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Take the Survey on HPM Burnout
In the previous post you learned about the long journey of research.  Well now is your time to contribute.  Researchers from the Duke Clinical Institute have been reaching out this summer to look for participants of all disciplines to participate in this survey on stress and burnout in hospice and palliative medicine.  So take 15 minutes (now, because you know you wont get to it later) and finish this quick survey.  And then if you really want to earn a gold star, forward it to people in the field with a personal endorsement. (If you already took it earlier this summer, do not take it again.) ----------...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 9, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Prescribe Long Acting Opioids? You Must Know About REMS
Here is the simple version: If you prescribe long acting opioids then you (and all your prescribing co-workers) should sign up for the FREE FDA/DEA mandated REMS training hosted by AAHPM on September 10th (yes, tomorrow!) andOctober 11th. Here is the (semi-)long version: The FDA and DEA have noticed the public health risk caused by long acting opioids being used inappropriately.  One part of their remedy is to increase training for prescribers of opioids.  The AAHPM along with 9 other interdisciplinary organizations (Collaborative on REMS Education CO*RE) are working to provide the educational activity....
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 9, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Cases: "Do you have something stronger than this dilaudid?" The case for opioid rotation
Discussion: Opioid rotation, or trial of an alternative opioid, is commonly practiced when a patient’s pain responds poorly to one opioid or intolerable side effects develop. These intolerable side effects may include nausea, vomiting, sedation, or even hyperalgesia. Although rotation is a common practice, a Cochrane review in 2004 found that evidence to support the practice for opioid rotation was anecdotal and in non-controlled studies. Randomized trials were suggested. Since that time, several prospective studies have been performed where opioid analgesic effect was inadequate or side effects to the opioid were i...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 6, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

The Bereavement Counselor: Public Misperception
(Please welcome Rea Ginsberg, LCSW-C, ACSW, BCD to Pallimed. She is a retired Director of Social Work Services and Hospice Coordinator. She has extensive experience working with both children and elderly adults mostly in hospitals and long term care facilities. - Sinclair) I’ve learned that people will forget what you said, People will forget what you did, But people will never forget how you made them feel. -- Maya Angelou We are often asked, How can you do that? How can you stand to do that work? Such a dreary subject. Grim but supposedly necessary. Don’t you get depressed with all the talk of dying? Facin...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 5, 2013 Category: Palliative Carer Workers Authors: Rea Ginsberg Source Type: blogs

ASCO and AAHPM Team up on Quality Improvement
“I’m seeing the road that I’ve traveled A road paved with heartache and tears And I’m seeing the past that I’ve wasted While watchin’ the bubbles in my beer” - Bob Wills I’ve always preferred Bob Wills’ “…bubbles…” to Don Ho’s “Tiny Bubbles”. The former always feel more contemplative, but also remind me to continue to break out of the doldrums…the usual…don’t take the world as it sits today as the way it will always be. For those looking to break new ground and collaborate on enhancing palliative ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 5, 2013 Category: Palliative Carer Workers Authors: John Hennessy Source Type: blogs

Cases: Anti-epileptic Medicines for Pain Management
Discussion:  Tri-cyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and anti-epileptic drugs (AEDs) are the mainstays of adjuvant therapy for neuropathic pain.  This Case of the Month will focus on oral anti-epileptic neuropathic pain analgesics. Due to lack of head-to-head data, evidence is presented as numbers needed to treat (NNT) and numbers needed to harm (NNH). For instance, an NNT of 5 for 50% pain reduction means for every 5 patients treated with a drug, only 1 of them would achieve a 50% reduction in pain. Gabapentin (Neurontin) and pregabalin (Lyrica) are considered firs...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 30, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Hospice is Still Special
When socializing with fellow young physicians, most of whom are not in palliative medicine, I am reminded, in Hospice and Palliative Medicine, I have the unique opportunity to share time and attention with my patients. We reflect on “the old days” of medicine, where physicians had long standing relationships with their patients which allowed them to more easily direct medical decision-making which was appropriate for the individual patient. I often tell others I chose this field because it is the closest thing to that particular kind of medicine, where we can still do ‘the right thing’ for patients,...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 23, 2013 Category: Palliative Carer Workers Authors: Kristina Newport Source Type: blogs

