FOUR Score: Coma scales & prognosis in the ICU
by Drew RosielleIn neuro-critical care, prediction of outcomes is often tricky because of the wide variability in the ability of the brain to recover and the usual long periods needed before seeing what is the limit of recovery. Most people are familiar with the Glasgow Coma Scale, but back in 2009 Mayo Clinic Proceedings published a study of the FOUR score), which presents some prognostic data for ICU patients. FOUR = ' Full Outline of UnResponsiveness. ' (It is also written as 4S. - Ed.)This was a single institution study (Mayo Rochester) primarily designed to investigate whether the FOUR score is a reliab...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 10, 2016 Category: Palliative Care Tags: icu neuro open access prognosis rosielle Source Type: blogs

Palliative Chemotherapy: An Oxymoron
By Rebecca Gagne HendersonI was inspired to write this after reading the series of posts on Pallimed titled “Against Euphemisms” by Drew Rosielle. At its very best, the term “Palliative Chemotherapy” is an oxymoron. At its worst, it is a treatment that robs the patient and family of quality of life and valuable time may have been spent doing the things that are important to them.As a palliative consultant on a campus which does not house a cancer center my referrals typically come from hospitalist attending physicians rather than oncologists. I cannot begin to tell you the number of conversations I have had through...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 1, 2016 Category: Palliative Care Tags: cancer chemotherapy euphamisms gagne henderson palliative rebecca Source Type: blogs

July 2016 Pallimed Review
by Christian SinclairJuly 2016 was a great month! New fellows started,advocates told the hospice story on Capitol Hill and online, theAAHPM held it ' s Summer Institute. Good things all around.Here is a recap of all of our posts from July 2016. We know there are some you may have already bookmarked, but forgot to read, or maybe you liked it so much you want to share it again.Make sure to follow, engage, like and comment with us onFacebook,Twitter,Google+,Pinterest,Tumblr andLinkedIN. And nowcatch us on Instagram, where we have grown quickly in the past month. And we always appreciate it when you recommend us to your p...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 31, 2016 Category: Palliative Care Tags: review sinclair Source Type: blogs

Photovoice Roundup Call for Submissions: Self Care
< h2 > Introducing a new fun visual roundup for Pallimed.org < /h2 > < div > Your mission, should you choose to accept it... < /div > < div > < br / > < /div > < ol > < li > Send us ONE square photograph from < b > your < /b > life that represents your self-care activity of choice. < /li > < li > Tell us in ONE sentence about this activity. < /li > < /ol > < div class= " separator " style= " clear: both; text-align: center; " > < a href= " https://4.bp.blogspot.com/-iI_r8HdBTEo/V5FRVUcM-QI/AAAAAAAA5a4/rooj8oiwOOwJ3o4WRcEvWN8pn-YlDf5ugCLcB/s1600/bowling%2Bsquare.png " imageanchor= " 1 " style= " margin-left: 1em; margin...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 29, 2016 Category: Palliative Care Tags: call for submissions photo photovoice roundup self care Source Type: blogs

Pallimed Roundup: The Best Advice
The editors of Pallimed are proud to announce a new editorial feature: Pallimed Roundup. In these articles we will publish a collection of quotes culled from palliative care professionals around the world. < br / > < h2 > < i > Looking back on the early days in your hospice and palliative career, what is the best advice you received? < /i > < /h2 > < br / > < b > “Best advice - find a mentor and be a mentor!” < /b > < br / > – Shirley Otis-Green, MSW, MA, ACSW, LCSW, OSW-C < br / > Twitter: @sotisgreen < br / > < br / > < b > Learn from your patients... < /b > < br / > < br / > “Thinking back to all of the wonderfu...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 27, 2016 Category: Palliative Care Tags: boundaries mentor palliative reflect roundup self-care Source Type: blogs

