Sunday, January 23, 2011

Could Medicine Learn Something From Sports Statistics?

In my teen years I was a baseball statistic junkie.  I stayed up late playing Earl Weaver Baseball on my Amiga 500, played Pursue The Pennant and had a wicked collection of baseball cards, that now are all gone (*sniff*).  I fell out of that phase but in a recent ESPN Magazine article I was inspired to think again about how medicine often struggles to be creative at times, especially when it comes to our data.  We have tons of data in health care, but do we really analyze it in the best way possible?

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Sunday, January 23, 2011 by Christian Sinclair ·

Gurgling or Death Rattle? Does it predict pneumonia?

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 Breath Sounds May Predict Hospital Acquired Pneumonia" by Dr. Rodrigo Vasquez et al. published in Chest (article behind paywall) is one of only 6 articles in all of PubMed that have 'gurgling' in the title.

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by Christian Sinclair ·

Thursday, January 20, 2011

Hospice and Palliative Care on the Radio

Since I usually hear about a radio interview after the fact, I typically do not post these here, but this one I thought might be particularly interesting since as many of you are opening this email and reading it tomorrow, the show may actually be airing live.

At 9am (Pacific) on KQED (Northern California Public Radio) Andrew Lasher, director of palliative medicine at California Pacific Medical Center and Robert Brody, chief of the Pain Consultation Clinic, member of the board of directors for Compassion and Choices will be talking for an hour on palliative issues.  I do not know either of these docs, but it would be interesting to see if any of you listen live and call in.  We might light up their switchboard.  I am curious if anything about hastened death may come up with Dr. Brody being on the board for Compassion and Choices.

Have any of you done radio interviews?  Any tips or tricks to share with each other?

I have done radio interviews and podcast interviews a few times.  They seem to be pretty low stress compared to TV interviews for me anyway.  One good tip someone gave me was to bring a pen and paper and as people call in, they told me to write down the person's name and the few key things they were asking about so you would not get flustered and forget.  Also it helped so you could say "Thanks for calling in Christine, good question."  Also make sure to ask where the 'mute/cough' button is.  Any other tips?

(Email tip via Chris Okon)

Thursday, January 20, 2011 by Christian Sinclair ·

2010 Hospice and Palliative Board Results Are Out Now

The wait is over as many people checked their email inbox today to find their board results.  Hopefully soon we will see a comprehensive report on pass rates.  Congratulations to all the people who passed their boards.



And if you still have some thoughts about the test now that you have your results feel free to join the comments on our November post about the boards. (Remember your confidentiality oath about the board questions!)

by Christian Sinclair ·

Tuesday, January 18, 2011

Psychological Morbidity in Patients and their Relatives after Severe COPD Exacerbation

A growing number of studies have focused on the psychological burden of advanced disease.  A recently published study in Critical Care Medicine evaluated the psychological burden in patients with COPD and their caregivers after an ICU stay.  The study was performed in France by the same group that brought us the trial of an ICU communication intervention published in NEJM a few years ago.

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Tuesday, January 18, 2011 by Lyle Fettig, MD ·

Tuesday, January 11, 2011

Congrats to the 2011 Hastings Center Cunniff-Dixon Physician Awards

Every January we are excited to celebrate some of the very talented physicians in palliative care with the Hastings Center Cuniff-Dixon Awards.  This year I am particularly excited for many reasons!  First of all my medical director at Kansas City Hospice and Palliative Care, Ann Allegre, MD, FACP, FAAHPM won the senior physician award.  She is a wonderful teacher who has done so much in the Kansas City area to advance palliative care and hospice.  Ann is a dedicated doctor who leads well and brings a variety and depth of experience.

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Tuesday, January 11, 2011 by Christian Sinclair ·

A Little Palliative Care Humor on TV

A new satirical take on TV sports news premiered tonight called Onion SportsDome.  In one of the opening clips (not available online yet), I caught a quick glimpse of palliative care being used for laughs.  The lead-in was that some NFL retirees had escaped and people should be on the look out for them.  The clip itslef is not particularly funny, but I grabbed a quick snap of the screen for all of you who do not have to waste your time watching it.



Any thoughts?

by Christian Sinclair ·

Sunday, January 9, 2011

Hospitalists and Code Status Discussions Upon Hospital Admission: The Importance of Framing

"Frame" sculpture near Strongstry, England
(photo by Liz Dawson) /  CC BY-SA 2.0
Consider a case:  A 60 year-old man is admitted to the hospital with failure to thrive secondary to metastatic cancer.  The physician who admits him asks the question out of the blue, "If your heart stops or you stop breathing, would you want us to attempt to resuscitate you?"  How many times is this exact conversation taking place right now and what do you think the answer usually is?  (The phony stat: "One out of every x minutes, a doctor conducts a code status discussion in a manner that may lead to a decision which is unlikely to help the patient achieve their goals of care.")

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Sunday, January 9, 2011 by Lyle Fettig, MD ·

Is Cyberspace the new Afterlife?

The New York Times had an interesting article last week entitled  "Cyberspace When You're Dead" about the approximately 375,000 Facebook users who die annually.  What happens to the account?  (We have covered this topic before: Amy Clarkson on Pallimed Arts: "Digital Afterlife" in 2009 and my 2010 post "Blogging Til I Die")

This topic is surprisingly gaining more attention for a culture typically described as 'death-denying.'  But I guess you can't really deny death after it happens.  It is very real then and probably easier to talk about since you may still have this online connection to the person even though in real life they are gone.  I suppose it can be eerie to look at someone's last post that may have happened moments before they died like Dr. Frank Ryan who drove a car off a cliff moments after a posting to Twitter.  

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by Christian Sinclair ·

My Most Referenced Palliative Medicine Book - 2 for 1 Offer

I am sure some of you were wondering what to get your team for their holiday gift this year.  Maybe some baked goods (calories-ugh!), gift cards (expensive!), a nice thank you note (to everyone that takes time!), or something else.  Well if you were looking for a great gift to show your appreciation and helps your team (both hospice and palliative care teams benefit) look no further for the perfect present.  The Hospice and Palliative Care Formulary, 2nd ed. from the editors of PalliativeDrugs.com.

They are giving readers of Pallimed a special 2 for 1 offer until the end of January using the code APA*.  

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by Christian Sinclair ·

Wednesday, January 5, 2011

In again, out again: CMS Reimbursement for Advance Care Planning

In a disheartening and aggravating (to me, anyway) reversal, the Obama Administration has announced that the recent approval (for reimbursement purposes) of time spent counseling patients on advance directives will not go in to effect after all (see today’s New York Times article).    As the administration spokesman pointed out, this change does not prevent patients and providers from having these important conversations, but it means that this continues to be a non-billable service under CMS (Medicare) regulations.

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Wednesday, January 5, 2011 by Christian Sinclair ·

Monday, January 3, 2011

Pallimed's Top 10 Viewed Posts of 2010

Thanks for a great 2010 Pallimed readers.  We had over 80,000 visits and over 130,000 page views in the calendar year 2010.  We will be aiming even higher in 2011 and we appreciate your readership and support over the years.  In case you missed some of our bigger posts this year here is a recap of the most viewed posts from 2010 (posts from prior years are not included). Views are listed after the link.


  1. How to Make the NEJM Early Palliative Care Article Spread - 1436
  2. Implantable Cardiac Defibrillators- Hospice Role in Deactivation? - 1269
  3. Game Changer: Early Palliative Care for Lung Cancer Patients Improves QOL AND Median Survival - 1177
  4. NYT on the Death of Palliative Care Physician Dr. Desiree Pardi - 1027
  5. Rob Pardi comments on the NY Times article about his wife, Palliative Care Physician Desiree Pardi - 984
  6. Catholic Directives on Artificial Nutrition and Hydration -892
  7. Life Before Death: Best. Website. Ever. - 886
  8. Why Palliative Care Needs Social Media - 871
  9. Atul Gawande Checks Out Hospice and Palliative Care - 828
  10. Surgical 'Buy-In' and the Surgical Contract - 658
What articles were your favorites?  Any of these that you missed?

Monday, January 3, 2011 by Christian Sinclair ·

Handy Hints for Attending a National Medical Conference

With the 2011 AAHPM Annual Assembly coming up, I will post the 8th edition of Handy Hints for a National Meeting. The original version was written in 2005 (editions have been more often than yearly).  My first national medical conference was a whirlwind of new ideas and experiences some of which I was not necessarily prepared for.  Later this week I will feature How to Give a Great Presentation, 4th edition. And later this month how to use social media to its fullest at a national conference.  Please feel free to comment and leave thoughts from your experience.  And if you don't agree with any thoughts here tell me why!

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by Christian Sinclair ·

RCT of Palliative Medicine Consultations on Admission

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.

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by Brian McMichael, M.D. ·

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