How Wellness Programs Support Palliative Care in Cancer Related Fatigue
This article was co-written with Sami Papacek a Certified Cancer Exercise Specialist at the University of Kansas Cancer Center. (Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 22, 2013 Category: Palliative Carer Workers Authors: John Hennessy Source Type: blogs

Subscribers Moving to A New Email Delivery Platform
We are moving to a new email delivery system called MailChimp from the old delivery system Feedblitz.  (Yeah, all new companies seem to have silly names. I can't stop them.).  What does this mean for you? 1) No more random ads on the emails 2) Ability to choose your subscription frequency: Daily (Full Post) MWF (Full Post) Weekly (Digest Version - short snippet of each post in the past week) 3) Ability for us to better understand the reasons why emails don't get delivered 4) Prettier looking emails that make you want to read and click 5) Clearer credits for the authors contributing to Pallimed If you wer...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 21, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Hospice and Palliative Online Efforts Featured in The Atlantic
As longtime readers will know, we here at Pallimed have advocated for social media being an effective change agent for issues relevant to hospice and palliative care for many years. With a thriving blog community (43! But we could always use more blogs!*), a strong Twitter presence of senior leaders and new leaders, a weekly Tweetchat since 2010 and several quality Facebook pages, the specialty which emphasizes communication skills at the bedside has done a good job communicating to the world as well. Paul Bisceglio (@PaulBisceglio) from The Atlantic featured some of these efforts and the newer trend of being very o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 21, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

The agony & the ecstasy of EBM in symptom management
So, I decided I might blog a little again. Probably the occasional Journal Club of the Cloud-type posts. Christian and fellow bloggers, thank you for all you do in keeping Pallimed thriving and relevant. So, Eduardo Bruera & colleagues at MD Anderson have published the results of their long-awaited follow-up trial to their 2006 double-blinded, placebo controlled trial suggesting that methylphenidate (MP) is no better than placebo for cancer-related fatigue (CRF). Original 2006 trial here New 2013 trial here Journal of Clinical Oncology editorial on the 2013 trial here (hat tip to this editorial for pointin...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 7, 2013 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs

Cases: Pain vs. Sufffering and the Role of the Pastoral Care
Discussion:  This was a process that was not resolved as in our modern media. The resolution was assisted by others in the Palliative Care Team, the Transplant Team, Unit Staff, Pastoral Care, Providence, and, of vital importance, her family members who realized her mortality and took ownership of her suffering and their contribution to the dysfunction in their household. In many of the rooms of the hospital are laminated Comparative Pain Scales with 1 being expressed as smiling demonstrating 'No Pain' to 10 being 'Unbearable/Excruciating Pain'. Modern technology addresses this pain well. Suffering of the soul, min...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 26, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Experience Cancer Through a Video Game
(Today we have our first post from Meredith MacMartin (@GraniteDoc), a palliative care doctor in New Hamsphire, who referenced this video game in a Tweetchat several weeks back. I'm pleased to welcome her to Pallimed and I know you will enjoy this thought provoking post. ~ Sinclair) My brother-in-law Dennis is seriously into video games. He’s a designer and programmer who has worked with NASA on using video game technology for training and community outreach purposes, and who is passionate about expanding the use of gaming for entertainment and especially education. I’ve had many conversations w...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 26, 2013 Category: Palliative Carer Workers Authors: Meredith MacMartin Source Type: blogs

