Friday, July 30, 2010

Donating Eggs from an Anoxic Brain Injury Patient?

Last week NEJM published an interesting case in the ongoing series: "A Request for Retrieval of Oocytes from a 36-year old Woman with Anoxic Brain Injury." Usually these cases are diagnostic dilemmas. This one focused on an ethical dilemma at end-of-life. It got coverage in the mainstream media as well.

The Case
A 36-year-old woman, in overall good health taking oral contraceptive pills (OCPs), was on a prolonged international flight, and collapsed. A physician on the plane found no pulse. A 2-hour long, in-flight, complicated course of ACLS ensued with compromised ventilation, until the plane made an emergency landing in Boston. The patient presented to the MGH ED approximately 2.5 hours after her collapse, with unstable vital signs and arrhythmia. She was intubated with a Glasgow Coma Scale (GCS) of 9 with some lateralization, eyes roving, not tracking with disconjugate gaze, brain-stem and spinal reflexes intact. Her work up revealed right lower extremity DVT, with multiple bilateral pulmonary emboli and evidence of right-heart strain. Initial CT and MR neuroimaging was unremarkable. The patient was admitted to the ICU.

Read more »

Friday, July 30, 2010 by Brian McMichael, M.D. ·

Your Death-Venture Will Begin Shortly

[I would like to introduce a new contributor to Pallimed, Holly Yang, MD  from San Diego Hospice and The Institute for Palliative Medicine. I have been courting Holly for a while to get her to blog for us, so I am glad to see her debut today! You can also find this web- and ocean-surfing doctor on Twitter by the handle @hollyby.  As with all of our contributrs all posts are her own and not the opinion of her employers.  Please welcome her with a few comments - Sinclair, ed. ]

As one of the comments on the Economist website said, “What the heck do they want to promote now – Death Tourism?” As much as I love traveling, I’m not packing my bags just yet. But, I will give you the low-down on the 39-page Quality of Death (QOD) report by the Economist Intelligence Unit and commissioned by the Lien Foundation, which ranks end-of-life care across 40 countries.  Go get your travel kit ready... here we go!


Read more »

by Holly Yang, MD ·

Wednesday, July 28, 2010

'Little old ladies with arthritis starting to die...'

A couple of recent NY Times articles.

The most salient one is a discussion of the movement in Washington State to officially DO SOMETHING about prescription opioid abuse, coming on the heels of course of the FDA rejecting the current REMS plan as, essentially, not going far enough.  The article basically discusses the discussion in Washington about what to do; no formal new plans have been offically proposed as far as I can tell from the article.  This is what they mention that is being discussed:

The regulations would not affect how narcotics are used to treat patients with cancer or those at the end of life because experts agree that such patients should receive as much pain medication as necessary.  
The panel is expected to require that, among other things, doctors refer patients to a pain specialist for review when their daily medication increases to a specified dosage level and they do not show improvement. The specialist can then determine whether to continue the drug, reduce it or use other treatments like physical therapy.
This is an exemplary quote from the article: 
“This is not just about addicts but little old ladies with arthritis starting to die because of this kind of medical practice,” said Dr. Alex Cahana, a pain specialist involved in devising the regulations in Washington State.

Read more »

Wednesday, July 28, 2010 by Drew Rosielle MD ·

What Can Palliative Medicine Learn from the Old Spice man?

And now for a little talk about six-pack abs...(not mine)

I am sure most of you have heard of if not seen the Old Spice Man (aka Isaiah Mustafa) and the sarcastic send up of all things macho.  The first one aired during the Super Bowl and was considered a marketing success with a strong post-Super Bowl viral spread. [For email subscribers, click here to go to the post on the web to see all the videos in this post]



Read more »

by Christian Sinclair ·

Monday, July 26, 2010

Atul Gawande Checks Out Hospice and Palliative Care

Hopefully most of you have heard of Atul Gawande, one of the more prolific and best physician writers of the past decade.  You may have even read one of his books: Better, Complications, or The Checklist Manifesto.  I was curious if he was going to get around to focusing on palliative care. The New Yorker published his latest article, called 'Letting Go' early online for the August 2nd edition of the magazine.

Read more »

Monday, July 26, 2010 by Christian Sinclair ·

Wednesday, July 21, 2010

Is it time to abandon methylphenidate?

Journal of Clinical Oncology has published a large (for palliative care), randomized, placebo-controlled trial of long-acting methylphenidate for cancer-related fatigue.  It continues the trend of mixed-to-negative findings (in controlled studies) of methylphenidate for fatigue (see the last big-ish RCT here; a negative RCT here for 'prophylactic' methylphenidate; a brow-furrowing meta-analysis of the whole topic here;  some grey literature on the effectiveness of modafinil for severe fatigue in cancer patients undergoing chemotherapy), and raises the question is it time to abandon methylphenidate?

Read more »

Wednesday, July 21, 2010 by Drew Rosielle MD ·

Thursday, July 15, 2010

Quality of Death Index from the Lien Foundation

(See the previous post for info on the Life Before Death site and outreach campaign)
The Lien Foundation and Singapore Hospice Council have released the first international Quality of Death Index.    Even the name of the report is pretty interesting.  I wonder how long they took deliberating about the name.  obviously a play on Quality of Life, but POW! 'death' right there in the name, not 'end of life' or some euphemism.  But that underscores one of the main goals of decreasing the taboo about dying and increasing the conversation.  For the index they ranked 40 countries along the following areas:

  • basic end-of-life healthcare environment
  • availability of end-of-life care
  • cost of end-of-life care
  • quality of that care


Read more »

Thursday, July 15, 2010 by Christian Sinclair ·

Life Before Death: Best. Website. Ever.

