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A blog about recent hospice and palliative medicine research, publications, and news, aimed at health care professionals.
Pallimed Bloggers
30 posts
Lyle Fettig, MD
2 posts
Brian McMichael, MD
6 posts
Christian Sinclair
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- June 30, 2011
- 12:59 AM
- 970 views
The New York Times Takes on the Issue of Rising Hospice Costs
by Christian Sinclair, MD in Pallimed: a Hospice & Palliative Medicine Blog
This week the New York Times talks about the rising costs of providing hospice care in America with a particularly juicy hook about a nearly $25 million whistle-blower settlement against an Alabama hospice. From there it talks about the focus of some hospices to seek patients who are likely to have longer lengths of stay, like dementia and stroke. One research analyst even goes as far to say "It's a lucrative business, at least under the current reimbursement system." They also........ Read more »
TAYLORJR, D., OSTERMANN, J., VANHOUTVEN, C., TULSKY, J., & STEINHAUSER, K. (2007) What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?. Social Science , 65(7), 1466-1478. DOI: 10.1016/j.socscimed.2007.05.028
- June 17, 2011
- 01:02 AM
- 1,276 views
Routine Palliative Medicine Consults for VAD Destination Therapy
by Brian McMichael, M.D. in Pallimed: a Hospice & Palliative Medicine Blog
In this month's issue of the Mayo Clinic Proceedings is the first article reporting on a case series with inclusion of palliative medicine (PM) consultations as a routine, integrated part of pre-op or early post-op care for patients receiving ventricular assist device (VAD) as destination therapy (DT). Both Drew and Holly have posted previously on Pallimed about VAD DT.
The Mayo Clinic is a nationally and internationally recognized tertiary and quaternary referral center. As such, beyond the ........ Read more »
Swetz KM, Freeman MR, Abouezzeddine OF, Carter KA, Boilson BA, Ottenberg AL, Park SJ, & Mueller PS. (2011) Palliative medicine consultation for preparedness planning in patients receiving left ventricular assist devices as destination therapy. Mayo Clinic proceedings. Mayo Clinic, 86(6), 493-500. PMID: 21628614
- June 13, 2011
- 12:52 AM
- 592 views
"If I've got 6 months to live, I want to know so I can party"
by Drew Rosielle MD in Pallimed: a Hospice & Palliative Medicine Blog
Journal of Supportive Oncology recently published the results of a pilot trial of an evidence-based decision aid for patients with metastatic cancer (free full-text available here, as always with JSO papers).
This was a small, single cancer center study of 27 patients with metastatic solid tumors (mean age 63 years, 56% African American, with a mixture of metastatic breast, colon, lung, and hormone refractory prostate cancers). All patients at the center (it's not clear how the patients ........ Read more »
Smith TJ, Dow LA, Virago EA, Khatcheressian J, Matsuyama R, & Lyckholm LJ. (2011) A pilot trial of decision aids to give truthful prognostic and treatment information to chemotherapy patients with advanced cancer. The Journal of Supportive Oncology, 9(2), 79-86. PMID: 21542415
- June 13, 2011
- 12:11 AM
- 627 views
Responding to Cancer Care Costs: Palliative Care Community - Get Ready
by Suzana Makowski MD in Pallimed: a Hospice & Palliative Medicine Blog
Last year, about this time, the New England Journal of Medicine (NEJM) rocked the world of Oncologists and Palliative Care Specialists, publishing an article about how early palliative care interventions not only add to quality of life, but also length of life. This year, NEJM published an equally provocative piece, a "Sounding Board" article that addresses the need to curve the cost of cancer care. Get ready Palliative Care colleagues to respond once again.
The anticipated growth in cost of ca........ Read more »
Smith TJ, & Hillner BE. (2011) Bending the cost curve in cancer care. The New England Journal of Medicine, 364(21), 2060-5. PMID: 21612477
- April 25, 2011
- 02:29 AM
- 1,269 views
Chemotherapy complications round-up...neuropathy,
by Drew Rosielle MD in Pallimed: a Hospice & Palliative Medicine Blog
A few recent studies about mitigating chemotherapy complications have caught my eye and bear mentioning.