Proposed Changes to Organ Donation Blur The Line on End of Life Care
Rolling into work this morning, NPR reported on a radical change in organ donation policies which could profoundly change how palliative care is perceived and how families and health care professionals make those very challenging decisions at the end of life.  At the heart of the effort is an attempt to increase the number of organ donors of course but the ethical question is in how to achieve that noble goal. Among the changes under consideration is the ability for hospitals and organ procurement organizations (OPOs) to make their own policies on how to approach families and patients about organ donation instead of f...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 24, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Home Palliative Care: Is there proof in the pudding?
This month, the Cochrane Collaboration has released a review of home palliative services for adults with advanced illness and their caregivers. The authors, led by Barbara Gomes, MSc, PhD, set the primary outcome as occurrence of death at home. Secondary outcomes included the time the patient spent at home, satisfaction with care, management and degree of pain and other symptoms, symptom burden, physical function, quality of life and caregiver pre and post bereavement outcomes. Economic data was also examined and included hospital costs, other institutional care costs, community care costs, informal care costs, and equipme...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 20, 2013 Category: Palliative Carer Workers Authors: Emily Riegel Source Type: blogs

Father's Day Without Your Father
I drove from Kansas City to Oklahoma to bury my father in a Veteran's Cemetery two years ago this summer, not long after Father's Day. I have not really thought much about that day in the following two years.  Which now feels kind of strange. Shouldn't I be think about it like a normal grieving adult child? It occurs to me now as I anticipate my wife and kids to celebrate my tenure as a father, that days like these are also memorial days for so many people.  Although I have talked with many people who have also lost one or both of their parents, it never really occurred to me as it is this week, the profound imp...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 14, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Origins: Debra Parker Oliver, PhD, MSW
David and Debbie relax before the first chemo treatment (Photo Credit: David's Videoblog) This summer you may meet many superheroes at your local cinema.  A frequent story telling device in the superhero genre is the origin story.  By showing how a superhero emerged from humble beginnings and transformed into a powerful force for good, one can give meaning to context and motivations and lead to a better understanding of who that person is.  In meeting many hospice and palliative care professionals over my career I have always enjoyed hearing how they discovered the field.  For some it is a startling ne...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 11, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Pallimed 8th Anniversary - You've Just Been Pep Talked
Back in March, the contributors of Pallimed got together for a hard conversation. We were only missing a few people but it was still a sizable gathering at a restaurant late one evening in New Orleans. We have met at Academy meetings before, really to check in with each other and how all of us were doing in our professional and personal lives.  But this was a little different.  None of us were posting with much regularity for the previous 18 months.   Compared to where we were in 2008, 2009, and 2010 we all recognized we had many more responsibilities and working on Pallimed really didn't alwa...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Cases: What Do I Say To My Kids?
DISCUSSION: Young children who are informed of their parents’ terminal illness are less anxious than those who are not told , but many terminally ill parents are daunted by this emotionally stressful task. Deciding how to break the news to children is made more difficult when taking into account the developmental level of each child. Palliative Care Teams often have several books available that guide parents through the process of discussing death and dying with their children. Parents’ abilities to apply the information in these books can be further enhanced with a session provided by the behavioral medicine c...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 7, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Palliative Care Can Burn You Out....Palliative Care Can Prevent Burn Out
Part 1. Palliative Care Can Burn You Out Have you had one of those emotionally draining days? You know the kind of day when family meetings are not going well.  Which is exactly how you feel when the first thing after introducing yourself a grandson asks: “why aren’t there any lawyers present at this meeting?” One of those days you are trying to help someone who is seriously ill and dying.  Sometimes it is emotionally harder because they might be closer to your age, reminding you that cancer or tragedies have no mercy.     Additionally, when you are h...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 5, 2013 Category: Palliative Carer Workers Authors: Jeanette Ross Source Type: blogs

What do you do when the advance directive doesn't make sense?
The wait was too long.  We had to change plans. I arrived home late after a long day at work and my wife asked if I wanted to go to that new restaurant everyone had been talking about.  We hopped into the car and drove off, not really thinking about a reservation.  We both groaned when the restaurant came into sight and we saw throngs of people waiting outside.  "Maybe it's not as bad as it looks," I said as I jumped out of the car to check, only to find out there was a 90 minute wait.  As I walked back to the car, I had already made up my mind to go down the road to an old standby. ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 31, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

