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 'hospice'. Sat, 03 Sep 2011 01:50:01 +0100 http://www.medworm.com/index.php?rid=5118631&cid=t_100065_87_f&fid=38368&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcontent%2F30%2F8%2F1606.full.pdf Eleanor Clift Veteran reporter Eleanor Clift wrote the essay Hospice And The ‘End Game’ after her husband’s death from cancer. In it she concludes that hospice “should be front and center in the debate over the kind of health care future that we want.” Disruptive Women plans to cover the topic of hospice, end of life and caregiving next year, so stay tuned. Read the essay here.  To listen to a podcast of the essay click here. The essay appears in Health Affairs‘ August 2011 issue. (Source: Disruptive Women in Health Care) Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=5118631 Wed, 10 Aug 2011 13:25:26 +0100 5118631 http://www.medworm.com/index.php?rid=5107847&cid=t_100065_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2011%2F08%2F08%2Fon-the-loss-of-a-cancer-blogger-guest-post%2F Since I began this blog, I have always wrestled with the question of how to handle Guest Posts of survivors that are not doing well.  Early on I even considered whether or not to publish the names and URL’s of blogs of folks that have passed away.  Last Wednesday I offered the difficult post by Alli, who was struggling with the inevitable issue of quality vs quantity of the time left us when our disease rises up and begins to beat down our last defenses. Now that I am working in a bone marrow transplant clinic and proudly wear my leukemia and transplant badges in order to give my patients hope, the editorial conflict is more acute.  I frequently had out Being Cancer Network business cards to my patients. But after all Death is what we fear when we first heard our doctor say the wo... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=5107847 Mon, 08 Aug 2011 19:16:06 +0100 5107847 http://www.medworm.com/index.php?rid=5086262&cid=t_100065_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F07%2F30%2Fthe-new-grief-how-modern-medicine-has-transformed-death-and-grief%2F The realities of death and dying have changed profoundly in a relatively short period of time. Why? Thank the ongoing and remarkable advances in medical diagnosis and treatment. As a result of these advances, life expectancy in countries like ours continues to grow. We all die, but modern medicine is getting better and better at staving off death. And because of this the nature of grief has changed. In her groundbreaking 1970 book, On Death and Dying, Elisabeth Kübler-Ross identified a process which she believed individuals pass through when they are confronted with death. At the time, sudden and unexpected death was much more common than it is today. The grief associated with that kind of loss is captured powerfully in Joan Didion’s memoir, The Year of Magical Thinking, which recounts ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5086262 Sat, 30 Jul 2011 13:44:25 +0100 5086262 http://www.medworm.com/index.php?rid=4945214&cid=t_100065_154_f&fid=35946&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCanadianMedicine%2F%7E3%2F0CocHP9ar1Q%2Fubc-hospice-gets-rubber-stamp.html Hospice residents are the winnersIt’s been five months since the UBC put their plan to build a hospice on the Point Grey Campus on hold. After checking out 15 locations, the Board of Governors agreed yesterday to stick with the plan, despite objections raised by the mostly new-immigrant Asian community living in the high-rise condo facing the sight. They say their opposition to the 15-bed facility has nothing to do with fears that property values might decrease or the "idea" of a hospice but rather deeply held cultural convictions based on their conceptions around death. According to Professor of Chinese Religions Paul Crowe, Chinese believe “on the assumption the world as we understand it is a unified, single place that’s inhabited by both the living and the spirits of the deceased;... Canadian Medicine blogs http://www.medworm.com/rss/comments.php?id=4945214 Tue, 14 Jun 2011 17:15:00 +0100 4945214 http://www.medworm.com/index.php?rid=4853123&cid=t_100065_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F05%2Fdeath-panels.html I hate to bring these up again - but I am sure everyone remembers them and how Obamacare was going to create death panels to kills all off. They kind of reminded me of something out of communist Russia or Hitler's Germany on getting rid of the undesirables. http://www.blogger.com/img/blank.gifButwhat if they were good death panels and included:- An oncologist to help weigh pros and cons of chemotherapy and other treatment- Palliative care consultants to help understand the options regarding life support and make recommendations about pain control.- A psychologist to advise on how to share the news with family members.- A spiritual adviser, chaplain, minister or priest to offer comfort and prayer if wanted.- A case manager to help organize transfer to the desired hospice. I think I would wa... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4853123 Mon, 23 May 2011 10:01:00 +0100 4853123 http://www.medworm.com/index.php?rid=4775395&cid=t_100065_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fend-of-life-care-costs-does-your-doctor-know-when-youre-going-to-die%2F2011.05.01 One interesting comment I have seen come up over and over is the idea that end-of-life costs are the thing that is spiralling out of control and that if we could somehow find a way to curb the costs of futile care, then that would somehow solve the health care inflation crisis. Andrew Sullivan endorsed such an idea the other day, a “Modest Proposal,” which is not nearly as radical or amusing as Swift’s. And indeed, there is a modicum of sense in the idea. Estimates are that spending in the last six months of a person’s life account for 30-50% of their overall health care costs, and that the spending in the last year of a person’s life accounts for 25% of overall medicare spending. So — simple solution, right? cut down on the futile care, and we’re ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4775395 Sun, 01 May 2011 18:00:00 +0100 4775395 http://www.medworm.com/index.php?rid=4723808&cid=t_100065_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhospice-patients-spend-less-overall-time-in-hospital-but-more-days-in-the-icu%2F2011.04.16 Chronically-ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003, but their intensity of care increased as well, according to a report by the Dartmouth Atlas Project. While in the hospital less, patients had many more visits from physicians, particularly specialists, and spent more days in intensive care units, as result of growth in intensive care and specialist capacity, the researchers said. Intensive interventions can lower a patients’ quality of life and cost more, the researchers noted. About one-fourth of all Medicare spending stems from the last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease, the authors noted. Following patient preferences for ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4723808 Sat, 16 Apr 2011 22:00:00 +0100 4723808 http://www.medworm.com/index.php?rid=4627000&cid=t_100065_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2011%2F03%2F23%2Fhome-this-moment-guest-posts%2F If you look at my counter on the left, you’ll see that we have passed 100,000 visits.  I mean to celebrate this moment with an announcement of a cool new project and feature.  But it will have to wait.  This way I can keep you in suspense.  I’ll give you a hint – it involves virtual interaction. Spring weather has drawn me away from the keyboard into the gardens.  Also I started a one month, five hour a day, temporary, non-professional job scoring essay answers on a test.  I went to the local Oncology Nurses Society meeting the other day and made a plea to any mangers present for a eight hour per week position working on the odd project or something.  That’s enough news from here. We haven’t heard from the gynecological cancer folks lately.  After a li... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=4627000 Wed, 23 Mar 2011 17:43:39 +0100 4627000 http://www.medworm.com/index.php?rid=4627032&cid=t_100065_158_f&fid=38949&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FAgingWithGraceCareconnection%2F%7E3%2F2ViCT7cuwzg%2Feliminating-confusion-that-surrounds.html Advance directives, which allow people to plan ahead for end-of-life care, can be too vague to cover many medical situations. Now, a growing number of states are promoting another program to help guide physicians with a patient's specific instructions. The programs are known as Physician Orders for Life-Sustaining Treatment, or Polst. They are meant to complement advance directives, sometimes known as living wills, in which people state in broad terms how much medical intervention they will want when their condition no longer allows them to communicate. A Polst, which is signed by both the patient and the doctor, spells out such choices as whether a patient wants to be on a mechanical breathing machine or feeding tube and receive antibiotics. Polst programs are currently in use in 14 sta... Aging with Grace CareConnection blogs http://www.medworm.com/rss/comments.php?id=4627032 Wed, 23 Mar 2011 13:34:00 +0100 4627032 http://www.medworm.com/index.php?rid=4570772&cid=t_100065_158_f&fid=38949&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FAgingWithGraceCareconnection%2F%7E3%2FdP1knIfBZLo%2Famericans-ready-to-talk-about-end-of.html A new report indicates that American’s are ready for more discussions about palliative and end of life care. The study, released at yesterday’s summit held by National Journal LIVE entitled “Living Well at the End of Life: A National Conversation,” surveyed hundreds of adults on issues relating to palliative care. According to the report, 96% of Americans surveyed thought that making palliative care a priority for the health care system was important. This percentage was even greater for those participants who had personal experience with palliative care. About 81% of respondents also believed that palliative and end of life care should be covered by Medicare. The survey demonstrated that opinions about end of life care were not shaped by political persuasion, but instead by wheth... Aging with Grace CareConnection blogs http://www.medworm.com/rss/comments.php?id=4570772 Thu, 10 Mar 2011 12:35:00 +0100 4570772 http://www.medworm.com/index.php?rid=4813624&cid=t_100065_136_f&fid=37856&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FThePeacefulLiberal%2F%7E3%2FtI08X7t4nTc%2Fmy-awesome-husband-saga-continues.html I'm going to tell you all the most amazing true story about what my husband did for me this week and of course one good friend who helped us.    