The first couple are about neurotoxic complications of chemotherapy. I've been seeing a lot of patients who have had quite severe problems from (usually chronic) peripheral neuropathies related to their chemotherapy. At least occasionally these complications are devastating - leading to very difficult to manage, disabling pain. I haven't seen this confirmed in the literature, not th........ Read more »
J. P. Durand, G. Deplanque, V. Montheil, J. M. Gornet, F. Scotte, O. Mir, A. Cessot, R. Coriat, E. Raymond, E. Mitry, P. Herait, Y. Yataghene, and F. Goldwasser. (2011) Efficacy of venlafaxine for the prevention and relief of oxaliplatin-induced acute neurotoxicity: results of EFFOX, a randomized, double-blind, placebo-controlled phase III trial. Journal of Clinical Oncology. info:/10.1093/annonc/mdr045
Smith TJ, Coyne PJ, Parker GL, Dodson P, & Ramakrishnan V. (2010) Pilot trial of a patient-specific cutaneous electrostimulation device (MC5-A Calmare®) for chemotherapy-induced peripheral neuropathy. Journal of pain and symptom management, 40(6), 883-91. PMID: 20813492
Loprinzi, C., Reeves, B., Dakhil, S., Sloan, J., Wolf, S., Burger, K., Kamal, A., Le-Lindqwister, N., Soori, G., Jaslowski, A.... (2011) Natural History of Paclitaxel-Associated Acute Pain Syndrome: Prospective Cohort Study NCCTG N08C1. Journal of Clinical Oncology, 29(11), 1472-1478. DOI: 10.1200/JCO.2010.33.0308
Cruz, F., Iracema Gomes Cubero, D., Taranto, P., Lerner, T., Lera, A., Costa Miranda, M., Cunha Vieira, M., Souza Fêde, �., Schindler, F., Carrasco, M.... (2011) Gabapentin for the prevention of chemotherapy- induced nausea and vomiting: a pilot study. Supportive Care in Cancer. DOI: 10.1007/s00520-011-1138-4
- April 21, 2011
- 10:00 PM
- 1,157 views
Continued deficits in the evidence base for palliative care in oncology
by Thomas Quinn, APRN, CHPN in Pallimed: a Hospice & Palliative Medicine Blog
An unusual and sobering study on the state of the “palliative oncology literature” has recently been published online. Searching 6 bibliographic databases, this group from M.D. Anderson undertook a massive review of the palliative oncology literature, comparing from 2004 and 2009 the number of articles, proportion of all oncology articles, topics, and study designs.
The paper begins by highlighting the familiar barriers to palliative care research: limited research funding, few personnel tr........ Read more »
Hui, D., Parsons, H., Damani, S., Fulton, S., Liu, J., Evans, A., De La Cruz, M., & Bruera, E. (2011) Quantity, Design, and Scope of the Palliative Oncology Literature. The Oncologist. DOI: 10.1634/theoncologist.2010-0397
- April 4, 2011
- 01:07 AM
- 1,121 views
Inpatient Rehab Improves Functional Status in Asthenic Cancer Patients
by Brian McMichael, M.D. in Pallimed: a Hospice & Palliative Medicine Blog
The lead research article in the current issue of the American Journal of Physical Medicine and Rehabilitation is Inpatient Rehabilitation Improved Functional Status in Asthenic Patients with Solid and Hematologic Malignancies. It was written by a team from the Department of Palliative Care and Rehabilitation Medicine and the Department of Biostatistics at the University of Texas, MD Anderson Cancer Center. This study sought to compare functional outcomes in asthenic patients with hematologic ........ Read more »
Guo, Y., Shin, K., Hainley, S., Bruera, E., & Palmer, J. (2011) Inpatient Rehabilitation Improved Functional Status in Asthenic Patients with Solid and Hematologic Malignancies. American Journal of Physical Medicine , 90(4), 265-271. DOI: 10.1097/PHM.0b013e3182063ba6
- March 22, 2011
- 10:51 PM
- 1,001 views
Components of Early Outpatient Palliative Care Consultation for Patients with NSCLC
by Lyle Fettig, MD in Pallimed: a Hospice & Palliative Medicine Blog
Vancouver 2011
We don't usually comment on stuff from the main palliative care journals, but the Journal of Palliative Medicine published a study that supplements the NEJM trial on early palliative care in metastatic non-small lung cancer. (See our initial reactions to the NEJM study here, here, and here.) The present study examines the content and length of time spent during the initial outpatient consultation that took place during the trial.
