Emita's gift to her children
In honor of the yarzheit (anniversity) of my mother's death, I am reprinting a post from March 14, 2007. The message remains important for all families, and I think she would have liked me to remind you.In the story below, there is an important sentence: We discussed possible actions with Dr. X and decided to halt all invasive treatments, a course that my family has long agreed to.I know from personal experience what this simple bit of family planning can mean for the terminally ill patient and for his or her relatives. My Mom's living will had this directive, among others:That no extraordinary measures be used...
Source: Running a hospital - May 23, 2013 Category: Health Managers 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, ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 22, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Top stories in health and medicine, May 21, 2013
Brought to you by MedPage Today.
1. Medical Home Transition Long but Worth It. The path to becoming a patient-centered medical home is long, rough, and varies for each practice, but getting there is essential to providing high-quality, affordable healthcare to all Americans.
2. Any Bed-Sharing Puts Baby at Risk for SIDS. Bed-sharing is associated with a five-fold increased risk of sudden infant death syndrome (SIDS) among younger infants even if their parents don’t smoke, use alcohol, or take drugs.
3. No Major Benefit for IV Feeding in ICU. Early parenteral nutrition in critically ill adults who could not tolerate e...
Source: Kevin, M.D. - Medical Weblog - May 21, 2013 Category: Family Physicians Tags: News Health reform Pediatrics 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 mus...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair 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 mus...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Our most important medical test device for cancer patients – the scale.
Sometimes in my practice, the nursing assistants would forget to take a patient’s temperature or even their pulse or blood pressure. But one test they never failed to do was to weigh the patient. Nothing better indicated a patient’s clinical status than his/her weight. If their weight was stable, then they were successfully holding off the cancer. If the weight went up, perhaps they were winning the battle. But if their weight went down, it was time to worry. Of course many will say that it is the chemotherapy that is making the patients shed pounds. Not true, except for some really harsh protocols. In fact, when we ...
Source: Dr.Kattlove's Cancer Blog - April 2, 2013 Category: Oncologists Source Type: blogs
The exploitation of cancer patients is wicked. Carrot juice for lunch, then die destitute
Jump to follow-up
The time when I lose patience with quacks is when they make unjustified claims about serious diseases. Giving false hope to the desperate (often at a high price) is plain wicked. If the patient stops more effective treatment, it’s homicide. Homeopaths have been jailed for that. Sometimes it’s a result of wishful thinking. Sometimes it’s to make money. The latter is morally more despicable. Both are culpable.
One example was the Totnes (aka Narnia) to “offer real alternatives to the conventional approach to cancer health care“.
Another case, the Dove Clinic, was investig...
Source: DC's goodscience - March 25, 2013 Category: Professors and Educators Authors: David Colquhoun Tags: Barbara Wren Cancer act Cancer Options Carctol College of Natural Nutrition Karol Sikora Patricia Peat Rosy Daniel University of Buckingham alternative medicine CancerActive College of medicine 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
Update on IRS Medical Device Tax Final Rule
Discussion
FierceMedicalDevices noted that while the IRS acquiesced to expanding its over-the-counter provision to include devices bought over the Internet or by telephone, but requests to better define "affordable," elaborate on "minimal or no training" and to exempt Class III devices were all spurned by the IRS.
Mark Leahey, CEO of the Medical Device Manufacturers Association, said the final ruling does nothing to dull the blow the 2.3% tax will deliver to jobs and innovation in the industry. “There is growing bipartisan support in Congress to repeal the medical device tax, and MDMA remains committed to working...
Source: Policy and Medicine - January 8, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs
Fourth time's a charm? It better be.
About 2 weeks ago (June 8th) I had my first formal visit with the spine surgeon, along with a medical resident on the surgical team. The conversation was sobering. They admitted that it could be possible to improve my quality of life with another spinal fusion surgery. But, they said, the procedure would be a true challenge for them and the risks would be great for me. There are many factors to consider before surgery even begins, but first… what would they do in the actual surgery?
Step 1: Make an incision on my (most likely) right side, across the ribs and under the arm.
Step 2: Crack a rib or two open (to make roo...
Source: Cancer, life, and me - June 22, 2011 Category: Cancer & Oncology Authors: Chris Tags: General Source Type: blogs