Yeah it could suck to be me if I didn't have such a bad ass husband by my side to slay some cancer ass if we can!  We always have hope and I'm also very aware of what we are facing as we enjoy every waking moment we can with each other.   I'm so freaking thankful that his job is allowing for him to be so passionate enough to take such great care of me.  He's better than  most of the nurses and I trust him a lot more in helping with so much that he does.    I can't help but gush about how wonderful my husband is to me as I survive what seems to be the most impossible.   How can I just be walking around o... ShoppingKharma: What comes around goes around blogs http://www.medworm.com/rss/comments.php?id=4813624 Fri, 18 Feb 2011 23:29:00 +0100 4813624 http://www.medworm.com/index.php?rid=4394699&cid=t_100065_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2011%2F01%2F24%2Fmoving-on%2F Daria With cancer things can happen rapidly.  And we are, all of us, inexorably, moving on. Just Saturday I received the following comment from Denise, a member of our little blogging community: “Shades of Blue (ovarian), Shoppingkarma (ovarian)and Livingwithcancer (Breast) are all now in hospice care. Pateeta, Jayne and Daria are wonderful women whom have provided me with courage and inspiration. If you have prayers to send, I’m sure they’d be happy to receive. God Bless all who suffer.” Before writing the post I checked on all three, only to discover that Daria Maluta (Living with Cancer) has died.  When I first started Being Cancer, not really knowing in what direction this site would go, I would search out and visit various personal cancer blogs, wanting to build a li... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=4394699 Mon, 24 Jan 2011 17:23:45 +0100 4394699 http://www.medworm.com/index.php?rid=4155364&cid=t_100065_136_f&fid=39213&url=http%3A%2F%2Fbeingcancer.net%2F2010%2F11%2F10%2Fso-long-farewell-guest-post%2F Some cancer blogs do not turn out so well.  It’s a fact we must reckon with.  Some of us lose the battle, lose the war.  But it does not have to be viewed as a failure.  The best of us make our exit with grace and courage.  A personal cancer blog can exemplify this grace and this courage, throughout its life, even up to the last post.  The author of the blog Borange, a multiple myeloma survivor, wrote her last post on a Saturday in April.  Her story is still intact online, serving to inspire others as it has from the beginning. Her last post published below is preceded by her profile paragraph. Because I Said So La Cootina aka The Coot, aka Aunt Crankypants. I am the mistress of Villa DeCay, and dogmom of Miss Molly. I have Multiple Myeloma, a blood and bone cancer. I am tryin... Being Cancer Network blogs http://www.medworm.com/rss/comments.php?id=4155364 Thu, 11 Nov 2010 00:25:31 +0100 4155364 http://www.medworm.com/index.php?rid=4105830&cid=t_100065_118_f&fid=34702&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fmspblog%2F%7E3%2FvR7n5RaPJ48%2F The view through the double glass doors is of a lovely garden; the autumn colors striking against the blue October sky.  Our friend rests peacefully in the room’s only bed, and we each spend a few moments with her.  At times it seems she knows we are there, although we come mostly now to comfort her family.  It is a sad time; we grieve for the loss we are all about to share, and seek ways to comfort those she held most dear. We are all thankful that she is here, in this quiet, restful place.  A nurse stops by to tell family how she did during the night, and to share what they’ve done to make her more comfortable.  Someone comes by a moment later with a sandwich, encouraging our friend’s husband to take care of himself, reminding him that there is coffee ... MSSPNexus Blog blogs http://www.medworm.com/rss/comments.php?id=4105830 Mon, 25 Oct 2010 14:47:58 +0100 4105830 http://www.medworm.com/index.php?rid=4045223&cid=t_100065_118_f&fid=39279&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Ffoxepractice%2F%7E3%2F1XhE5xoGibY%2Fhcsm-scoop-week40 At Fox ePractice we’re committed to providing you with everything you need to understand, position yourself, and to take advantage of the fundamental shift that is taking place in marketing a medical practice. To that end, each week this page will highlight some of the best content that we have come across on the web in order to further your knowledge of the opportunities before you. We will showcase both Healthcare Social Media experts who speak out on the subject, as well as those sites that demonstrate what we feel are healthy examples of how to put the concept of Web 2.0 to work for their healthcare businesses. So read on … and “get the scoop”: Transcript of the First MDchat for October 5, 2010 October 5, 2010 saw an internet event take place the likes of which we’... Fox ePractice blogs http://www.medworm.com/rss/comments.php?id=4045223 Fri, 08 Oct 2010 22:54:22 +0100 4045223 http://www.medworm.com/index.php?rid=3880858&cid=t_100065_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Femergency-palliative-care-we-cant-save-you%2F2010.08.18 An alert reader alerted me to this related piece in Slate: “We Can’t Save You: How To Tell Emergency Room Patients That They’re Dying.” An excerpt: The ER is not an easy place to come to these realizations or assess their consequences. A handful of physicians are trying to change that. Doctors like Tammie Quest, board-certified in both palliative and emergency medicine, hope to bring the deliberative goal-setting, symptom-controlling ethos of palliative care into the adrenaline-charged, “tube ‘em and move ‘em” ER. Palliative/emergency medicine collaboration remains rare, but it’s growing as both fields seek to create a more “patient-centered” approach to emergency care for the seriously ill or the dying, to improve symptom m... Better Health blogs http://www.medworm.com/rss/comments.php?id=3880858 Thu, 19 Aug 2010 00:00:00 +0100 3880858 http://www.medworm.com/index.php?rid=3798562&cid=t_100065_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftransitioning-primary-care-to-patient-centered-team-care%2F2010.07.28 While the “patient-centered medical home” may be a good idea, it needs a better name. It sounds like a hospice, reports surgeon and columnist Pauline Chen, M.D. She outlines the initial experiences of practices making the transition to the new practice model. One problem uncovered by pilot projects is that doctors in transition to the practice model have to spend inordinate amounts of time of things other than patients. And while the patients want and welcome the changes, they face a learning curve too, as they move from seeing just the doctor to working with a team of providers for their care.  Physicians suggested using resources from the Patient-Centered Primary Care Collaborative, a collaborative group set up to help offices make the transition. (New York Times) *T... Better Health blogs http://www.medworm.com/rss/comments.php?id=3798562 Wed, 28 Jul 2010 16:00:00 +0100 3798562 http://www.medworm.com/index.php?rid=3762902&cid=t_100065_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-beauty-of-life-and-death-too-easily-forgotten%2F2010.07.17 Yesterday I had a university student shadowing me in the emergency department. AF is a bright student, a hard worker who will make a wonderful physician. She is always curious and insightful when I ask her questions, or show her new things. Today,  she saw something that was new for her, but perhaps too common for me. I walked into the room of an infirm, frail old gentleman who was gracious and polite, as was his family. It turns out he came to us with a terminal illness. I did not know it, but his physician was meeting him. So, as AF and I walked into the room, the patient’s physician walked in after us, and continued a conversation about hospice that he had apparently begun earlier in the day. Realizing I had nothing to add, and would not be needed, I slipped away with my shadow... Better Health blogs http://www.medworm.com/rss/comments.php?id=3762902 Sat, 17 Jul 2010 15:00:09 +0100 3762902 http://www.medworm.com/index.php?rid=3808792&cid=t_100065_136_f&fid=35300&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fmetastatic-liver-cancer%2F%7E3%2FMRZqzpXj2wc%2F Please comment to give Kath-e a hug: being a metastatic liver cancer patient with primary non hodgkins lymphoma, she organized and shares her hospice experience: Hi Kaht-e here: I’m in this for three months since my prognosis and a brief update… Things changed since 3 months: I’m on morphine all day long … Funny thing it [...] (Source: Metastatic liver cancer) Metastatic liver cancer blogs http://www.medworm.com/rss/comments.php?id=3808792 Mon, 05 Jul 2010 06:09:43 +0100 3808792 http://www.medworm.com/index.php?rid=3678644&cid=t_100065_136_f&fid=35303&url=http%3A%2F%2Fwww.assertivepatient.com%2F2010%2F06%2Fsome-random-notes-on-hospice.html I met with a social worker from hospice, Ann, two weeks ago, and I've been meaning to blog about it ever since, but something has gotten in the way. (Something emotional. I can't define it any better than that.) But I want to get this onto my blog, so I'm just going to read through my notes from