Finding humor in death and dying is probably an even more taboo subject than death itself, yet many who have worked with people near the end of life can probably recall numerous situations were laughter really was a dose of good medicine for all involved.  Humor can be a great way to break tension, yet still speak to some truths, however painful.  For example, I recently saw this balloon in a patient's room (picture taken with permission of the family):
They shared that the patient got a big kick out of seeing this instead of the common yet false exhortation of 'Get well soon.'  The balloon often took people by surprise when walking into the room, and that seemed to be the zinger the patient enjoyed to give.

Read more »

by Christian Sinclair ·

First Inaugural Tweetchat for #HPM

Effective use of social media in health care can be elusive.  It is one thing to say 'Be our friend on Facebook' or 'Follow us on Twitter', but quite another to foster a community.  As Steve Smith, CEO of AAHPM Tweeted tonight:

  ssmithaahpm Martha Twaddle spoke to the AAHPM staff this week about "finding her tribe" in palliative care; this feels like the Twitter equivalent! #hpm -8:50 PM Jul 14th, 2010

The Twitter equivalent Steve is referring to is the first Twitterchat for Hospice and Palliative Medicine which took place Wednesday night.  I never announced it on the blog, but instead Tuesday night sent out a tweet announcing the event less than 24 hours away:

Christian Sinclairctsinclair Official Announcement of the first ever Hospice and Palliative Medicine TweetChat Wed at 8p CST use hashtag #hpm




Read more »

by Christian Sinclair ·

Tuesday, July 13, 2010

Welcome Mashable Readers!

We are glad to have you here at Pallimed if you have come to us from the recent Mashable post on 5 Ways Social Media Promote Good Health.  (For our regular Pallimed readers, Mashable is the top site for all things social media and the #3 ranked blog by Technorati.)


Since you clicked on the link to Pallimed, I thought I would make it easy for you to find some of our good content, especially related to social media and hospice and palliative medicine. 
Also check out our sister blogs: Arts & Humanities and Case Conferences, our our blog post labels for blogs and Twitter.

If you have any questions please leave a comment!

Tuesday, July 13, 2010 by Christian Sinclair ·

Why Paul The Prognosticating Octopus Pesters Me

Ahhhh....we can all breathe a collective sigh of relief now that the World Cup is over.  The soccer football lovers are no longer anxious and missing work watching games at 930am. The soccer haters can be happy they no longer have to hear about Ronaldinho, Xavi, Bafana Bafana, Vuvuzela, pitches, kits, Jabulani balls and other such inanity. And everyone else can just let out a big sigh, because it helps you feel better and surely  the World Cup is stressing you out.

But the thing I can't get over is the story of the octopus in Germany who 'predicted' the correct winner of 7 games featuring Germany and the final between Spain and the Netherlands.  He has been called Paul the Psychic Octopus but since he really can't read people's minds (like a psychic), most reputable news outlets switched to the somewhat more accurate 'prognosticating' octopus.

Read more »

by Christian Sinclair ·

Palliative Care Grand Rounds Up at Geripal

Palliative Care Grand Rounds was posted last week at Geripal by Eric Widera.  He did a great job making a game out of it using 3 seemingly random things mentioned in each post as the heading for each submission.  Head over to the always thought provoking Geripal and get the best of the hospice and palliative care blogosphere.

As always go comment on the blogs you read to keep encouraging good content!

And if you want to go one better you can email palliative care grand rounds to your teams, post it to your Facebook page and share great palliative care writing.

See past postings of Palliative Care Grand Rounds at the PCGR blog.

Photo credit: (Flickr user catcubed)

by Christian Sinclair ·

Thursday, July 8, 2010

Randomized! Trial! of Prognotic Disclosure Methods!

American Journal of Respiratory and Critical Care Medicine (AJoRaCCM!) has published a randomized trial of two methods of prognostic disclosure about critically ill patients.  The exclamation points represent artifacts of my slack-jawed shock when I read the article's title:  a controlled trial evaluating how we should talk with patients is a very rare thing.  Although while after reading the trial, my reaction is more of a (!) - more questions than answers dammit! - why does it always have to be this way! - one wasn't of course expecting big answers, and the trial highlights some important questions. 

Read more »

Thursday, July 8, 2010 by Drew Rosielle MD ·

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.

Read more »

by Drew Rosielle MD ·

Tuesday, July 6, 2010

Why Palliative Care Needs Social Media

[ATTENTION: If you are apathetic or antagonistic towards social media of if I (or someone else) have ever turned you off with all this social media talk, I beg you to please read this one blog post if you care an ounce about hospice and palliative medicine.]

[DISCLAIMER: Yes I am giving a webinar in a July 21st with CAPC on social media in palliative care, and yes I would encourage you and your team/agency to sign up. And I hope this post tells you why you should do that.]

Now that we have that stuff out of the way, I will ask you one simple question to show you why you should be part of a palliative care movement with social media.

Have you ever wondered (aloud or to yourself) why people never hear or understand about hospice and palliative care until you have to explain it to them?

Read more »

Tuesday, July 6, 2010 by Christian Sinclair ·

Monday, July 5, 2010

Self Care of the Palliative Care Clinician

In reviewing the hospice and palliative medicine (HPM) fellowship lecture series for our upcoming academic year, Karin (the fellowship director) and I (hospice site director) talked a bit about self-care as part of a well-rounded curriculum.  We have 6 hours of the nearly 100 hours of lecture/small group dedicated to self-care sessions with the faculty, fellows, and community professionals who attend the lectures.  It may seem like a small percentage but when compared to other specialties this is a lot of time dedicated solely to avoiding burnout beyond the normal de-briefings that occur at the point of care during the clinical week.

Read more »

Monday, July 5, 2010 by Christian Sinclair ·