In the study, palliativ........ Read more »
Jacobsen, J., Jackson, V., Dahlin, C., Greer, J., Perez-Cruz, P., Billings, J., Pirl, W., & Temel, J. (2011) Components of Early Outpatient Palliative Care Consultation in Patients with Metastatic Nonsmall Cell Lung Cancer. Journal of Palliative Medicine, 2147483647. DOI: 10.1089/jpm.2010.0382
- March 20, 2011
- 09:29 PM
- 1,271 views
Japanese Communication Style: Comparing the Disclosure of a Nuclear Crisis to Disclosure of Cancer Diagnosis/Prognosis
by Lyle Fettig, MD in Pallimed: a Hospice & Palliative Medicine Blog
A reporter for the New York Times recently made this statement (see video below):
"I think the Japanese tend to try to maintain a veneer of calm and not breech topics that might be alarming or insulting (emphasis added). For example, until recently, it was the norm for families not to tell a family member who had cancer (about the cancer) just to save suffering on the part of the family member and we see some of that mentality at play in some of the communications we have seen from Ja........ Read more »
Miyata H, Takahashi M, Saito T, Tachimori H, & Kai I. (2005) Disclosure preferences regarding cancer diagnosis and prognosis: to tell or not to tell?. Journal of Medical Ethics, 31(8), 447-51. PMID: 16076967
Miyata, H., Tachimori, H., Takahashi, M., Saito, T., & Kai, I. (2004) Disclosure of cancer diagnosis and prognosis: a survey of the general public's attitudes toward doctors and family holding discretionary powers. BMC Medical Ethics, 5(1), 7. DOI: 10.1186/1472-6939-5-7
Hosaka, T. (1999) Disclosure of true diagnosis in Japanese cancer patients. General Hospital Psychiatry, 21(3), 209-213. DOI: 10.1016/S0163-8343(98)00075-9
- February 3, 2011
- 12:42 AM
- 728 views
Does Hospice Agency Profit Status Affect Care Received?
by Christian Sinclair, MD in Pallimed: a Hospice & Palliative Medicine Blog
(Disclaimer: I currently work for a non-profit hospice agency and have not worked for a for-profit agency)
This has been a question that many in the hospice community have asked but the research on the subject has been pretty minimal and most strongly influenced by strong anecdotal experiences from people who have worked on either side of the for-profit (FP) and non-profit (NP) divide. JAMA’s lead article this week ("Association of Hospice Agency Profit Status With Patient Diagnosis, Location........ Read more »
Wachterman, M., Marcantonio, E., Davis, R., & McCarthy, E. (2011) Association of Hospice Agency Profit Status With Patient Diagnosis, Location of Care, and Length of Stay. JAMA: The Journal of the American Medical Association, 305(5), 472-479. DOI: 10.1001/jama.2011.70
- January 23, 2011
- 11:49 PM
- 916 views
Gurgling or Death Rattle? Does it predict pneumonia?