the meeting and post everything that seems relevant. Laurie and Monica were part of the meeting, and, although they didn't say much, it was a help to have them there. I was not feeling all that great on that Monday morning, and at the time I thought it was because of stress from the meeting itself, but I had also gotten up during the night, needing to throw up. When I got out of bed to go to the bathroom, I blacked out briefly and fell, hitting my head. (I've done th... The Assertive Cancer Patient blogs http://www.medworm.com/rss/comments.php?id=3678644 Sat, 19 Jun 2010 19:32:18 +0100 3678644 http://www.medworm.com/index.php?rid=3676853&cid=t_100065_136_f&fid=35303&url=http%3A%2F%2Fwww.assertivepatient.com%2F2010%2F06%2Fmore-fun-on-friday.html I've spent the past couple of hours updating several lists. These are the list of friends and acquaintances I want notified when I am terminal (which is NOT YET, ladies and gentlemen), and another list (almost identical) of the people I want contacted with my funeral information. And then there's a third list--one of the friends whom I think can be asked to help when I am dying, since I plan to do that at home, with the support of Hospice, granted, but it still takes a lot of hands to have a good death. I realize that many of my readers are upset by the posts I've been writing lately about my end-of-life planning, but I can't apologize for this--who do you think is going to make these plans for me? My sons? I don't think so. They don't have the exp... The Assertive Cancer Patient blogs http://www.medworm.com/rss/comments.php?id=3676853 Fri, 18 Jun 2010 21:42:16 +0100 3676853 http://www.medworm.com/index.php?rid=3644959&cid=t_100065_136_f&fid=35303&url=http%3A%2F%2Fwww.assertivepatient.com%2F2010%2F06%2Fmore-cheerful-topics-.html Just a quick post here, because I'm expecting Megan in an hour and I need to get ready. I think Megan and I are going to work in the garden--weeding, then spreading compost and mulch. I have two big bags of chicken compost now, thanks to Laurie, who dragged them over here, and all my fruits and vegetables need composting. Then we'll do some errands, and that will probably be it. If there's time, I'll ask her to walk Connie, but I probably won't go. So, that topic actually was cheerful, while I meant to be ironic and talk about the visit with a social worker from hospice yesterday. ... Yes, this is how I'm spending my days, preparing for the end of my days. For now, I'll just say that the social worker, Ann, was great, and she answered all... The Assertive Cancer Patient blogs http://www.medworm.com/rss/comments.php?id=3644959 Tue, 08 Jun 2010 16:59:26 +0100 3644959 http://www.medworm.com/index.php?rid=3629710&cid=t_100065_111_f&fid=34712&url=http%3A%2F%2Fdigitaldoorway.blogspot.com%2F2010%2F06%2Fhospice-on-blackdoctororg.html I recently wrote an informational article on hospice for BlackDoctor.org, and that article is now published. You can read it by clicking here. (Source: Digital Doorway) Digital Doorway blogs http://www.medworm.com/rss/comments.php?id=3629710 Thu, 03 Jun 2010 16:37:00 +0100 3629710 http://www.medworm.com/index.php?rid=3545440&cid=t_100065_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-grief-turns-into-rage%2F2010.05.08 Twice in the last few months I have encountered grief as rage. Both were in the setting of the cardiac arrest of individuals who were already very ill. One was aged, with severe, end-stage heart disease. One was of middle age, but with metastatic cancer and on hospice. In one instance, family members became angry because we did not leave the body in the ER for eight hours so that everyone could come and pay their respects. (Which I always thought was the purpose of a funeral home.)  In another, a family was angry because we did not allow everyone back into the room during the resuscitation of their cancer-stricken loved one — a resuscitation the family insisted upon, and which required rescinding hospice status. From observing their demeanor, their presence would have caused to... Better Health blogs http://www.medworm.com/rss/comments.php?id=3545440 Sat, 08 May 2010 14:00:15 +0100 3545440 http://www.medworm.com/index.php?rid=3204900&cid=t_100065_105_f&fid=38964&url=http%3A%2F%2Fdrwes.blogspot.com%2F2010%2F01%2Fhospice-some-misconceptions.html The Los Angeles Times had an earlier starter piece on hospice care recently with some remarkable figures:Over the last 25 years, the number of Americans turning to hospice for end-of-life care has climbed dramatically -- from 25,000 in 1982 to 1.45 million in 2008, as more and more people choose to spend their final days in the comfort of home or a patient facility with a home-like environment rather than in a hospital pursuing aggressive treatments.I have been involved with hospice twice now - once with my father several years ago, and recently with my mother-in-law who just died of pancreatic cancer. There are many references out there about hospice, and for a general overview for those thinking about hospice for themselves or a loved one, I'd steer you toward this introduction (pdf), pr... Dr. Wes blogs http://www.medworm.com/rss/comments.php?id=3204900 Mon, 25 Jan 2010 16:15:00 +0100 3204900 http://www.medworm.com/index.php?rid=3197627&cid=t_100065_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2Fu7rrPFIWFxU%2F The following guest post by Debra Gordon, an award-winning freelance medical writer, was recently featured on the Better Health blog. The original post can be found on Debra Gordon’s Musings on Medicine and Health Care blog. Back in the day when I was a newspaper reporter I completed a biomedical ethics fellowship at the University of Virginia Medical Center in Charlottesville, VA. In addition to sitting in on the hospital’s bioethics committee discussions, I spent much of the week shadowing a nurse in the ICU. They called her the Death Nurse because her job was to intervene with doctors, nurses, patients and families when the time came for a patient to move from the ICU to hospice. While her title was Supportive Care, she flat out told her me her job was to help people die; no... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=3197627 Fri, 22 Jan 2010 15:14:41 +0100 3197627 http://www.medworm.com/index.php?rid=3136735&cid=t_100065_158_f&fid=36018&url=http%3A%2F%2Fcaregiversbeacon.blogspot.com%2F2010%2F01%2Fholidays-and-bereavement-joy-memories.html Laughter can change to tears in a moment for those who are coming out of grief after losing a loved one. The holidays are a time of gratitude, hope, and new beginnings. But those who are bereaved, even many years ago, can be surprised when unexpectedly something triggers the twinges of the old grief. Those who are widows and widowers know the feeling.In the midst of the celebrations something touches off a memory and suddenly there is the sharp pain of missing the loved one. One's chest squeezes, one's throat chokes, and a few tears, or a waterfall of tears, seems to come out of nowhere. It could be in the grocery store, at a party, or driving by a familiar scene. Other people, who have not experienced deep bereavement and these waves of grief that well up unexpectedly, might wonder what t... The Caregiver's Beacon - Resources, Links, Ideas, News blogs http://www.medworm.com/rss/comments.php?id=3136735 Sat, 02 Jan 2010 03:00:00 +0100 3136735 http://www.medworm.com/index.php?rid=2876326&cid=t_100065_136_f&fid=39025&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Feverythingchangesbook%2F%7E3%2FbIC8OY6mMp4%2Fend-of-life-cancer “Are you going to write in your book about the people who died?  It is so depressing,” a person in the publishing world asked while I was writing Everything Changes.  My answer: a polite version of “You better f***ing believe I am.” How could I write a book about cancer and exclude the people who died and their families?  Yep, it has its sad moments, but that’s why cancer sucks.  That’s why we raise money for research.  That’s why I write a blog and wrote a book, and promote young adult cancer organizations: all so we can support each other around the pissy hard times. Charissa is an recent widow who I’ve become friends with.  She is an incredible woman who I adore.  (See her recent post Mourning As A Young Adult?)  And I love my regular communication wi... Everything Changes blogs http://www.medworm.com/rss/comments.php?id=2876326 Thu, 08 Oct 2009 15:44:32 +0100 2876326 http://www.medworm.com/index.php?rid=2523682&cid=t_100065_137_f&fid=35426&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTheAlzheimersReadingRoom%2F%7E3%2FEp4hrN9C_UI%2Fwhen-alzheimers-isnt-alzheimers-its.html You probably noticed by now that I write over and over, make sure you get a good personal care physician. It took me 4 tries to find the right person for my mother--she suffers from Alzheimer's disease. I forgot to mention the nurses.Eighteen years ago, my father was diagnosed with cancer. He passed away 11 months later.He had a wish--he wanted to die at home. My mother, and I, with a tremendous amount of help and support from Hospice gave him his wish.When my father was dying, I repeatedly tried to get information from the oncologist. I wanted to know what to expect, how things unfold, where we were in the cycle, and the patterns I could expect. He would never give me a direct answer.When the nurse from Hospice came on the scene, she answered all of my questions. She told me what to expec... Alzheimer's Reading Room, The blogs http://www.medworm.com/rss/comments.php?id=2523682 Wed, 24 Jun 2009 15:16:04 +0100 2523682 http://www.medworm.com/index.php?rid=2389719&cid=t_100065_87_f&fid=34825&url=http%3A%2F%2Fwww.wesleyjsmith.com%2Fblog%2F2009%2F05%2Firish-socialized-medicine-shortchanges.html Dying people in Ireland are having a hard time accessing vital hospice services under the country's socialized medical system. From the Story: TERMINALLY ill patients are being put on waiting lists for vital end-of-life care as a result of the State's long-term failure to adequately