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Mandated Queries of the Florida Prescription Drug Monitoring Program: Early Experiences from a Cancer Center-based Outpatient Palliative Medicine Clinic
This article describes our e xperiences in the first month of experience with the new law, although we plan to examine queries for a total of three months before closing this QI project.For the purpose of this QI project, we have documented patients ’ demographics, including each patient’s age, gender and limited identifying information, such as patient names and identification numbers; this data will be de-identified for any statistical analysis planned in the future. We also recorded patients’ main diagnosis and pain symptoms, the numbe r of prescribers listed by the PDMP as well as the dose of the patient’s opio...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 14, 2018 Category: Palliative Care Tags: kollas opioids pdmp quality improvement The profession Source Type: blogs
Does Colace (docusate) Work For Constipation? No!
This study was highlighted in theGeriPal Top 25 articles in HPM.- Ed.)Randomized, Double-Blind, Placebo-Controlled Trial of Oral Docusate in the Management of Constipation in Hospice Patients. Tarumi et al. Journal of Pain and Symptom Management, 2013: 45(1), 2-13.Palliative care fellows may wonder about their attendings fixation on bowel movements. It may be because we do not ask medical students to disimpact patients any more or because, given the lack of ambulatory care many residents do, they do not see it as a big deal (Constipation a GREAT topic for those of us who like puns and dad jokes).For patients, how...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 20, 2018 Category: Palliative Care Tags: arnold constipation docusate geripal top 25 pallimed writing group senna Source Type: blogs
Cats & Dogs: Can We Find Unity on Health Care IT Change?
By MATTHEW HOLT
Today we have a humming economy and insane politics. In early 2009 we were in economic meltdown and were about one week into the sanest, soberist Administration and even Congress over many recent decades. In February 2009 They passed a stimulus bill that had a huge impact on the health IT market (and still does). At that time there was much debate on THCB about what the future of health IT policy should look like and how the stimulus “Meaningful Use” money should be spent. My January 2009 summary of that whole debate introduced the notion of “Cats and Dogs in health IT”. They’...
Source: The Health Care Blog - August 15, 2018 Category: Consumer Health News Authors: matthew holt Tags: Matthew Holt 2008 Election EHR Health 2.0 Policy Policy/Politics RHIOs Startups Source Type: blogs
Lifestyle change as precision medicine
Are you frustrated that you dropped only a few pounds following a new diet, but your best friend lost almost 30? Why did the probiotics that helped your sister’s bloating sensation do nothing for you? Your coworker swears that going gluten-free made his joint pain disappear, but you just came away craving more bread and pasta. In a world where we expect personalized products and services delivered promptly to our screens and doors, medicine is not even close to bringing this level of experience. Why does precision medicine in the 21st century remain so elusive?
We are using an old framework to resolve the most common...
Source: Harvard Health Blog - August 9, 2018 Category: Consumer Health News Authors: Marcelo Campos, MD Tags: Health Source Type: blogs
How Proposed Changes to Medicare Documentation Regs Can Impact Palliative Care
by Amy Davis (@MaximizeQOL)(CMS open to comments until Sep 10, 2018. See end of post for details. - Ed.)Centers for Medicare and Medicaid Services (CMS) hasproposed sweeping reforms to documentation requirements, clinician reimbursement, and the Quality Payment Program (QPP), to begin in 2019. (1) If approved in their current form, the changes are likely to have dramatic net negative effects on outpatient palliative care reimbursement. A detailed review and analysis of all 1,473 pages of the Proposed Rule, plus its addenda, would not be practical here. The reader is referred to thecomplete text (1) andothers ’ asses...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 2, 2018 Category: Palliative Care Tags: billing CMS davis The profession Source Type: blogs
True Confessions On Why I Prescribe Things Without ' Evidence '
by Drew RosielleWe have a ' required reading ' list for our fellowship, which includes a bunch of what I think are landmark or otherwise really important studies. One of them is thisvery well done RCT of continuous ketamine infusions for patients with cancer pain, which showed it to be ineffective (and toxic).We also recently have seen another high-quality study published with negative results for ketamine. This was a Scottish, multi-center, randomized, placebo-controlled, intention-to-treat, and double-blinded study oforal ketamine for neuropathic pain in cancer patients. The study involved 214 patients, 75% of whom were ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 6, 2018 Category: Palliative Care Tags: fatigue ketamine methylphenidate neuropathic pain research research issues rosielle The profession Source Type: blogs
10 Surprising Health Benefits of Mindfulness Meditation
“The real meditation practice is how we live our lives from moment to moment to moment.” – Jon Kabat-Zinn
As someone who strives daily to be the best I can be, to be present in the moment, minimize stress and appreciate the beauty and preciousness of life, I’m always keen to learn about scientifically-proven new health benefits of mindfulness meditation.
