers. Here are a few digest items from the past week, that I just need to get out of my to do box:1) Washington Post writer Rob Stein wrote an insightful article on race and end of life issues. Catch it on Washington Post while it is free (a few more days I believe). Some of the highlights of the article: "I think we need to be very attentive to attending to suffering in our patients and do everything we can to help minimize and ameliorate it," said Richard Payne, who runs Duke University's Institute on Care at the End of Life. "African Americans and other minorities are at greater risk of not dying well." The a... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=474466 Thu, 15 Mar 2007 22:15:00 +0100 474466 http://www.medworm.com/index.php?rid=463973&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F03%2Fdeaths-secondary-to-opioid-poisoning.html Some of you may have seen an email circulating from the Wisconsin Pain & Policy Study Group (PPSG) about an article from last summer's Pharmacoepidemiology and Drug Safety. The email highlights an article and two commentaries regarding a causal association between increasing opioid prescriptions and increasing deaths from opioid 'poisoning*.'The conclusion of the article is that we have entered a national epidemic of drug poisoning deaths, around the same time as increases in prescription opioid dispensing, and these may be related (inadvertently). Of the increase in unintentional deaths from poisoning, the opiate group had one of the largest % changes (+91%). In 2002, prescription opioids were implicated in more poisoning deaths (5528) than heroin (1937) or cocaine (3909). (For compari... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463973 Tue, 06 Mar 2007 05:04:00 +0100 463973 http://www.medworm.com/index.php?rid=463975&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F03%2Fopioids-and-heart-disease-freak-out.html A few quickies before the weekend...1)The American Heart Association is releasing guidelines on pain management in patients with coronary artery disease which places opioids in front on NSAIDs & COX-2 inhibitors as preferred agents (Guidelines here--both BMJ & Medscape have good news articles about them). (Medscape articles are available with a free registration.) The Medscape one has a good discussion of the already rough-and-tumble fight that is breaking out due to the prominence opioids get. From BMJ:"First line drug choices include paracetamol (acetaminophen), aspirin, tramadol, and short term use of other narcotic analgesics. If these fail to achieve adequate pain control, the next option is non-acetylated salicylates, such as naproxen."First line. As you can imagine there is goin... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463975 Fri, 02 Mar 2007 18:16:00 +0100 463975 http://www.medworm.com/index.php?rid=463974&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F02%2Fchristians-wed-post.html Early this week I was getting really bummed because I was thinking I had nothing to write about for Pallimed, and then BOOM! it all came at me at once. Enjoy!1) The NOLA case against a physician (Dr. Anna Pou) and 2 nurses (Lori Budo and Cheri Landry) being charged with murder/euthanasia is currently getting ready to go to the Grand Jury investigation. The jury was selected but the trial was delayed by Mardi Gras. (Seriously.)Interestingly the coroner submitted the deaths as 'undetermined' early in February, and said there was not enough evidence for homicide after consulting with leading forensics experts. Apparently this has not deterred the District Attorney, and the Grand Jury will proceed.One connection to a previous Pallimed post was that there was an outcry by supporters of Pou, Bud... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463974 Thu, 01 Mar 2007 04:27:00 +0100 463974 http://www.medworm.com/index.php?rid=463976&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F02%2Fadvance-directives-maybe-do-something.html Two from the latest JAGS and one from Journal of Medical Ethics...1)First is a mortality follow-back study on advance directives and quality of terminal care. I have expressed skepticism about AD's on this blog before--wondering whether they really improve end of life care etc.--and I'm happy to report that here is a bit of data proving me wrong. The study was a typical, solid Teno mortality follow-back survey of ~1500 bereaved family members. About 70% of patients had AD's before they died; those with AD's were more likely to be older, female, and white. AD's were definitely associated with 'better' terminal care:"For decedents with written ADs, the last place of care was most likely to be a nursing home. Those with an AD used less life-sustaining treatment in the last month of life, beca... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463976 Tue, 27 Feb 2007 23:26:00 +0100 463976 http://www.medworm.com/index.php?rid=463980&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F02%2Fpalliative-pope-letters-ebm-bashing.html 1) Did anyone else miss the Pope talking about palliative care last weekend (Feb. 11)? Where was I?I work at a Catholic hospital, so any pronouncement about health care by the Pope usually draws some attention. For those of you who also work with Catholic health care systems, you may want to read some of this and tie it in to your palliative care education. Maybe it will help with the administration supporting your efforts? I give you a few choice quotes from the article: “There is a need to promote policies which create conditions where human beings can bear even incurable illnesses and death in a dignified manner,” he said, pointing to the need for more palliative care centers.While the Catholic Church has always sought to follow the “example of the Good Samaritan” in showing “... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463980 Wed, 21 Feb 2007 04:15:00 +0100 463980 http://www.medworm.com/index.php?rid=463990&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F02%2Ffamily-complaints-about-hospital-deaths.html It should be noted that with Christan's flurry of posts the last couple of weeks Pallimed has now exceeded the 300 post mark.Several things in brief:1)BMJ reports that over half of complaints against Britain's NHS regarding hospital care were to do with deaths:"In many cases, families complained that they had received contradictory or confusing information from different staff caring for a relative. In other cases, relatives felt that they were unprepared for the death or had no time to arrange for family members to be present."Sound familiar?2)BMJ also has an interesting look at the role of NGOs in physician assisted suicide. It examines two organizations in detail (Exit in Switzerland and Compassionate Choices in the US). Both function as patient advocacy groups, assisting people s... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463990 Fri, 09 Feb 2007 19:25:00 +0100 463990 http://www.medworm.com/index.php?rid=463995&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2005%2F11%2Fnew-and-lingering-controversies-in.html My wife is a pediatric emergency physician (done with fellowship in 2006!) and so I get the pleasure of perusing her Pediatrics journal when it is delivered to our mailbox monthly. Well the October 2005 Issue was particularly exciting because my wife was the lead author on the first paper. (Not a palliative med article)But since anyone reading this blog is unlikely to be primarily concerned about the correlation between HSV and the signs of pediatric abuse, I will get to the 2 palliative medicine minded articles that were in this issue. I will focus here on one of them.The first article highlighted 6 controversies in Pediatric EOL care and the knowledge of these issues from residents, attendings and nurses. Now in reading this I thought these are just as relevant in adult EOL care and I th... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463995 Sat, 19 Nov 2005 04:20:00 +0100 463995 http://www.medworm.com/index.php?rid=463993&cid=t_100064_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2005%2F11%2Fterri-schiavo-look-back.html I had the pleasure of hearing Mary Labyak, MSSW, LCSW of The Hospice of the Florida Suncoast speak at the Missouri Hospice and Palliative Care Association meeting this week. She spoke about her experiences as President of the hospice agency that was charged with caring for Mrs. Schiavo. Ms. Labyak's talk fit very well with a recent article in the Annals of Internal Medicine reviewing Mrs. Schiavo's case from three different perspectives. A firm knowledge of the legal, ethical, and medical perspectives of this case from fellow professionals and not the media is essential for anyone willing to call themselves a palliative medicine professional.Regardless of your discipline in end-of-life care, the issues surrounding the case of Mrs. Schiavo are frequently recalled by patients, families and h... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463993 Wed, 16 Nov 2005 05:48:00 +0100 463993