invest in hospice services. Figures released to the Irish Examiner show that on a single day last week, more than 130 people facing imminent death were told it could be weeks before they would be able to access a hospice due to a lack of resources.The figures, released by the Irish Hospice Foundation (IHF) ahead if its national fundraising day tomorrow, show on April 27 a total of 133 patients suffering from terminal cancer, renal and respiratory illnesses were told they could not immediately access the pain re... Secondhand Smoke blogs http://www.medworm.com/rss/comments.php?id=2389719 Wed, 06 May 2009 16:20:00 +0100 2389719 http://www.medworm.com/index.php?rid=2347912&cid=t_100065_87_f&fid=34825&url=http%3A%2F%2Fwww.wesleyjsmith.com%2Fblog%2F2009%2F04%2Ftelling-paramedics-not-to-resuscitate.html The UK is permitting terminally ill patients to be listed on a register so that they are not resuscitated by paramedics in the event of a medical emergency. From the story:Health Service paramedics have been told not to resuscitate terminally-ill patients who register on a controversial new database to say they want to die.It has been set up by the ambulance service in London for hundreds of people who have only a few months to live so that they may register their 'death wishes' in advance. It is believed to be the first in the country, but other trusts around the country are expected to follow suit to comply with Government guidelines which state that patients' wishes should be taken into account, even at the point of death. Similar plans exist here in the USA, and I'm not opposed to them... Secondhand Smoke blogs http://www.medworm.com/rss/comments.php?id=2347912 Sat, 18 Apr 2009 05:05:00 +0100 2347912 http://www.medworm.com/index.php?rid=2270320&cid=t_100065_87_f&fid=34825&url=http%3A%2F%2Fwww.wesleyjsmith.com%2Fblog%2F2009%2F03%2Fcompassion-and-choices-admits-to.html Compassion and Choices, the assisted suicide advocacy group, has admitted to undermining proper hospice care. That's not how they put it, of course. It brags that nearly 100% of Oregon assisted suicides last year--88% with which their representatives were involved--were in hospice. From the C and C press release:Compassion and Choices, the nation's largest advocate for end-of-life care and choices and steward of the Oregon Death with Dignity Act, today noted that nearly 100% of terminally ill individuals using the law in 2008 were enrolled in hospice. Hospice enrollment among those using the Act increased to 98%, with 59 of the 60 individuals enrolled. Over the prior 10 years of the Act's existence, 86% of patients using the Act were enrolled in hospice, in itself a very high rate of use.T... Secondhand Smoke blogs http://www.medworm.com/rss/comments.php?id=2270320 Mon, 16 Mar 2009 18:12:00 +0100 2270320 http://www.medworm.com/index.php?rid=2232374&cid=t_100065_87_f&fid=34825&url=http%3A%2F%2Fwww.wesleyjsmith.com%2Fblog%2F2009%2F03%2Fhospice-organization-reacts-to-fen.html The other day I posted about how a lawyer for one of the Final Exit Network defendants said that hospice is just assisted suicide in slow motion. This is dangerous demagoguery that could convince people not to seek the benefits that hospice can provide. The National Hospice and Palliative Care Organization has now issued a press release rebutting the baseless charge. From the release:"Hospice compassionately cares for people who are near the close of life--but hospice isn't about how you die, it's about how you live. Hospice and palliative care focuses on how dying persons and their loved ones live each day, providing comfort and guidance along the way," said J. Donald Schumacher, president and CEO of National Hospice and Palliative Care Organization. "The quote from that news article demo... Secondhand Smoke blogs http://www.medworm.com/rss/comments.php?id=2232374 Tue, 03 Mar 2009 18:54:00 +0100 2232374 http://www.medworm.com/index.php?rid=2177823&cid=t_100065_136_f&fid=36165&url=http%3A%2F%2Fpurpleride.blogspot.com%2F2009%2F02%2Ftoday.html Again thanks for all the kind comments and good wishes.Richard is not as well today. He's had trouble eating and is more sleepy. This may be a side effect of his last radiation treatment on the mass on his clavicle. He received a higher radiation dose on Friday since they cut the total number of treatments.It also may be from enlargement of the abdominal plasmacytoma. I wish I could accept these changes as they come and not speculate about cause or look for a solution. I'm a nurse...I want to fix it.I get so angry at times. I remember him as he was 10 or even 5 years ago and I want that man back.Nurses from Hospice came today and admitted Richard to their program. Right now we don't need too much from them, but the time will come, and everything is now in place for when their services are ... The Beast... blogs http://www.medworm.com/rss/comments.php?id=2177823 Wed, 11 Feb 2009 04:15:00 +0100 2177823 http://www.medworm.com/index.php?rid=1990729&cid=t_100065_109_f&fid=34730&url=http%3A%2F%2Fpsychiatrist-blog.blogspot.com%2F2008%2F11%2Fengage-with-grace-end-of-life.html Does your family know if you want to be put on a ventilator if needed?  Kept alive with i.v. fluids and nutrition? For how long?So you have a living will or advance directive?Can your family find it?It's a tough discussion to have, but even tougher to discuss when you have a feeding tube in your nose, a breathing tube in your throat, and are unconscious. So, while everyone's enjoying turkey at the table this week, someone bring up the topic so that everyone knows how aggressive to be if you are facing death. The website, Engage with Grace, can help.----- Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. (Source: Shrink Rap) Shrink Rap blogs http://www.medworm.com/rss/comments.php?id=1990729 Wed, 26 Nov 2008 20:00:00 +0100 1990729 http://www.medworm.com/index.php?rid=1990548&cid=t_100065_87_f&fid=34825&url=http%3A%2F%2Fwww.wesleyjsmith.com%2Fblog%2F2008%2F11%2Fnhs-meltdown-insufficient-training-in.html The NHS is collapsing from top to bottom. Now, we learn that its medical personnel have insufficient training in end of life care. From the story: Many terminally ill patients who want to die at home are being needlessly admitted to hospital, a public spending watchdog said on Wednesday. It said the majority of National Health Service doctors and nurses lack training in end-of-life care.The National Audit Office (NAO) said in a report that up to three quarters of people near the end of their lives had expressed a preference to die at home. But it said a lack of support services meant that many people died in hospital when there was no clinical reason for them to be there. "Dying people are often not being treated with the dignity and respect they deserve and their wishes are often disregar... Secondhand Smoke blogs http://www.medworm.com/rss/comments.php?id=1990548 Wed, 26 Nov 2008 17:20:00 +0100 1990548 http://www.medworm.com/index.php?rid=1975917&cid=t_100065_158_f&fid=36018&url=http%3A%2F%2Fcaregiversbeacon.blogspot.com%2F2008%2F11%2Fvideo-advance-healthcare-directives.html To have your healthcare wishes followed you need to have an Advance Healthcare Directive. Some people want to have as much medical care as possible if they are near the end of life, and others wish to have as little as possible. (Source: The Caregiver's Beacon - Resources, Links, Ideas, News) The Caregiver's Beacon - Resources, Links, Ideas, News blogs http://www.medworm.com/rss/comments.php?id=1975917 Wed, 19 Nov 2008 19:13:00 +0100 1975917 http://www.medworm.com/index.php?rid=1930323&cid=t_100065_136_f&fid=35300&url=http%3A%2F%2Fwww.metastaticlivercancer.org%2F2008-11-04-cancer-treatment%2Fstage-iv-colon-cancer%2F actually means Lisa’s father is dying…   Please give all your hugs, love, experience and support to Lisa.   Stage iv colon cancer story summarized   Lisa’s father underwent chemotherapy for colon cancer. The colon cancer metastized to his liver and the doctors stopped administering the chemotherapy drug Erbitux.   Immediately the chemotherapy effects subsided and all looked well again at first.   Now reality struck again as the pain in his abdomen begins to worsen.   Read Lisa’s father’s complete colon cancer story below.   I need someone to help me with some words of advice.   Please leave a comment if you have advice for Lisa.   First and foremost Lisa says:   I am so scared as to what I’ve read online a... Metastatic liver cancer blogs http://www.medworm.com/rss/comments.php?id=1930323 Tue, 04 Nov 2008 04:03:13 +0100 1930323 http://www.medworm.com/index.php?rid=1914745&cid=t_100065_136_f&fid=35300&url=http%3A%2F%2Fwww.metastaticlivercancer.org%2F2008-10-29-cancer-treatment%2Flesly-is-losing-the-love-of-her-life-to-metastatic-liver-cancer%2F Lesly shares how she is living the last days together with the only love of her live who is suffering with metastatic liver cancer. She left her condolences in a comment at Patrick’s post who very recently lost his father due to metastatic liver cancer.   Thanks to the cancer stories you leave on our blog, people that go the same path don’t have to walk it alone.   Thanks Lesly, Patrick and all others for contributing to this website and as such contributing to the life of others!   Like you say Lesly, love indeed is a beautiful thing. It gives the motivation to do the things needed to be done when you take care of your loved one.   51 is way too young to go I find, be it due to cancer or any other disease.   Cherish the precious time together as long a... Metastatic liver cancer blogs http://www.medworm.com/rss/comments.php?id=1914745 Wed, 29 Oct 2008 07:57:26 +0100 1914745 http://www.medworm.com/index.php?rid=1908860&cid=t_100065_136_f&fid=35300&url=http%3A%2F%2Fwww.metastaticlivercancer.org%2F2008-10-27-cancer-treatment%2Fwhat-do-you-say-to-man-who-is-going-to-die%2F Charlotte’s father’s cancer starts resisting the chemotherapy he gets to cure his colon cancer and secondary liver cancer. In here comment at More news from Trish - metastatic liver cancer survivor, she aks:   What do you say to man who is going to die?   