The Search for Greener Grass: The Second Opinion in a Far Away City
You drive down a busy expressway amidst thousands of other vehicles and a billboard jumps out at you.  In the font of confidence, it reads, ""The first step in fighting cancer should be a second opinion."  The billboard informs you of the location of the nearest Cancer Treatment Center of America (CTCA), "only" about 130 miles from the billboard. When I saw this billboard, my initial response was to recall a recent article about CTCA which challenged their dubious centerpiece claim: Patients with cancer who receive treatment there survive longer than those who don't.  The article po...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 29, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

Palliative Care Triggers for Oncology
I read the ASCO Post when I’m on airplanes.  At least I do, below 10,000 feet… and after I have finished the Sudoku. The ASCO Post is the People magazine of oncology.  The articles are short… typically one page, with lots of pictures consisting mostly of the authors.  It is medical journal lite, with terms and prose simple enough for a layman to both understand and to not fall asleep by the end of the article.  It probably can be best described as Oncology for Dummies. (Also, to give the full extent of its look and feel… there is usually one or two ads attached with that go...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 28, 2013 Category: Palliative Carer Workers Authors: John Hennessy Source Type: blogs

Memorial Day
The exact origins of Memorial Day are not exactly agreed upon. Many cities claim to be the founders of this holiday. The tradition, however, dates back to Civil War times. At one time Memorial day was known as Decoration Day, as it was the day families and friends of fallen Civil War soldiers would choose place flowers and "decorate" the graves. The first official Memorial Day was May 30th 1868, after the day was declared by General John Logan, commander of the Grand Army of the Republic (a veterans' organization). The holiday was adopted by Michigan and New York and then by all the Northern states through the l...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 26, 2013 Category: Palliative Carer Workers Authors: Amber Wollesen, MD Source Type: blogs

Verb Selection in Code Status Discussions: A Potentially DisruptiveHospital Innovation
This study identifies two methods of framing. In 68% of encounters, life sustaining treatments featured as the first topic of conversation. The order in which options are presented represents an important frame and a nudge towards the first option listed. The modal verb serves as the other vehicle by which the decision is framed. Have you ever heard a physician say something like, "If the mask you are on doesn't keep your oxygen level up, we might need to place a tube in your throat and hook you up to life support to keep you alive, but we want to know if you want that." Some patients will declare a longstand...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 24, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

Verb Selection in Code Status Discussions: A Potentially Disruptive Hospital Innovation
This study identifies two methods of framing. In 68% of encounters, life sustaining treatments featured as the first topic of conversation. The order in which options are presented represents an important frame and a nudge towards the first option listed. The modal verb serves as the other vehicle by which the decision is framed. Have you ever heard a physician say something like, "If the mask you are on doesn't keep your oxygen level up, we might need to place a tube in your throat and hook you up to life support to keep you alive, but we want to know if you want that." Some patients will declare a longstanding ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 24, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

Cases: Working Through Moral Distress
Discussion: Moral distress occurs when the clinician knows the appropriate action to take, but is unable to carry it out, and feels forced to give care contrary to her values. It is more often described in the nursing literature, but is beginning to come to the awareness of physicians as well. Moral distress often occurs in end-of-life situations when the decision is made to provide aggressive life-sustaining treatments that are felt to put excessive burden on patients and families. Clinicians who see patients at the end of life may be particularly vulnerable to moral distress. For those of us who serve as consultants, o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 22, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Tweetchat Is Terminal! Dying Victim Of Twitter API Changes
Twitter is changing how data can be accessed, which will more than likely lead to the demise of @tweetchat. :( — TweetChat (@TweetChat) May 4, 2013 I am not talking about our Wednesday 9pm EST (8pm CST /6pm PST)  HPM tweetchat.  Our live palliative tweetchat conversations are alive and well since the inaugural tweetchat  in June 2010.  We would love to have you join us! What is in a state of demise and is going away June 11 2013 is the web service www.tweetchat.com . This is a site that easily allows you to monitor one subject on Twitter organized around a hashtag. I have been an a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 22, 2013 Category: Palliative Carer Workers Authors: Jeanette Ross Source Type: blogs