Get better sleep.
Anyone who’s suffered the lingering mental and physical effects of a poor night’s sleep on a regular basis, as I have on numerous occasions in the past, can appreciate this all-important benefit from mindfulness meditation: better sleep. In fa...
Source: World of Psychology - July 5, 2018 Category: Psychiatry & Psychology Authors: Suzanne Kane Tags: Mindfulness Research Self-Help Stress Source Type: blogs
Restricting opioid prescribing: Some error has to be tolerated
I have written previously about the raging opioid epidemic in Ohio. Attacking and reversing this tidal wave will require many weapons, resources and time. Opioid addiction is a crafty and elusive adversary that will be difficult to vanquish. Our battle plan will have to be nimble and adjusted over time, much as military leaders must do in actual armed conflict.
Here in Ohio and elsewhere, physicians must abide by new prescribing restrictions. Prior to prescribing a controlled pain medicine, doctors are required to check the patients OARRS report online, which catalogues the patient’s prescription history. ...
Source: Kevin, M.D. - Medical Weblog - June 27, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/michael-kirsch" rel="tag" > Michael Kirsch, MD < /a > Tags: Conditions Pain Management Primary Care Source Type: blogs
The Not-Quite Annual ASCO Round-Up - 2018 edition
by Drew RosielleTheAmerican Society of Clinical Oncology annual meeting, besides being a feast for the pharmaceutical business news pages (google ' ASCO ' and most of the hits will be about how announcement X affected drug company Y ' s stock), is also one of the premiere platforms for publishing original palliative-oncology research. So every year I try to at least scan the abstracts to see what ' s happening, and I figure I might as well blog about it. It ' s tough to analyze abstracts, so I ' ll mostly just be summarizing ones that I think will be of interest to hospice and palliative care folks. I imagine I ' ve missed...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 6, 2018 Category: Palliative Care Tags: artificial nutrition ASCO cannabanoid code status conference reviews fatigue hpmglobal marijuana mindfulness mucositis neuropathic oncology pain race rosielle scrambler Source Type: blogs
The AMA Gets it Right by Defending Evidence-Based Medicine and Patient, Physician Autonomy
Gun control advocates like to accuse legislators of being “afraid of the NRA,” implying that reason and principle have nothing to do with their legislative decisions. In the same way, Jackie Kucinich, in a column in The Daily Beast, suggests that the failure of Congress to pass CARA 2.0 (Comprehensive Addiction and Recovery Act) is due primarily to the lobbying clout of the American Medical Association, pointing to its status as the “seventh highest lobbying spender in 2017.” The article quotes opioid reform advocate Gary Mendell as saying “the AMA will resist anything that regulates healthcare”—an inter...
Source: Cato-at-liberty - May 30, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Fight Aging! Newsletter, May 28th 2018
This study indicates that frailty and other age-related diseases could be prevented and significantly reduced in older adults. Getting our heart risk factors under control could lead to much healthier old ages. Unfortunately, the current obesity epidemic is moving the older population in the wrong direction, however our study underlines how even small reductions in risk are worthwhile." The study analysed data from more than 421,000 people aged 60-69 in both GP medical records and in the UK Biobank research study. Participants were followed up over ten years.
The researchers analysed six factors that could impact on...
Source: Fight Aging! - May 27, 2018 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
The Ethics of Keeping Alfie Alive
By SAURABH JHA
Of my time arguing with doctors, 30 % is spent convincing British doctors that their American counterparts aren’t idiots, 30 % convincing American doctors that British doctors aren’t idiots, and 40 % convincing both that I’m not an idiot.
A British doctor once earnestly asked whether American physicians carry credit card reading machines inside their white coats. Myths about the NHS can be equally comical. British doctors don’t prostate every morning in deference to the NHS, like the citizens of Oceania sang to Big Brother in Orwell’s dystopia. Nor, in their daily rounds, do they calculate opportun...
Source: The Health Care Blog - May 21, 2018 Category: Consumer Health News Authors: at RogueRad Tags: OP-ED Uncategorized AlfieEvans Source Type: blogs