How would you answer that question? Please leave a comment.   When father diagnosed with metastatic liver cancer we were shocked but upbeat and kept talking about finding a cure.   But when after a few days of more tests, biopsy and scans the oncologist said that chemotherapy would most likely kill my father, we just became all very silent. Exactly, what do you say now?   We never found the right words to put father’s mood back to where it was. All we did was managing to put a smile on his fac... Metastatic liver cancer blogs http://www.medworm.com/rss/comments.php?id=1908860 Sun, 26 Oct 2008 16:00:56 +0100 1908860 http://www.medworm.com/index.php?rid=1798248&cid=t_100065_140_f&fid=35448&url=http%3A%2F%2Fseemedlikeagoodideathetime.com%2F2008%2F09%2F16%2Fshe-heals-the-hospice-dwellerssuicidal-people-and-more%2F AMAZING…She heals people on their death beds in hospices! Plus….aids, TB, and most amazing..ta da…suicidal people! Girls, I think we are seeing the very first video of Xenu. Check out the speech interpreter in the back ground! Bwahahahaha But, this one is my all time favorite….. CURSING PREACHER (and I do mean CURSING) Whaddya think of this, BIOTCHES? LMAO [...] (Source: bipolar chicks blogging) bipolar chicks blogging blogs http://www.medworm.com/rss/comments.php?id=1798248 Wed, 17 Sep 2008 02:55:36 +0100 1798248 http://www.medworm.com/index.php?rid=1794471&cid=t_100065_136_f&fid=35300&url=http%3A%2F%2Fwww.metastaticlivercancer.org%2F2008-09-16-cancer-treatment%2Fone-caregiver-is-never-enough-patricks-father-has-metastatic-liver-cancer%2F Patrick is scared for what is to come… Patrick’s story below (commented at Can chemotherapy cure metastatic liver cancer?) feels like he is telling our story with our father, our fears included …   We will share what we did in the hope, Patrick, you can gain some much needed strength out of it.   Get as much care givers as possible   Rule number 1 is that your father needs a person 24/7 who only takes care of father’s need. This would be the ideal situation.   As you can understand, one person can never-ever give 24/7 support. So you need to find as much people to help you as possible and as much help as possible.   When people wanted to visit father I told them:   if you have a pot of thick, healthy homemade soup ready, just bring, s... Metastatic liver cancer blogs http://www.medworm.com/rss/comments.php?id=1794471 Tue, 16 Sep 2008 04:40:29 +0100 1794471 http://www.medworm.com/index.php?rid=1720412&cid=t_100065_136_f&fid=35300&url=http%3A%2F%2Fwww.metastaticlivercancer.org%2F2008-08-21-cancer-treatment%2Fnew-metastatic-liver-cancer-treatment-chocolate%2F Eclairs covered with lots of chocolate was father’s new cancer treatment as in …a treat that brought a smile on father’s face!   Love is the best medicine!   Love doesn’t cure cancer and for sure chocolate is not a treatment for metastatic liver cancer. But love is the best foundation to give the much needed care a terminal cancer patient needs.   Parents love their children and devote lots and lots of their time and energy in raising their kids. The same effort will be needed when you are taking care of a loved one with cancer.   With kids, parents have a dream that they will end up like this or that… when talking about secondary liver cancer your dreams are on hold. The reality is that non of the metastatic liver cancer stories we gathere... Metastatic liver cancer blogs http://www.medworm.com/rss/comments.php?id=1720412 Thu, 21 Aug 2008 03:09:13 +0100 1720412 http://www.medworm.com/index.php?rid=1671484&cid=t_100065_111_f&fid=34712&url=http%3A%2F%2Fdigitaldoorway.blogspot.com%2F2008%2F07%2Fgraduating-from-hospice.html "So, my supervisor asked me to let you know that since you're doing so well, you'll be 'graduating' from hospice in two weeks. We're sorry, but we have to discharge you from our service."I watched his face for his reaction to the news."Wow," he said. "I had no idea that was gonna happen. Do I really have to be discharged?""Well, based on the relatively strict guidelines, I'm afraid so. Your breathing is better, your kidney function has improved, your appetite is steady, you've gained ten pounds, and you're getting out of the house almost every day. Medicare has very strict criteria for being on hospice, and you no longer meet the criteria. I know it's scary," I continue, "but you have your family nearby, and your doctor agrees that you're doing amazingly well.""Yeah. I have to admit, I'm f... Digital Doorway blogs http://www.medworm.com/rss/comments.php?id=1671484 Wed, 30 Jul 2008 06:45:00 +0100 1671484 http://www.medworm.com/index.php?rid=1618033&cid=t_100065_111_f&fid=34712&url=http%3A%2F%2Fdigitaldoorway.blogspot.com%2F2008%2F07%2Fnotes-on-hospice-gift-of-death-at-home.html He lay there in the bed, feet extended in permanent contractures, arms curled at his chest, immobile. Ulcers burrow deep into various parts of his body: sacrum, hip, elbow, shoulder, right ear. He is non-verbal, eyes intermittently open, but what---or if---he sees is up for conjecture.At this point of the end of life process, there are no more fluids being given, and no more food. Morphine is delivered via a pump that sits on the bed-side table like a silent sentinel. A small needle is inserted under the skin in a part of the body where there is still some semblance of subcutaneous fat. Once there is absolutely no fat left, this mode of delivery may not work as well.A "rattle" is now heard in the chest as fluid builds up in the lungs. One really needs no stethoscope to know what's going on... Digital Doorway blogs http://www.medworm.com/rss/comments.php?id=1618033 Mon, 14 Jul 2008 02:35:00 +0100 1618033 http://www.medworm.com/index.php?rid=1535723&cid=t_100065_111_f&fid=34712&url=http%3A%2F%2Fdigitaldoorway.blogspot.com%2F2008%2F06%2Funions-and-confusion.html My new per diem position as a hospice nurse with a local visiting nurse agency entails mandatory membership in a union, the first time I have ever needed to join a union. I am woefully unprepared (and ignorant) when it comes to union issues, and I imagine that my education in this area may provide some fodder for writing as time goes on.Interestingly, the union in my new workplace has been in contract negotiations with my employer for ten months, the last contract expiring in August of 2007. Just yesterday, after a less than a half day of orientation, I was allowed to go home 90 minutes early, and only today I learned that a picket line formed in front of the office not one hour after I had left for home. Was I purposefully sent home so that I wouldn't see the picket line? Did my boss want... Digital Doorway blogs http://www.medworm.com/rss/comments.php?id=1535723 Sat, 21 Jun 2008 01:26:00 +0100 1535723 http://www.medworm.com/index.php?rid=1525934&cid=t_100065_87_f&fid=34825&url=http%3A%2F%2Fwww.wesleyjsmith.com%2Fblog%2F2008%2F06%2Fnot-telling-patients-when-their-time.html Apparently many doctors don't tell cancer patients when they enter the terminal stage of the disease. From the story:Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care. Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died.The story proceeds to inaccurately describe AB 2747 as being about making sure people are told when they are dying when its real purpose is to open the door to backdoor assisted suicide via dehydration and terminal sedation, and thereby corrupt palliat... Secondhand Smoke blogs http://www.medworm.com/rss/comments.php?id=1525934 Tue, 17 Jun 2008 14:25:00 +0100 1525934 http://www.medworm.com/index.php?rid=1492032&cid=t_100065_111_f&fid=34712&url=http%3A%2F%2Fdigitaldoorway.blogspot.com%2F2008%2F06%2Fthinking-about-hospice.html Contemplating yesterday's post from Sogyal Rinpoche, a Tibetan Buddhist master and teacher, I am considering my new position as a hospice nurse for which I will begin orientation quite soon. Hospice truly is about the alleviation of suffering when curing has ceased and caring holds sway.As the individual and his or her family make the choice to no longer pursue treatment, the job of hospice is to provide unfettered symptom management and pain relief as the patient moves towards death. Hospice is also about the care of the family and caregivers. Caring for a person who is evolving towards death can be an exhausting and overwhelming experience, and it is the responsibility of the hospice team to ascertain the family's level of coping, working to alleviate their suffering to whatever extent i... Digital Doorway blogs http://www.medworm.com/rss/comments.php?id=1492032 Wed, 04 Jun 2008 12:27:00 +0100 1492032 http://www.medworm.com/index.php?rid=1467835&cid=t_100065_111_f&fid=34712&url=http%3A%2F%2Fdigitaldoorway.blogspot.com%2F2008%2F05%2Fhospice-and-palliative-care-new.html I have accepted a per diem position with a local visiting nurse agency which provides both palliative care and hospice care to people in our region. Since I became a nurse in 1996, I have worked in the urban areas which are located just under an hour from our home. I have always commuted elsewhere to work, and subsequently have never provided nursing care here in my own county.For several reasons, I am quite excited about this position. For one, I will actually be able to see patients in and around the town where we live, as well as in neighboring towns and counties, some of which are quite lovely and bucolic. Making home visits in our area---rather than in the down-and-out city---will be a novel and welcome experience, and I look forward to not necessarily having to deal so much with drug... Digital Doorway blogs http://www.medworm.com/rss/comments.php?id=1467835 Mon, 26 May 2008 10:54:00 +0100 1467835 http://www.medworm.com/index.php?rid=1419627&cid=t_100065_87_f&fid=34825&url=http%3A%2F%2Fwww.wesleyjsmith.com%2Fblog%2F2008%2F05%2Fwhy-does-our-government-keep-attacking.html Back during the Clinton Administration, federal bureaucrats launched a devastating assault on hospice--called "Operation Restore Trust"--in which the Feds presumed that a patient who did not die within 6 months of entering hospice was there fraudulently, and as a consequence, demanded tens of millions in refunds from hospice programs throughout the country. I was a hospice volunteer at the time and saw the devastating effect: My last patient, who was dying (and died) of ALS--was tossed out on his ear because he had unexpectedly survived 18 months. The chilling effect placed on the entire hospice movement by Operation Restore Trust continues to this day--along with the suffering it causes.Well now, the government under President Bush is at it again: This time they seek to cut hospice paymen... Secondhand Smoke blogs http://www.medworm.com/rss/comments.php?id=1419627 Mon, 05 May 2008 02:56:00 +0100 1419627 http://www.medworm.com/index.php?rid=1364991&cid=t_100065_137_f&fid=35352&url=http%3A%2F%2Fyellowwallpaper.net%2Fblog1%2F2008%2F04%2F10%2Fhospice%2F My mother seems to have moved into a twilight place.  She is eating less and less, and sleeping almost all day.  The staff at Garden Manor are wonderful, as is Hospice.  She is always dressed (which must be an ordeal, since she can’t even stand up on her own) and someone has painted her nails and curled her hair.   She is usually sitting in one of the recliners in the common area, which makes me feel better.  I had once fantasized that I would take her home when this time came, but I would not be able to take care of her the way they do. I feel like I’m dreaming.  It’s such a cliché, but that’s the way it feels.  I have spells when I question our decision to call Hospice.  But I’ve come to the conclusion that NOT calling Hospice is a decision, too.  My mother left an advanc... The Yellow Wallpaper blogs http://www.medworm.com/rss/comments.php?id=1364991 Thu, 10 Apr 2008 21:38:42 +0100 1364991 http://www.medworm.com/index.php?rid=1296185&cid=t_100065_158_f&fid=36018&url=http%3A%2F%2Fcaregiversbeacon.blogspot.com%2F2008%2F03%2Fspiritofcaringcom-plans-fundraisers-for.html At SpiritsofCaring.com you can read about the caring people who are raising money to make a difference for Hospice Partners of San Luis Obispo, the Women's Shelter of San Luis Obispo, and the Central Coast Seniors Center. Spirits of Caring is a component of the Center for Creative Thought, located at the Central Coast Seniors Center.The two part fundraiser will include the following.1. Saturday, August 2, 2008 there will be a Tri Tip BBQ, a Creative Auction, Entertainment and Live Music and Door Prizes at the Central Coast Seniors Center.2. Saturday Nov. 15, 2008, there will be a Raffle, Live Music, and a salad luncheon, also at the Central Coast Seniors Center. (Source: The Caregiver's Beacon - Resources, Links, Ideas, News) The Caregiver's Beacon - Resources, Links, Ideas, News blogs http://www.medworm.com/rss/comments.php?id=1296185 Tue, 11 Mar 2008 23:36:00 +0100 1296185 http://www.medworm.com/index.php?rid=1237756&cid=t_100065_111_f&fid=34712&url=http%3A%2F%2Fdigitaldoorway.blogspot.com%2F2008%2F02%2Fat-hospice.html "There always is an answer," he says, as I spear some pasta bowties and hand him the fork. "I just don't know what it is." I hand him another forkful of food---chicken this time---and he eats it with relish, relinquishing the fork only when he has licked every bit of sauce from the four long prongs. His puzzled mind seizes on one thought, and then the fork and its contents become his universe once again.I visit another patient in her room, not having seen her for several weeks. "So, what's new?" I ask, as I sit on the edge of the bed. "Nothing that's good," she replies with a sigh. "Can I get you anything?" She reaches out her hand. "Just some black coffee and ice water. That's all." She's lonely, but chooses solitude as her health continues to decline, staying in her room throughout the d... Digital Doorway blogs http://www.medworm.com/rss/comments.php?id=1237756 Sun, 17 Feb 2008 17:41:00 +0100 1237756 http://www.medworm.com/index.php?rid=1233299&cid=t_100065_137_f&fid=35357&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FAlzheimersNotes%2F%7E3%2F235388125%2F I’d heard about “Hospice help” but never knew much about it until my mother-in-law was in a coma before her death.  The nurse in charge of Mum’s care at the hospital introduced us to the Hospice representative.  From there we learned how much help they could be in a family member’s final days.  They helped us make arrangements. They cared for Mum so she could return to the nursing home for her last few days. They were there to comfort the family and answer questions. They also were available to offer help after Mum’s death. Recently I learned that: AGIS.com has partnered with the Hospice Foundation of America (HFA) to offer expert advice and information on end-of-life issues for caregivers. This new addition to the AGIS eldercare portal showcase... Alzheimer's Notes blogs http://www.medworm.com/rss/comments.php?id=1233299 Fri, 15 Feb 2008 06:00:21 +0100 1233299 http://www.medworm.com/index.php?rid=1184660&cid=t_100065_111_f&fid=34712&url=http%3A%2F%2Fdigitaldoorway.blogspot.com%2F2008%2F01%2Fwhen-cancer-spreads-its-wings.html Cancer insidiously spreads itself into remote corners of the body, with greedy fingers reaching out where it is most unwanted. With unmatched stealth, it manages to send pieces of itself to distant organs through avenues of lymph or blood. And strangely enough, even if the cancer originated in the lungs, any distant metastasis will always show microscopic signs of its organ of origin if a scientist or doctor cares to check. So, if a brain cancer eventually lodges itself into the femur or spine, there are cellular markers that will actually brand that metastasis as originating in the brain. It's like a postmark by the cancer post office which delivers nauseating information of its original port of entry.As the cancer nudges its way into various body systems and organs, it chokes off blood s... Digital Doorway blogs http://www.medworm.com/rss/comments.php?id=1184660 Tue, 29 Jan 2008 07:17:00 +0100 1184660 http://www.medworm.com/index.php?rid=1184661&cid=t_100065_111_f&fid=34712&url=http%3A%2F%2Fdigitaldoorway.blogspot.com%2F2008%2F01%2Fof-hospice-and-free-agency.html Life as a (per diem) hospice nurse has certainly altered what (some of) my workdays can be like. Instead of answering to the unending demands of more than eighty needy patients as a care manager, I now answer to the rather predictable needs of no more than six residential patients.What is unusual about my hospice work is that, during any given shift, one nurse and one home health aide must not only provide direct care to six patients in varying states of illness, including medications, bathing, treatments, dressings, and toileting. We are also responsible for preparing meals, cleaning up after meals, feeding patients who need to be fed, doing laundry, answering phones, taking out trash and recycling, and doing general housekeeping. If it sounds like a lot, it is, and I often feel that I am... Digital Doorway blogs http://www.medworm.com/rss/comments.php?id=1184661 Tue, 29 Jan 2008 02:46:00 +0100 1184661 http://www.medworm.com/index.php?rid=1106392&cid=t_100065_158_f&fid=36018&url=http%3A%2F%2Fcaregiversbeacon.blogspot.com%2F2007%2F12%2Fchristmas-and-bereavement.html Coping with the loss of a loved one and with holidays at the same time can be one of the most isolating and painful situations. While red bows and words of joy are part of the decorations everywhere, the grieving person feels many mixed emotions. People who are bereaved can feel pain over loss, sometimes guilt over being here without the loved one, relief that someone is no longer suffering, and isolation from the cheerful shoppers and festive music and events. It can be a roller coaster emotionally.Hospice all over America provides workshops as the holidays are coming up to help bereaved people cope. There are grief groups for every type of loss. In a typical group each member might introduce herself or himself, and describe the loss and the loved one. Facilitators from Hospice provide gu... The Caregiver's Beacon - Resources, Links, Ideas, News blogs http://www.medworm.com/rss/comments.php?id=1106392 Wed, 19 Dec 2007 21:02:00 +0100 1106392 http://www.medworm.com/index.php?rid=1097640&cid=t_100065_111_f&fid=34712&url=http%3A%2F%2Fdigitaldoorway.blogspot.com%2F2007%2F12%2Fdeath-in-afternoon.html This afternoon, I worked my second orientation shift at a residential hospice where I have been hired as a per diem hospice nurse. Situated not far from where I live, working in such a small and homey environment with no more than six patients at a time is a far cry from my usual work as a Nurse Care Manager for the poorest of the poor in the inner city. (More on that upcoming career transition in subsequent posts.)As a nursing student, hospice work was my stated career goal, and although I have not actually worked for a hospice organization per se, I have coordinated and taken part in hospice care for a number of my patients over the years. As a visiting nurse, terminal patients would often remain on our service, with family members or an automatic pump administering morphine around the c... Digital Doorway blogs http://www.medworm.com/rss/comments.php?id=1097640 Sat, 15 Dec 2007 16:16:00 +0100 1097640 http://www.medworm.com/index.php?rid=1019483&cid=t_100065_158_f&fid=36018&url=http%3A%2F%2Fcaregiversbeacon.blogspot.com%2F2007%2F11%2Fnational-home-care-and-national-hospice.html November is National Home Care and National Hospice Month, and an article at Medical News Today says that over "7.5 million American's receive daily assistance from nearly one million caregivers." Val Halamandaris, president of the National Association for Home Care and Hospice, says , "Dedicated people spend their days taking care of those who can no longer care for themselves, making them silent heroes who should be recognized and thanked all year round."The article, dated November 9, 2007, provides tips to help family members know when it's time to get help from Home Care or Hospice.It also provides questions to ask when choosing a home care provider.At the home page for the National Association for Home Care and Hospice you will find information on legislation, caregiving, education, a... The Caregiver's Beacon - Resources, Links, Ideas, News blogs http://www.medworm.com/rss/comments.php?id=1019483 Mon, 12 Nov 2007 00:16:00 +0100 1019483 http://www.medworm.com/index.php?rid=1013536&cid=t_100065_158_f&fid=36018&url=http%3A%2F%2Fcaregiversbeacon.blogspot.com%2F2007%2F11%2Fcaregivers-who-are-grieving-can-turn-to.html In 1996 when my husband died from cancer, I was not aware of the many types of bereavement groups, educational activities, and counseling that are available from Hospice. Today, I'm very familiar with our local Hospice in San Luis Obispo , California, both from my own experience and from my work.Family members, caregivers and friends who are grieving can go to the website for the Hospice Foundation to locate a Hospice nearby for grief support. Hospice of San Luis Obispo County is located at 1304 Pacific Street, San Luis Obispo, CA 93401, and the phone number is (805) 544-2266 or (805) 434-1164. The website is at hospiceslo.org.The variety of grief support programs range from special events to prepare for getting through the holidays without a loved one, to multi-cultural events such as Dia... The Caregiver's Beacon - Resources, Links, Ideas, News blogs http://www.medworm.com/rss/comments.php?id=1013536 Thu, 08 Nov 2007 03:07:00 +0100 1013536 http://www.medworm.com/index.php?rid=985816&cid=t_100065_117_f&fid=34612&url=http%3A%2F%2Fwww.thedoctorweighsin.com%2Fjournal%2F2007%2F10%2F28%2Fmore-sick-children-are-dying-at-home-at-that-is-a-good-thing.html by Pat SalberIt is always unbearably sad to learn about a child's death.  But for families with children living with complex chronic conditions, such as progressive neuromuscular diseases or cancer, it is something they must be prepared to deal with.   The miracles of modern medicine simply cannot cure every serious childhood illness.  Given that, what do we know about where these children die?  A recent study, led by Chris Feudtner, MD, PhD, MPH and colleagues, published in JAMA (June 27, 2007) documented that increasingly these children are dying at home instead of in the hospital - and I believe that is a good thing, allowing both the child and loved ones the comfort and privacy we all want to have at the end of life.  Advances in techno... The Doctor Weighs In blogs http://www.medworm.com/rss/comments.php?id=985816 Sun, 28 Oct 2007 18:56:32 +0100 985816 http://www.medworm.com/index.php?rid=835597&cid=t_100065_158_f&fid=36018&url=http%3A%2F%2Fcaregiversbeacon.blogspot.com%2F2007%2F08%2Fwhen-caring-for-someone-on-hospice.html Caregivers who are taking care of someone who is a Hospice patient at home can telephone the Hospice nurses to ask questions about care, to provide updates, and to ask for recommendations or suggestions. The Hospice nurses are compassionate and supportive, and caregivers can turn to them for help.Often the Hospice nurses advise or train the caregiver in how to perform procedures such as helping to put someone in a comfortable position, helping a patient ambulate on a walker as safely as possible, or how to carry out other procedures when the nurses are not there.The booklets, handouts, and written material that Hospice brings to the home can be reference guides for the caregiver, and I always try to study the material to see if there is anything else I can do to make the patient more comfo... The Caregiver's Beacon - Resources, Links, Ideas, News blogs http://www.medworm.com/rss/comments.php?id=835597 Fri, 31 Aug 2007 23:35:00 +0100 835597 http://www.medworm.com/index.php?rid=800027&cid=t_100065_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=761451&cid=t_100065_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=654382&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F06%2Faahpm-vs-other-specialty-meetings-shm.html I had the pleasure to give a talk at the Society for Hospital Medicine (SHM) Annual Meeting in Dallas Texas last Friday, and it was very interesting for me because it was the first non-hospice/palliative medicine national meeting I had visited. The SHM is celebrating ten years in business as the group representing hospitalists, a fast emerging field of physicians. Now the AAHPM has been operating since 1988, and so I thought it would be interesting to compare the two groups and see how far they have come.Society of Hospital MedicineMembers: ?Founded: 1997# of practicing Hospitalists (2003): >8000 # of Hospitalists Groups (2003): >1800Fellowships (non-ACGME): 13 Int Med, 4 Fam Med, 4 PediatricAnnual Meeting Attendance (est by me): 1500Estimated Intensity of Pharma Sponsorship at Annual Meet... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=654382 Sat, 02 Jun 2007 06:25:00 +0100 654382 http://www.medworm.com/index.php?rid=650903&cid=t_100065_87_f&fid=34865&url=http%3A%2F%2Fwww.thecancerblog.com%2F2007%2F05%2F31%2Ftammy-faye-wont-let-cancer-get-her-down%2F Filed under: Lung Cancer, Colon and Rectal Cancer, Hospice, Daily news, Celebrity newsOn May 8, Tammy Faye Messner (formerly Bakker), announced that doctors had stopped treating her cancer, that her fate was in the hands of a higher power. Last night, I heard Tammy Faye's voice on television as she spoke to Entertainment Tonight reporters about the state of her health right now.Tammy Faye's colon cancer, diagnosed in 1996, has spread to her lungs and is causing her severe pain. Her back hurts, she said, and her stomach hurts and she is having difficulty breathing. Still her message is loud and clear: she is not giving up.When doctors told her there was nothing more they could do, Tammy Faye, 65, said she felt sorry for herself for about one minute. Then she reminded herself there is someth... The Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=650903 Thu, 31 May 2007 04:00:00 +0100 650903 http://www.medworm.com/index.php?rid=644749&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F05%2Fprognosis-links.html Here is a listing of many online resources for prognostication near the end-of-life. This post is made after a request from a audience member at a talk I gave recently on Evidence-Based Prognostication. My plan is to update these links and qualify them over the next several weeks. Please feel free to add more in the comments section or email them to me.The following links are for medical use only (i.e. they are not party tricks!). They should be used as guidelines to help understand the inherent uncertainty of the probability of medical outcomes. Before using any of these tools, you should be familiar with the validation and data sets. Pallimed and Christian Sinclair or his employers are not responsible for any medical outcomes based on these links. Please discuss these results with a medi... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=644749 Wed, 30 May 2007 16:00:00 +0100 644749 http://www.medworm.com/index.php?rid=611633&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F05%2Ftopical-methodone-hispanics-hospice.html 1) This last Monday I gave a talk to our palliative medicine fellowship program about topical and transdermal medication in palliative care. While I am generally not a big fan of topical/compounded medications (because of a general lack of efficacy research or basic science studies for many), I did come across a case series of 4 patients who received topical methadone for open wound pain management. I have worked with morphine gel before with mixed success, but never tried a different opioid. In 2005, Romayne Gallagher, MD, CCFP and colleagues mixed methadone and Stomadhesive powder and sprinkled it in the wound. 3 patients had dementia, and the patients could not use pain scales, so the staff rated their pain. (Obviously a weak part of the study) Now this was not successful in all cases w... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=611633 Thu, 10 May 2007 03:32:00 +0100 611633 http://www.medworm.com/index.php?rid=587328&cid=t_100065_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=563573&cid=t_100065_87_f&fid=34865&url=http%3A%2F%2Fwww.thecancerblog.com%2F2007%2F04%2F23%2Fcongresswoman-millender-mcdonald-dies-of-cancer%2F Filed under: Politics, Hospice, Daily newsCalifornia Democratic Rep. Juanita Millender-McDonald, subject of an April 20 post, died of cancer early Sunday. She was 68. if(window.yzq_d==null)window.yzq_d=new Object(); window.yzq_d['YlkINtGDJGY-']='&U=13bf48if4%2fN%3dYlkINtGDJGY-%2fC%3d571921.10592332.11211305.1442997%2fD%3dLREC%2fB%3d4495406'; <img width=1 height=1 alt="" src="http://us.bc.yahoo.com/b?P=b4WTcUWTVvr8OjckQD.BAxE.GKrAiEYsAl4ACPHo&T=1dor6uhuu%2fX%3d1177289310%2fE%3d8903239%2fR%3dnews%2fK%3d5%2fV%3d2.1%2fW%3dH%2fY%3dYAHOO%2fF%3d1313552715%2fH%3dY2FjaGVoaW50PSJuZXdzIiBjb250ZW50PSJjYW5jZXI7aG9tZTtIb3VzZTtEZW1vY3JhdGljO0JlYWNoO2l0O1JlcHVibGljYW47bHVuZztlbWVyZ2VuY3k7ZWxlY3Rpb247dGF4ZXM7Y2hpbGRyZW47V2FzaGluZ3RvbjtyZWZ1cmxfdXNfZjUyNl9tYWlsX3lhaG9vX2NvbSIgcmVmdXJsPSJ... The Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=563573 Mon, 23 Apr 2007 04:00:00 +0100 563573 http://www.medworm.com/index.php?rid=548570&cid=t_100065_87_f&fid=34865&url=http%3A%2F%2Fwww.thecancerblog.com%2F2007%2F04%2F17%2Fthe-clouds-parted-and-the-rain-fell%2F Filed under: Liver Cancer, HospiceMy friend's husband lost his mother to liver cancer during the wee hours of Sunday morning. He had traveled with his family from Ohio to Florida expecting to take his mom home with him so she could spend her last months where she once lived. Steve never got to take his mom home. She died just days after he landed in Florida. Still, I am confident he won't return to Ohio empty-handed. His positive and healthy perspective on losing his mom will surely keep him company.I got to see Steve and Kim -- my very best friend whose bouncy ringlets I envied long before I got my own post-chemotherapy curls -- on the same day Steve's mom died. They needed to get away and wanted a distraction for their two small children.I am honored to have been chosen as my friends' de... The Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=548570 Tue, 17 Apr 2007 04:00:00 +0100 548570 http://www.medworm.com/index.php?rid=547258&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F04%2Falvimopan-end-stage-heart-failure-other.html 1)Medscape is reporting that alvimopan (an investigational drug for opioid-induced constipation) caused a small increase in heart attacks in one of its phase III trials ( 1.1% of patients with placebo vs. 2.6% with alvimopan had cardiovascular events). The FDA is apparently reviewing things. Alvimopan, along with methylnaltrexone, has been one of the much hoped for up & coming agents for opioid constipation (and potentially other side effects), so we'll see where this leads. That magnitude of increase in CV events is similar to many other drugs which have remained on the market (newer antipsychotics come to mind)--the FDA will have to decide if the added benefit of this new drug will be worth the risks....