by Christian Sinclair, MD in Pallimed: a Hospice & Palliative Medicine Blog
The physical exam is an important skill for the practitioner of palliative medical arts because we may be working with patients in their home where technical diagnostic options are limited or in a treatment mode that has been defined by avoiding further diagnostic tests. So I am particularly interested by any article that discusses clinical examination skills relevant to palliative medicine. Of course the title did not hurt in causing me to pause. "Gurgling ........ Read more »
Vazquez, R., Gheorghe, C., Ramos, F., Dadu, R., Amoateng-Adjepong, Y., & Manthous, C. (2010) Gurgling Breath Sounds May Predict Hospital-Acquired Pneumonia. Chest, 138(2), 284-288. DOI: 10.1378/chest.09-2713
- January 4, 2011
- 12:30 AM
- 886 views
RCT of Palliative Medicine Consultations on Admission
by Brian McMichael, M.D. in Pallimed: a Hospice & Palliative Medicine Blog
In the current issue of Archives of Internal Medicine, under the category, "Health Care Reform" is a Research Letter entitled, Hospital-Based Palliative Medicine Consultation: A Randomized Controlled Trial. It is brought to you by the good folks at UCSF. It was a 2-year, randomized, prospective, clinical trial of patients 65 years or older with heart failure, cancer, chronic obstructive pulmonary disease, or cirrhosis, who were able to give informed consent, and who spoke English.Patients were r........ Read more »
Pantilat, S., O'Riordan, D., Dibble, S., & Landefeld, C. (2010) Hospital-Based Palliative Medicine Consultation: A Randomized Controlled Trial. Archives of Internal Medicine, 170(22), 2038-2040. DOI: 10.1001/archinternmed.2010.460
- November 30, 2010
- 12:36 PM
- 1,155 views
Are You Glad Darvocet Got Pulled by the FDA? Are You Sure?
by Christian Sinclair, MD in Pallimed: a Hospice & Palliative Medicine Blog
I know many palliative care practitioners were cheering the news that the world's least effective opioid propoxyphene (Darvocet (w/ APAP) /Darvon) (similar efficacy to acetaminophen) is being pulled off the market by the FDA. Along with meperdine (Demerol) I am not sure if a medicine exists that produces as much disdain as propoxyphene amongst palliative care clinicians.
But let's look a little closer as to why this happened. The FDA cites the increasing cardiotoxicity ........ Read more »
Beaver, W. (1984) Analgesic Efficacy of Dextropropoxyphene and Dextropropoxyphene-containing Combinations: a Review. Human , 3(1 suppl), 191-220. DOI: 10.1177/096032718400300118
Collins, S., Edwards, J., Moore, R., & McQuay, H. (1998) Single-dose dextropropoxyphene in post-operative pain: a quantitative systematic review. European Journal of Clinical Pharmacology, 54(2), 107-112. DOI: 10.1007/s002280050430
Ripamonti, C., Bianchi, M., & Bruera, E. (2004) Methadone: An Orphan Drug?. Journal of Palliative Medicine, 7(1), 73-74. DOI: 10.1089/109662104322737278
- November 22, 2010
- 12:54 AM
- 910 views
Prognostic Tool in Pediatric Oncological Hospice
by Brian McMichael, M.D. in Pallimed: a Hospice & Palliative Medicine Blog
In the December 1st issue of Pediatric Blood and Cancer is an article that presents the validation of a prognostic tool in pediatric hospice care. The study was produced by a team from the Hospital A.C. Camargo, a large cancer center in São Paulo, Brazil. Their overall survival rate in the treatment of pediatric cancers is just over 75%, roughly on par with those in the United States at approximately 80%. At this institution, a nurse-led, multidisciplinary palliative care team was developed in........ Read more »
Kurashima, A., Latorre, M., & Camargo, B. (2010) A palliative prognostic score for terminally ill children and adolescents with cancer. Pediatric Blood , 55(6), 1167-1171. DOI: 10.1002/pbc.22644
- November 20, 2010
- 11:00 PM
- 528 views
Prognostic Tool in Pediatric Oncological Hospice
by Brian McMichael, MD in Pallimed: a Hospice & Palliative Medicine Blog
An article in the December 1st issue of Pediatric Blood and Cancer presents the validation of a prognostic tool in pediatric hospice care. The study was produced by a team from the Hospital A.C. Camargo, a large cancer center in São Paulo, Brazil, which developed the prognostic tool to predict 60-day survival of pediatric end-stage oncology patients.... Read more »
Kurashima, A., Latorre, M., & Camargo, B. (2010) A palliative prognostic score for terminally ill children and adolescents with cancer. Pediatric Blood , 55(6), 1167-1171. DOI: 10.1002/pbc.22644
- November 3, 2010
- 10:41 PM
- 670 views
Cartography of EOL Pain
by Brian McMichael, MD in Pallimed: a Hospice & Palliative Medicine Blog
On a new paper in the Annals of Internal Medicine by Alex Smith & Eric Widera of GeriPal.... Read more »
Smith AK, Cenzer IS, Knight SJ, Puntillo KA, Widera E, Williams BA, Boscardin WJ, & Covinsky KE. (2010) The epidemiology of pain during the last 2 years of life. Annals of internal medicine, 153(9), 563-9. PMID: 21041575
- September 26, 2010
- 11:49 AM
- 992 views
Let's Talk about Sex
by Brian McMichael, M.D. in Pallimed: a Hospice & Palliative Medicine Blog
I thought I would post on what I hope will turn out to be an occasional series on sexuality here on Pallimed. We've covered sexuality some before. A post that leaps to mind is one by Christian in 2007 about the controversy that arose over a case where the staff at the world's first hospice designed specifically for young adults openly deliberated and decided to facilitate a 22-year-old patient's request to have sex before he died.
So, my foray is on an article that came ........ Read more »
Rothenberg, M., & Dupras, A. (2010) Sexuality of individuals in the end-of-life stage☆. Sexologies, 19(3), 147-152. DOI: 10.1016/j.sexol.2010.03.006
- September 8, 2010
- 01:11 AM
- 812 views
RCT of Oxygen vs. Room Air (Delivered by a Concentrator)
by Lyle Fettig, MD in Pallimed: a Hospice & Palliative Medicine Blog
Drawing of a nasal cannula from Wikimedia Commons
It's a common assumption amongst both the general population as well as medical professionals that breathlessness equals some problem with oxygen delivery, and therefore, every patient with dyspnea should have at least a little bit of oxygen delivered through a nasal cannula regardless of their oxygen saturation (sometimes endlessly). Because of the ubiquitous nature of oxygen therapy, why not? It helps many patients, and it makes s........ Read more »
Abernethy, A., McDonald, C., Frith, P., Clark, K., Herndon II, J., Marcello, J., Young, I., Bull, J., Wilcock, A., & Booth, S. (2010) Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. The Lancet, 376(9743), 784-793. DOI: 10.1016/S0140-6736(10)61115-4
- July 30, 2010
- 09:07 AM
- 871 views
Donating Eggs from an Anoxic Brain Injury Patient?
by Brian McMichael, MD in Pallimed: a Hospice & Palliative Medicine Blog
focused on an ethical dilemma at end-of-life. It got coverage in the mainstream media as well, about a women who collapsed on an airplane with a pulmonary embolism, had severe anoxic brain injury, and the family requested her oocytes be harvested.... Read more »
Greer DM, Styer AK, Toth TL, Kindregan CP, & Romero JM. (2010) Case records of the Massachusetts General Hospital. Case 21-2010. A request for retrieval of oocytes from a 36-year-old woman with anoxic brain injury. The New England journal of medicine, 363(3), 276-83. PMID: 20647203
- May 5, 2010
- 11:55 PM
- 1,435 views
Hypothermia, SSEPs, and Prognosis
by Drew Rosielle MD in Pallimed: a Hospice & Palliative Medicine Blog
As a follow up for today's top-post, some more floundering about prognosis in brain injuries, and yes this one is for the progno-wonks out there.
Neurology also has an article looking at the prognostic importance of bilateral absence of the N20 response of median nerve somatosensory evoked potentials for patients with hypoxic-ischemic encephalopathy (anoxic brain injury) who have undergone therapeutic hypothermia.
Some background (although this NEJM review is the best place to go........ Read more »
Leithner C, Ploner CJ, Hasper D, & Storm C. (2010) Does hypothermia influence the predictive value of bilateral absent N20 after cardiac arrest?. Neurology, 74(12), 965-9. PMID: 20308680
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