Against Euphemisms - Part 4 - Assisted Death
< div class= " separator " style= " clear: both; text-align: center; " > < a href= " https://4.bp.blogspot.com/-iy0WfUuDtU8/V37J7NSPSWI/AAAAAAABYsY/5mM_Ssm4k-YKVMQ0XjkTQ1Dyu5CgLNFBQCLcB/s1600/Against%2Beuphemism%2B%25281%2529.png " imageanchor= " 1 " style= " clear: right; float: right; margin-bottom: 1em; margin-left: 1em; " > < img border= " 0 " height= " 320 " src= " https://4.bp.blogspot.com/-iy0WfUuDtU8/V37J7NSPSWI/AAAAAAABYsY/5mM_Ssm4k-YKVMQ0XjkTQ1Dyu5CgLNFBQCLcB/s320/Against%2Beuphemism%2B%25281%2529.png " width= " 320 " / > < /a > < /div > by Drew Rosielle < br / > < br / > < i > (This is the last of four po...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 26, 2016 Category: Palliative Care Tags: ethics/law euphemisms euthanasia/suicide rosielle The profession Source Type: blogs

It is as simple as saying “Hello, my name is…”
< div class= " separator " style= " clear: both; text-align: center; " > < a href= " https://2.bp.blogspot.com/-T2iuzuc0Pc0/V5YTWdua7mI/AAAAAAABbJ8/f5EePf0RoKwVVvasrs0Tvg6ZASpfYkSbwCLcB/s1600/hello-my-name-is-logo-square3.PNG " imageanchor= " 1 " style= " clear: right; float: right; margin-bottom: 1em; margin-left: 1em; " > < img border= " 0 " height= " 291 " src= " https://2.bp.blogspot.com/-T2iuzuc0Pc0/V5YTWdua7mI/AAAAAAABbJ8/f5EePf0RoKwVVvasrs0Tvg6ZASpfYkSbwCLcB/s320/hello-my-name-is-logo-square3.PNG " width= " 320 " / > < /a > < /div > by Christian Sinclair < br / > < br / > This weekend I was on-call for our in...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 25, 2016 Category: Palliative Care Tags: communication The profession tribute Source Type: blogs

Hope is a Hot Button
by Kathy Kastner < br / > < br / > < div class= " separator " style= " clear: both; text-align: center; " > < a href= " https://4.bp.blogspot.com/-N-8PrA4vNgg/V5Zge4ARKOI/AAAAAAABbLA/XijkFrppj-gaHtmWcua8GHkRc4FVjlpHQCLcB/s1600/false%2Bhope.png " imageanchor= " 1 " style= " clear: right; float: right; margin-bottom: 1em; margin-left: 1em; " > < img border= " 0 " height= " 183 " src= " https://4.bp.blogspot.com/-N-8PrA4vNgg/V5Zge4ARKOI/AAAAAAABbLA/XijkFrppj-gaHtmWcua8GHkRc4FVjlpHQCLcB/s320/false%2Bhope.png " width= " 320 " / > < /a > < /div > As life draws to an end, hot buttons need only be barely touched to set off ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 24, 2016 Category: Palliative Care Tags: chat hpmchat kastner tweetchat Source Type: blogs

Against Euphemisms - Part 3 - Palliative Sedation
"Palliative Sedation."Golly I hate this one. Frankly 'terminal sedation' was better, because it was at least less confusing, but  neither of them are clear or transparent, and particularly 'palliative sedation' is just so confusing and potentially laden with too many meanings to be ever useful. There are so many clinical scenarios out there in which someone is sedated (deliberately, or as an aftereffect of trying to control pain/anxiety/dyspnea/etc; deeply or lightly; continuously until death vs temporarily as respite) in circumstances that the average person would agree would be 'palliative' or 'of-palliative-intent'...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 20, 2016 Category: Palliative Care Tags: euphemisms palliative sedation rosielle The profession Source Type: blogs