(Medscape articles are available free if you sign-up.)2)Heart has a review of the man... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=547258 Mon, 16 Apr 2007 15:48:00 +0100 547258 http://www.medworm.com/index.php?rid=537779&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F04%2Fproxies-single-fraction-radiotherapy.html Several things, relatively briefly:1)The latest JCO has a couple of articles to note. First presents some research looking at if female cancer patients identify different individuals as their health care proxies and primary caregivers. It is from a survey of older women with cancer and finds that only about half of them name the same person to be their health care proxy decision maker, emergency contact, as well as their primary support person/caregiver. This finding was true even for women in partnered relationships. The second is a systematic review of radiotherapy for analgesia of painful bone metastases, specifically looking at single vs. multiple fraction radiotherapy. It confirms the consensus: they are about equally effective in providing analgesia, toxicity is about the same, but p... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=537779 Wed, 11 Apr 2007 00:51:00 +0100 537779 http://www.medworm.com/index.php?rid=533920&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F04%2Fend-of-life-care-in-blogosphere.html This study has been highlighted by many to focus on the over utilization of "limited" resources near the end of life. His post is insightful and candid and a call for how do we fix the mismatch of technology and goals of care in health care. Feel free to check it out and post your comments and opinions. Not every day you get to tell a CEO of a hospital what you think.2) The Wall Street Journal has started a health blog that has been pretty good, although it focuses a bit too much on pharma for my tastes. They recently highlighted a Boston Globe article noting that not all bed sores are preventable. I think this is something most health care people know, but as we see more decubiti we are learning more about how complex they really are. There is no new definitive study that prompted this a... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=533920 Tue, 10 Apr 2007 03:06:00 +0100 533920 http://www.medworm.com/index.php?rid=492197&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F03%2Fdo-not-hospitalize-orders-honesty.html 3 things:1)The latest Journal of the American Geriatrics Society has an article on factors associated with 'do not hospitalize' orders in demented nursing home patients. It involved a nation-wide (U.S.) sample of patients (~90,000) and used minimum data set data. Overall 7% of demented NH residents had DNH orders (wide range--0.7% in Oklahoma and over 25% in Rhode Island). Things that were associated with having a DNH order included increased age, being white, being in an urban NH with a wealthier patient mix, being on a special dementia unit, being in a NH with an NP or PA on staff, and having a living will and health care power of attorney. The percent of your NH's patients receiving hospice care was not associated with having a DNH order although being in an area in which fewer NH pat... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=492197 Fri, 23 Mar 2007 00:58:00 +0100 492197 http://www.medworm.com/index.php?rid=474466&cid=t_100065_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=474467&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F03%2Fshortage-of-oncologists-what-about.html The US media has been hot on the article out of the Journal of Oncology Practice by Erikson yesterday about the forecasted shortage of oncologists. The study was well done and should be replicated by many disciplines, including hospice and palliative medicine, but since I don't have the time to write that article I will do a hastily written, poorly designed, non-blinded, utterly biased, uncontrolled case report of my opinion.First looking at the JOP study (available free, so you don't have to rely on NBC news or USA Today to get your facts.), they looked at the following numbers*:Existing Oncologists: 10,000Annual Graduation of Fellows: 500 from 250 programs2005 Capacity of Oncology Visits: 42 million2020 Expected Demand of Oncology Visits: 65 million2020 Expected Capacity of Oncology Visi... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=474467 Thu, 15 Mar 2007 04:05:00 +0100 474467 http://www.medworm.com/index.php?rid=463973&cid=t_100065_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=463974&cid=t_100065_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=463980&cid=t_100065_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=463988&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F02%2Fny-times-on-open-access-hospice.html NY Times has a positive article about "open-access" model hospices. (For those of you not familiar with this it is a model where hospices provide/pay for costly and even disease-modifying treatments like chemotherapy, hospitalizations, etc.) Most interesting, to me, is that it seems several private insurers are trialling open-access in an effort to increase the number of hospice enrollees and lengthen hospice length of stay (one also hopes they are planning on publishing their findings on enrollment, LOS, cost, and patient/family satisfaction).Open-access is not without criticism, much of it about cost of course but also about it changing the nature (or at least the flavor) of hospice. Instead of opining on that I think I'll do my taxes instead and let commenters share their thoughts.(Mult... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463988 Sat, 10 Feb 2007 19:58:00 +0100 463988 http://www.medworm.com/index.php?rid=463991&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F02%2Fcongressman-to-seek-hospice-and-young.html Charlie Norwood, a congressman from Georgia, had a press release yesterday that he is foregoing further treatment for his NSCLC. He is a 7-term Republican who is not resigning his seat, and has said in some new reports that he may consider further treatment if he becomes better. The press release states that he will also receive 24-hour nursing care at his home.I am glad to see the public mention of hospice care for public figures. I always have wondered when you hear about a famous person dying at home if they had hospice services or if they were able to hire their own nurses and physicians to come and visit them. I wished that the hospice philosophy could benefit from more public mentions like this and Art Buchwald.(Although it should be noted that 24-hour in-home nursing care is not par... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463991 Fri, 09 Feb 2007 03:53:00 +0100 463991 http://www.medworm.com/index.php?rid=463981&cid=t_100065_116_f&fid=34686&url=http%3A%2F%2Fwww.pallimed.org%2F2007%2F01%2Fprostitutes-for-hospice-patient-some.html Well if you are not regularly reading this blog (you should be if you are in hospice or palliative medicine...), I figure I can at least get your attention if I put 'sex' in the title of the post.The Oxford Mail (UK) reports on a recent complicated case at the Douglas House, the world's first hospice designed specifically for young adults. A 22 year old resident suffering from Duchenne's Muscular Dystrophy wanted to have sex before he died. His solution was to find a prostitute since his prospects at developing a loving relationship in such a short amount of time to have a meaningful sexual encounter was unlikely given his condition. He brought his request to the staff and they debated in their ethics committee whether or not they should honor his request. The debate centered on providing ... Pallimed: A Hospice & Palliative Medicine Blog blogs http://www.medworm.com/rss/comments.php?id=463981 Sat, 27 Jan 2007 04:00:00 +0100 463981 http://www.medworm.com/index.php?rid=470308&cid=t_100065_109_f&fid=34730&url=http%3A%2F%2Fpsychiatrist-blog.blogspot.com%2F2006%2F12%2Fmy-three-shrinks-podcast-1.html So we finally did our first podcast after talking about it for a month. It's about 25 minutes long and can be found here [this link didn't work using Firefox...I'm working on it fixed]. We couldn't use Shrink Rap for the name, as DrDave is already using it for his psychology interview-type podcast, ShrinkRapRadio. So we came up with this title, My Three Shrinks, with surprisingly little discussion. (Wife prefers the name, Shrinky Dinks, but that makes me feel a bit emasculated. Don't go there.) Yes, the theme is ripped from the 1960's TV sitcom, My Three Sons, even down to the re-done logo and theme song (Clink wanted us to do Put Down the Duckie, but it just didn't seem to fit in well... maybe in a later one.) Can you figure out which shrink is which? So, here are the show notes for the ... Shrink Rap blogs http://www.medworm.com/rss/comments.php?id=470308 Mon, 04 Dec 2006 05:44:00 +0100 470308