But I'm a pediatrician. I don't do "death."
(A hearty welcome to Emily Riegel, MD (@emriegel) a Med/Peds physician who completed a hospice and palliative medicine fellowship a few years ago and is now at KU Medical Center helping lead pediatric palliative care in Kansas City.  Emily is a keen observer who could easily be writing the great next medical drama on TV, but until then I'm happy she is contributing to Pallimed - Sinclair) In the March issue of Pediatrics,  Jonna D. Clark, MD, and Denise M. Dudzinski, PhD, take on the audacious task of encouraging pediatricians to step into the role of decision maker for terminally i...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 22, 2013 Category: Palliative Carer Workers Authors: Emily Source Type: blogs

Cases: What to do after the patient is made comfort measures only (CMO)
Discussion:  Deciding to focus only on comfort is a major transition point for patients, families and health care providers.  After making this decision, most families are not sure what comes next.  They look to health care providers to reassure them that they are doing the right thing and to ensure that their loved one does not suffer and that they are prepared for the next few days. The following questions should guide one’s action after a patient is made CMO: 1.   Are the patient’s symptoms adequately treated/prevented? A standardized comfort measures only order sheet can optimize sy...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 8, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

What to do after the patient is made comfort measures only (CMO)
Discussion:  Deciding to focus only on comfort is a major transition point for patients, families and health care providers.  After making this decision, most families are not sure what comes next.  They look to health care providers to reassure them that they are doing the right thing and to ensure that their loved one does not suffer and that they are prepared for the next few days. The following questions should guide one’s action after a patient is made CMO: 1.   Are the patient’s symptoms adequately treated/prevented? A standardized comfort measures only order sheet can optimize sy...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 8, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

The Fault In Our Stars (TFIOS): An Insightful Depiction Of Teens Living With Serious Illness
I have to confess that even though I am a grown woman I seem to like many young adult–teenage books (I am still seventeen at heart). I am frequently asking my daughter and nieces about books they enjoyed when I’m looking for something to read. So far the books I have read include some teenage love stories happening in a futuristic dystopia in which the main characters are at risk of dying because of being in a arena fighting other children like in the hunger games; or being at risk of getting injured while performing difficult stunts like jumping from a train like in the divergent series. The Fault in Our Sta...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 8, 2013 Category: Palliative Carer Workers Authors: Jeanette Ross Source Type: blogs

The Fault In Ours Stars (TFIOS): An Insightful Depiction Of Teens Living With Serious Illness
I have to confess that even though I am a grown woman I seem to like many young adult –teenage books (I am still seventeen at heart). I am frequently asking my daughter and nieces about books they enjoyed when I’m looking for something to read. So far the books I have read include some teenage love stories happening in a futuristic dystopia in which the main characters are at risk of dying because of being in a arena fighting other children like in the hunger games; or being at risk of getting injured while performing difficult stunts like jumping from a train like in the divergent series.  The Fault in ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 8, 2013 Category: Palliative Carer Workers Authors: Jeanette Ross Source Type: blogs

Relief From Death Anxiety: In Your Medicine Cabinet Already?
The radio show Wait, Wait....Don't Tell Me! has a weekly segment called "Bluff the Listener" during which a caller listens to three unbelievable stories and then guess which one of the three is actually true.  Much to my surprise, this week's "true" (yet unbelievable) story is about evidence that acetaminophen might relieve existential angst. (Here's a direct link to the audio segment.) Julius Axelrod (Source: National Institutes of Health) Really?  Good ole' Tylenol might relieve bothersome thoughts about the ultimate threat to our existence?  How could I not investigate this furthe...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 5, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

Lung Cancer Guidelines With No Mention of Palliative Care?
(Ed. - Welcome Mr. John Hennessy to the Pallimed family.  His background in executive leadership of oncology programs brings a potential outsiders perspective to Pallimed.  Thankfully he is a strong ally and champion for hospice and palliative care as you will see from his first post. Great to have you here John. - Christian)  Disappointed…frustrated…we’ve all been there.  My most vivid memories are of birthdays at home, when books and socks were unwrapped rather than remote control model airplanes and car keys. It wasn’t my birthday this week, but my daily e-mails usually inc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 2, 2013 Category: Palliative Carer Workers Authors: John Hennessy Source Type: blogs

