Thursday, July 8, 2010

Educational Exchange/Editorials I Loved and Didn't

This is a reminder that the deadline for submissions for the Educational Exchange at AAHPM 2011 is next week - July 16.  See my prior post.  It's a really good thing.  Link to more information is here.

And a few editorials/commentaries recently that I loved, or didn't love, but I thought were worth mentioning, acknowledging that I probably won't be blogging about them in any depth.


  1. First is one marking the 50th anniversary of the development of CPR.  It's a nice history, celebrates the thousands of lives it has saved, and talks about current challenges (particularly with improving rates of bystander CPR for witnessed out of hospital cardiac arrests).  All good, but it studiously avoids any discussion of the profound cultural and medical impact the procedure has had in its widespread application to otherwise dying patients, not those suffering a simple cardiac arrest, and the psychic trauma inflicted on patients and families who have been lead to believe that not seeking CPR when dying from an untreatable terminal illness is something akin to suicide, giving up, losing faith, etc.
  2. Next is a commentary about the fact that many people with intellectual disabilities are surviving into mid and late adulthood, and how ill prepared most clinicians are to deal with the unique needs of this population (e.g. the older patient with Down syndrome).   While it doesn't mention palliative care of end of life care, this is a subject that's near and dear to my heart, and has begun to be investigated. 
  3. Last is an eye-opening editorial by Tim Quill and a colleague about decision making in brain injured patients, and the very uncomfortable matter of hospital reimbursement:
"At the University of Rochester Medical Center, we launched an initiative to provide early consultation about palliative care for patients with severe brain injury, as part of routine ICU care. This initiative resulted in earlier and more systematic discussions with families about prognosis, patients' values, and acceptable outcomes. After implementation, there was a small but significant decrease in the number of tracheostomies performed and an increase in the number of patients from whom mechanical ventilation was withdrawn without tracheostomy. Families were satisfied with the quality of care and the choices they were given, but the process had a significant negative effect on the hospital's bottom line because of the dramatically reduced reimbursement."

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