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Evidenced based medicine

Enough with the crystal balls!

I’m puzzled at how most clinicians I work with have somehow learned to use the crystal ball metaphor when discussing prognosis. As in “We don’t have a crystal ball” (so we can’t say how much time you have left). Really? Read the rest of this entry »

Language is Important! by JPM Columnist Marian Grant, NP

We all have experience with patients and families where what we say, and how we say it, matters. As palliative care professionals, most of us are expert communicators. We know, for instance, that talking about DNAR (Do not attempt resuscitation) vs. DNR (Do not resuscitate) can result in two different conversations. But are we careful enough about the words we use when we talk about palliative care? Read the rest of this entry »

Prometheus’ Predicament Part 2 of 3: Prognostication in ETOH Hepatitis

Key prognostic indicators in ETOH hepatitis include the Maddry Discriminant Function and MELD scores. The DF helps in determining management strategy as well with the DF cut off of 32 ..... read more... Read the rest of this entry »

Prometheus’ Predicament Part 1 of 3: A case of ETOH Hepatitis

A patient in his fifties was brought in by his mother on his birthday for acute detoxification. Patient had been holed up alone in his home binge drinking for many weeks. When mom went to wish him for his birthday, she noticed that he was inebriated, jaundiced and had lost a lot of weight and drove him immediately to the ER Read the rest of this entry »

American Board of Internal Medicine releases new MOC module on Hospice and Palliative Medicine

We have achieved a huge milestone for palliative care. Earn 10 MOC credits by completing of the new ABIM Hospice and Palliative Medicine Self Evaluation Module! This module consists of 25 multiple choice questions, rationale for the answer choices for each question and a set of references. Read the rest of this entry »

Towards a Broader Definition of Healing

For many patients, healing refers ultimately to cure. Palliative care supports patients on this journey, but we also recognize that as a person approaches the end of life, healing can shift from cure to represent not only relief from pain or nausea, but an opportunity to reconcile families, bring resolution to old hurts or unmet expectations. Read the rest of this entry »

Dying Cancer Patients

Dying cancer sufferers should not be given “futile” and expensive drugs, experts have said in a warning over the “culture of excess” in treating the disease..... Read the rest of this entry »

Palliative Care State-by-State report

CAPC has just released a “report card”reflecting on the state of palliative care across the nation. THe report was created for the first time in 2008, and apparently as a nation since then we went from a C to a B. What it means in reality? I guess more quality palliative care programs across the nation.

Seven states and DC and got an A, more than half of the states are ranked B, and there are two that got an F. One can download the full report here or just look at specific state statistics.

 

Burdensome Transitions: Harry Potter and Health Care Reform: by Joan Teno, MD, MPH

Based on research and my clinical experience, my concern is the financial incentives of Medicare and Medicaid result in some health care providers hospitalizing NH residents to qualify them for SNF Medicare benefits. My fear is what you pay for is driving force in these health care transitions. Often this is not an explicit decision, but the middle-of-the-night reflex act of sending a frail, older patient to the ER. Read the rest of this entry »

Ondansetron associated with fatal arrythmias

The FDA has issued a warning that Ondansetron may increase the risk of developing prolongation of the QT interval, which can lead to an abnormal and potentially fatal heart rhythm, including Torsade de Pointes. Read the rest of this entry »

Call for Preventive Palliative Care

HHS Secretary Sebelius & U.S. Surgeon General Regina M. Benjamin unveiled the first ever National Prevention Strategy outlines the ways that public and private partners can help Americans stay healthy and fit and improve our nation’s prosperity. I applaud this seminal national effort. I would also like to call attention to the fact that there is currently no information about "preventive palliative care" in this important national document. Read the rest of this entry »

Watching videos helps patients make EOL decisions

The CBS Evening News ran a story last week that highlighted the fact that 25% of all Medicare spending (about $100 billion) occurs during the last year of life, in part because patients are receiving futile, aggressive treatments. The news story featured a 53 year old woman who was diagnosed with pancreatic cancer. It also talked compassionately about how difficult it is as a doctor to tell a patient that curative treatment is not likely to be effective.

Read the rest of this entry »

Can We Talk?
Watch and share this five minute video about the need for prophylactic end-of-life conversations. Laura Heldebrand, an ICU nurse tells her mother's story.
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