Cases: Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and musc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Pallimed Case Conferences is Moving (Here)
Editorial decisions and challenges in upkeep will mean Pallimed: Case Conferences will be moving over the next year to the main Pallimed website (www.pallimed.org). The first case is already (re-)published: Transdermal Granisetron for Refractory Nausea and Vomiting  When the Case Conference blog was first started in 2008, there was always hope to find an editor to oversee it, but early collaborations ultimately did not facilitate stable editorial leadership. The aim to use cases to illustrate important teaching points in palliative care is still an important one.  The University of Pittsburgh Palliative Care De...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and musc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Raising Palliative Care Awareness Through Film Screeenings
(Ed. - Can you believe it another new author!  Please welcome Paul Tatum @doctatum, a family medicine physician board certified in geriatrics and palliative care who practices medicine in at the University of Missouri in Columbia.  Paul is no stranger to blogging and also posts at Geripal.  Please welcome him to Pallimed! - Christian) When I strike up conversation on the airplane and discussion turns to palliative medicine, the response tends to be either one of a blank stare and question about what is palliative medicine or a knowing smile and a ready story about how hospice and palliative medicine made a ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Paul Tatum Source Type: blogs

2013 TEDMED Report: What ideas could we help spread?
(Ed. - Please welcome another new blogger to Pallimed, Earl Quijada, MD (@equijada). Earl is a hospice and palliative care doctor in the Inland Empire of California. I first met Earl on Twitter and later at the 2011 AAHPM Assembly in Vancouver and I am very excited he is now a Pallimed contributor! - Sinclair) I know I’m not supposed to say this but I’ll say it once - we’re not a death denying society. I’m starting to learn about death in nonclinical settings. My mind is opening and I’m stoked. I just returned from 2013 TEDMED where the opening salvo encouraged me to drop my palliative car...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 26, 2013 Category: Palliative Carer Workers Authors: Earl Quijada Source Type: blogs

Pallimed Blog Updates
I'm sure some of you are surprised to see you email boxes filling up with Pallimed posts again.  Since coming back from the AAHPM/HPNA Annual Assembly we have been busily working on a few projects behind the scenes as we look to the future of this website. Energizing the base We had a great meeting of Pallimed contributors in New Orleans during the New Orleans meeting in March. There were many fresh commitments from some of our key contributors, and you can see that both Lyle Fettig and Suzana Makowski have started writing again.  The conversations sparked a energy which made all of us realize how satisfying, f...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 24, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

What's Your Vision of End of Life Care?
(Ed. - Today's post is the first from Renee Berry @rfberry at Pallimed who is a digital media specialist with a strong passion and extensive knowledge about hospice and pallaitive medicine. Renee and I co-host the weekly hospice and palliative medicine tweetchat on Wednesday nights (along with Alicia Bloom).  We are excited to have her input on the recent TEDMED conference where End of Life issues were featured. - Sinclair)  I noticed an interesting conversation starting on Twitter last week about an illustration drawn as a part of TEDMED's great challenges. TEDMED is an annual conference dedicated to breakthrou...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 24, 2013 Category: Palliative Carer Workers Authors: Renee Berry Source Type: blogs

Prevention and Palliation: Together Forever
What do the following patients have in common? A 45 year old man who has a 60 pack-year history develops lung cancer and is diagnosed at an advanced stage.* A 33 year old woman with post-traumatic stress disorder who has been drinking since the age of ten and develops fulminant hepatic failure. An 82 year old man ends up in the surgical intensive care unit after a self-inflicted gunshot wound three months after his wife of 60 years dies. The mother of a 55 year old woman with morbid obesity, obstructive sleep apnea, and pulmonary hypertension laments that the park nearby isn't safe for people to use. All four patients ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 15, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