Mindfulness Prayer to Begin IDT Meetings
by John FlorianI am a hospice chaplain working in Central Ohio and am asked in that role to provide a prayer at the beginning of our interdisciplinary team meetings. I want the prayer to be truly interfaith and non-denominational, but even more importantly, I want the prayer to meet the team where it is in the moment, and to inspire them in their work. I use a mindfulness bell to set the tone for the prayer and to create a space in the day.Here is a prayer I created for our team:(mindfulness bell)Let's take a deep breath . . . and find our spiritual center (pause)May God bless our ministry today.We call to mind the patient...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 17, 2016 Category: Palliative Care Tags: chaplain idg idt mindfulness prayer spirituality Source Type: blogs

Against Euphemisms - Part 2 - Compassionate Extubation
by Drew Rosielle(This is the second of four posts by Drew on the language we use in hospice and palliative care. You may want to read his reflection on 10 years of practice or his first post on euphemisms - "Comfort Care." - Ed.)Euphemistic phrase #2 that I'd like to never hear again: "Compassionate extubation."By which people typically mean 'extubating someone who is on invasive mechanical ventilation who is not expected to survive long, to a plan of care that focuses on symptom alleviation.'What bugs me about it is the use of the term 'compassionate' to try to encompass the idea of a dying patient, care goals focuse...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 13, 2016 Category: Palliative Care Tags: euphemisms icu rosielle The profession Source Type: blogs

Passing the Hospice and Palliative Medicine Boards
by Christian SinclairCongrats to all of the 200+ new attending hospice and palliative medicine (HPM) physicians who completed fellowship at the end of June. We've already compiled advice on how to be the best physician you can be, but now you are probably starting to think about passing the HPM boards come November 7th, 2016*. (Same goes for those fellows who finished in 2015, since the board exam is on a two-year cycle.)You will find some good information on the American Academy of Hospice and Palliative Medicine (AAHPM) subspecialty certification page. But beyond knowing the blueprint and areas covered by the exam, what ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 12, 2016 Category: Palliative Care Tags: Blogs to Boards sinclair The profession Source Type: blogs

JAMA Got It Wrong: Giving Prognostic Information to Families of Critically Ill Patients Is Not the Same as Palliative Care
by Elizabeth LindenbergerI know I am not alone in my disappointment this week with the authors’ conclusions in “Effect of Palliative Care-Led Meetings for Families of Patients with Critical Illness: A Randomized Clinical Trial.” The study intervention involved the provision of an informational brochure and two focused meetings specifically designed to provide families with information about prognosis. The study found no difference in most outcomes between usual care and the intervention, and PTSD symptoms were in fact increased in the intervention group. The authors concluded that "these findings do not support routi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 11, 2016 Category: Palliative Care Tags: communication families family JAMA Lindenberger palliative prognosis prognosticate Source Type: blogs

Building Online Community in Hospice and Palliative Care
by Christian T Sinclair In this digital age, it is common to hear how devices isolate us from real authentic relationships. There are books written about how no one gets together once a week at the bowling alley or the coffee house, to just talk with friends and build that valuable relationship glue. I chuckle when I hear these concerns, because what I have experienced has been quite the opposite with the weekly #hpm chat on Twitter.*(If you just saw the hashtag or the word Twitter and you immediately thought “I don’t do Twitter,” stick with me until the end!) Next Thursday marks the 6th anniversary of #hpm chat, ou...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 8, 2016 Category: Palliative Care Tags: chat hpmchat sinclair tweetchat Source Type: blogs

Against Euphemisms - Part 1 - Comfort Care
by Drew RosielleWell, I've been practicing palliative medicine for 10 years - 11 including my fellowship. So I feel like maybe I can take off my young turk hat, and put on my grumpy old man socks (I'm looking at you Bob Arnold and David Weissman) and start complaining.What I wanted to complain about is the use of euphemistic, moralistic, and/or confusing terminology in our field, to describe our clinical work, and suggest we'd all be better off if we just said what we mean, as cleanly as possible. All of medicine has this problem, but palliative care you are my tribe, so this is what I'm going to complain about today and o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 7, 2016 Category: Palliative Care Tags: euphemisms rosielle The profession Source Type: blogs