Wednesday, December 3, 2008

Pall-Pourri

So-super-briefly you won't believe it.

1)
JAMA has a paper looking at some aspects of the 'natural history' of LVADs (see recent post). The paper adds some further detail to the review I blogged about before - complication rates, etc. One question it answered for me is that how many patients 'get off' LVAD therapy without heart transplantation (the answer is just a few percent at one year - the rest died or continued on the LVAD). Notably, this study confirms patients who receive LVADs after a cardiac surgery do a lot worse than those who don't (presumably these patients suffered major complications post-operatively). Annual cost ~$150,000. This is the future of medicine, unless our economy and health care system really does collapse this time, all of us in palliative care will be caring for more and more of patients before (hopefully) and after LVAD implantation.

2)
Tapendatol is a new oral analgesic just approved by the FDA for moderate to severe acute pain (Medscape article here - sorry you need a free log-on sometimes and I couldn't find a better freer source). Apparently both a mu-opioid receptor agonist, with some other properties like norepinephrine reuptake inhibition - smells somewhat tramadol-ish to me. Anyone know anything about this? Or of research in cancer pain populations?

3)
Archives has a paper looking at rate of GFR decline and mortality in older adults (only for the prognosis completists) as well as a prospective study looking at depression and antidepressant use in CHF patients suggesting that it's the depression itself and not antidepressant use which accounts for increased mortality. Hooray.

4)
The depression and physician assisted suicide fist-fight (which one could cartoonishly characterize as the depression-doesn't-matter-in-PAS vs. screen-'em-all-fools debate) continues in letters to the editor in BMJ recently. Letters here, here, and here; blog post about original article here.

BMJ also has a letter arguing with the cancer pain guidelines I blogged about here: the letter makes a not-completely-crazy argument that buccal/transmucosal fentanyl should be considered the breakthrough med of choice at least for some types of 'breakthrough' pain.

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