How Does Physician Assisted Dying Work? Beyond philosophy and rhetoric
The New England Journal of Medicine released an article this week on the experience of implementing a Death with Dignity program in Washington at a University based Cancer Center. In the Fall of 2008, the voters of Washington State passed the Death with Dignity act allowing for the legal practice of prescribing medications for the self-administration by a person with a terminal illness with the goal of ending their life. This can be described using a variety of briefer terms: physician-assisted suicide, physician-assisted death, medically hastened death and others. (For the record it is not technically euthanasia since tha...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 10, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

End of Life in the News: Where are all the Palliative Care Teams?
by Suzana Makowski By now, many of you may have heard or read Charles Ornstein,(@charlesornstein) a Pulitzer Prize-winning senior reporter, on NPR or in ProPublica on "How Mom’s Death Changed My Thinking About End-of-Life Care."  He tells of his mother's final days in the hospital, after having aspirated during the placement of a naso-gastric tube that resulted in cardio-pulmonary arrest and subsequent days in the ICU.  He speaks to the sense of being alone and the lack of guidance in the process of end-of-life decision-making.  My heart dropped when hearing this story - for his (and hi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 9, 2013 Category: Palliative Carer Workers Authors: Suzana Makowski Source Type: blogs

Basketball, The Presence of Suffering, and the Practice of Medicine
It's the first week of April, and we're on the verge of the penultimate games of the NCAA Basketball Tournaments.  Since only four teams remain, chances are good that your favorite team is out of the tournament.  As someone who has experienced that feeling 25 times over the years (but who's really counting?), I offer my condolences.  To the few who still have a team in the tourney, condolences are pending for 75% of you. In honor of March Madness, I offer a challenge.  Watch the video below and follow the narrator's instructions to count the number of times the team with the white shirts passes the bal...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 4, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

Death Panels a Solution to Unwanted Intrusion at End of Life
by Abe R Feaulx, Special Reporter When death is near, and no cure is available, more and more patients are turning to hospice to meet their end-of-life needs. To meet those needs, more and more hospice agencies are building hospice homes. These state-of-the-art facilities provide a place for patients to spend their final days, away from the commotion of the hospital or the dreariness of the nursing home. A hospice home is a free-standing facility designed to provide a private and comfortable setting where patients can die peacefully, often surrounded by friends and family. Yet many hospice homes are finding that privacy c...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 1, 2013 Category: Palliative Carer Workers Authors: Abe R Feaulx Source Type: blogs

State of the Science from the 2013 AAHPM Annual Assembly
The State of the Science plenary is one of my favorite traditions at the AAHPM Annual Assembly.   This year, Jay Horton and Kim Johnson took the lead in presenting analyses of some of the previous year's most important hospice and palliative medicine research.  For those attendees interested in seeing their slides again, you can find them here. Some of the research below further confirms our previous understanding of the state of the science (for instance, the studies on the low utility of feeding tubes in many circumstances).  Other studies provide quality randomized controlled trial data on questions whic...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 17, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

David and Debbie Oliver's AAHPM Plenary: Comforting Others While Living With Illness
One could write pages about David and Debbie Oliver's remarkable plenary presentation Friday at the American Academy of Hospice and Palliative Medicine Annual Assembly in New Orleans.  David has stage IV nasopharyngeal carcinoma and has taken his cancer journey to the public.  Before I go any further, I'll refer you to David's book, "Exit Strategy: Depriving Death of Its Strangeness," Paul Tatum's Interview with David at Geripal from August 2012, and below, see a clip from David's Cancer Videoblog in which he talks about cancer and palliative care. Of the many themes which arose from their presentatio...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 15, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

7th Annual Pallimed and Geripal Gathering
Are you excited about the AAHPM/HPNA/SWHPN 2013 Annual Assembly this week?  I hope you or at least your colleagues are able to attend.  We will be continuing the tradition of gathering readers and contributors to this blog and Geripal.  It has grown over the years naturally and we are excited to meet other people you may only nknow by a screen name or email address. There will be a strong Pallimed contingent this year with Drew Rosielle, Lyle Fettig, Jeanette Ross, Holly Yang, Suzana Makowski, Thomas Quinn, and Amber Wollesen in attendance, so please rech out and say hello. We do have a date and time for t...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 11, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs