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theory"},{"term":"tappana"},{"term":"tarbi"},{"term":"taylor"},{"term":"tea"},{"term":"telehealth"},{"term":"theatre"},{"term":"thienprayoon"},{"term":"thurston"},{"term":"time"},{"term":"tinianov"},{"term":"toomey"},{"term":"transdisciplinary"},{"term":"transgender"},{"term":"transition"},{"term":"trapasso"},{"term":"trauma"},{"term":"triangulation"},{"term":"tribute"},{"term":"trust"},{"term":"twiter"},{"term":"uncertainty"},{"term":"unconscious"},{"term":"universe"},{"term":"upstairs"},{"term":"urology"},{"term":"van Meines"},{"term":"van mienes"},{"term":"vandekieft"},{"term":"veteran"},{"term":"video"},{"term":"volunteering"},{"term":"warraich"},{"term":"washington"},{"term":"weakness"},{"term":"webinar"},{"term":"whitburn"},{"term":"wollesen"},{"term":"young"},{"term":"young adult"},{"term":"zitter"}],"title":{"type":"text","$t":"Pallimed"},"subtitle":{"type":"html","$t":"Pallimed covers current palliative medicine, hospice, and end-of-life research and news, with a particular focus on publications not from the major palliative care journals.  It is aimed at health care professionals who work with people nearing the end of life."},"link":[{"rel":"http://schemas.google.com/g/2005#feed","type":"application/atom+xml","href":"https:\/\/www.pallimed.org\/feeds\/posts\/default"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/-\/nursing+home?alt=json-in-script\u0026max-results=6"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/search\/label\/nursing%20home"},{"rel":"hub","href":"http://pubsubhubbub.appspot.com/"},{"rel":"next","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/-\/nursing+home\/-\/nursing+home?alt=json-in-script\u0026start-index=7\u0026max-results=6"}],"author":[{"name":{"$t":"Drew Rosielle MD"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/04345646798042773615"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"32","height":"32","src":"\/\/3.bp.blogspot.com\/-sdxTTBPb3Kw\/UddApiGn9-I\/AAAAAAAABLE\/mriu5xh44dA\/s113\/ea37b7645cd78e7867d246cd755bc8d4.jpeg"}}],"generator":{"version":"7.00","uri":"http://www.blogger.com","$t":"Blogger"},"openSearch$totalResults":{"$t":"11"},"openSearch$startIndex":{"$t":"1"},"openSearch$itemsPerPage":{"$t":"6"},"entry":[{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-5855576081533146022"},"published":{"$t":"2019-11-01T14:31:00.001-05:00"},"updated":{"$t":"2019-11-01T15:18:53.647-05:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"caregiver"},{"scheme":"http://www.blogger.com/atom/ns#","term":"caregiving"},{"scheme":"http://www.blogger.com/atom/ns#","term":"communication"},{"scheme":"http://www.blogger.com/atom/ns#","term":"geriatrics"},{"scheme":"http://www.blogger.com/atom/ns#","term":"miles"},{"scheme":"http://www.blogger.com/atom/ns#","term":"nursing home"},{"scheme":"http://www.blogger.com/atom/ns#","term":"reframing"},{"scheme":"http://www.blogger.com/atom/ns#","term":"social work"},{"scheme":"http://www.blogger.com/atom/ns#","term":"social worker"}],"title":{"type":"text","$t":"Community Living for Hospice Patients: Don't \"Put\" People in Nursing Homes"},"content":{"type":"html","$t":"\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"https:\/\/1.bp.blogspot.com\/-ENKDNeYbAGE\/Xbw6vKaZyyI\/AAAAAAABvw8\/04FYULY0B7gN9vvyhQW2U0Hwh4rDGNPKgCLcBGAsYHQ\/s1600\/20130725_144941.jpg\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" data-original-height=\"799\" data-original-width=\"781\" height=\"320\" src=\"https:\/\/1.bp.blogspot.com\/-ENKDNeYbAGE\/Xbw6vKaZyyI\/AAAAAAABvw8\/04FYULY0B7gN9vvyhQW2U0Hwh4rDGNPKgCLcBGAsYHQ\/s320\/20130725_144941.jpg\" width=\"313\" \/\u003E\u003C\/a\u003E\u003C\/div\u003Eby Lizzy Miles (\u003Ca href=\"https:\/\/twitter.com\/LizzyMiles_MSW\" target=\"_blank\"\u003E@LizzyMiles_MSW\u003C\/a\u003E)\u003Cbr \/\u003E\u003Cbr \/\u003ENo one should ever be “put” in a nursing home. You might agree with this statement because you don’t like nursing homes, but that is not what I’m saying. The word “put” is offensive when you are describing a person, unless you are talking about putting a 3 year old in the time out corner because he colored on the walls.\u003Cbr \/\u003E\u003Cbr \/\u003EI would like to make the argument that no adult wants to be ‘put’ anywhere. You put dishes away, you do not put people away. When we are facing a situation in which the care needs exceed the family member’s ability, there are times where the best option is for the elder to \u003Ci\u003Emove to a safer environment\u003C\/i\u003E.\u003Cbr \/\u003E\u003Cbr \/\u003ELet’s look at these two scenarios:\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ci\u003EDaughter puts mom in a facility because mom is too much of a burden for daughter to take care of at home.\u003C\/i\u003E\u003Cbr \/\u003E\u003Cbr \/\u003EOr\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ci\u003EMom moved to a new community in which there were nurses who could take care of her health care needs. There are chefs who make her meals and caretakers who help her with her activities of daily living. She has opportunities to make new friends, play bingo, listen to music, and arrange flowers. Daughter’s time with mom can be spent sharing memories, watching movies and working on jigsaw puzzles together.\u003C\/i\u003E\u003Cbr \/\u003E\u003Cbr \/\u003ESame scenario. Which one feels better to you?\u003Cbr \/\u003E\u003Cbr \/\u003EWe do not want to say to our loved one, “You are too much for me.”\u003Cbr \/\u003E\u003Cbr \/\u003EWhat we want to say is, “I want you to have the best care possible and I believe this choice will be better for both of us. I love you and I will continue to spend time with you.”\u003Cbr \/\u003E\u003Cbr \/\u003EI should know. I was the daughter. I was an only child in my late twenties when my mom’s sister died. My aunt had lived near my mom and checked in on her daily. My mom was in declining in health and not really doing the best job caring for herself. She wrecked her car and wasn’t eating well. And suddenly I was the one responsible for her and I lived 90 minutes away. I was still working full time and tried to take care of things long distance, but I didn’t feel it was working. There was no end in sight either - though she was declining, she wasn’t terminally ill.\u0026nbsp; After touring seven facilities, I found one that I liked and brought her to see it. She liked it and moved to an assisted living facility in my city that would be able to care for her until the end of her life.\u003Cbr \/\u003E\u003Cbr \/\u003EAs it turned out, it was the best decision I could have made. The facility staff welcomed her with open arms and she thrived.\u0026nbsp;She lived there six years and was the happiest I had known her my whole life. During this time my mom and I even became closer than we ever had before.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003EThere is no happy place. Happiness is an attitude.\u003C\/b\u003E\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ca href=\"https:\/\/1.bp.blogspot.com\/-QdO1j_oMSdY\/Xbw6-DZZg2I\/AAAAAAABvxM\/TdZAoOAaGfU_tb-N_Nnf6jSmp4d2GOLMwCEwYBhgL\/s1600\/20130830_101548.jpg\" imageanchor=\"1\" style=\"clear: left; float: left; margin-bottom: 1em; margin-right: 1em;\"\u003E\u003Cimg border=\"0\" data-original-height=\"1600\" data-original-width=\"1200\" height=\"200\" src=\"https:\/\/1.bp.blogspot.com\/-QdO1j_oMSdY\/Xbw6-DZZg2I\/AAAAAAABvxM\/TdZAoOAaGfU_tb-N_Nnf6jSmp4d2GOLMwCEwYBhgL\/s200\/20130830_101548.jpg\" width=\"150\" \/\u003E\u003C\/a\u003EWe’re not supposed to have favorites in hospice care, but a hospice patient who was on service for a couple of years just recently died. I’m really going to miss her. Every time I saw her she was always smiling and expressing gratitude. She was the happiest person I had ever seen in a facility, including my mom. She dressed to the nines with all of her bracelets and necklaces and gushed about the staff, the activities and even the food. As you can imagine, when facility staff were giving tours, they always introduced her to the visitors. This resident also had very attentive staff because she was such a pleasure to be around. Her joy for life was contagious.\u003Cbr \/\u003E\u003Cbr \/\u003EYes, a move to a nursing home is hard, but most patients adjust. In my experience, those who don’t adjust are likely to be unhappy in any setting.\u0026nbsp; There are residents who don’t leave their room at the facility – but I bet you they never left their house either.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ca href=\"https:\/\/1.bp.blogspot.com\/-rjmLmTMzJI0\/XbxDasf14PI\/AAAAAAABvxk\/SxKBlIAygIELmNoKN0FQEhjnJbCixchLQCLcBGAsYHQ\/s1600\/sarah-dorweiler-x2Tmfd1-SgA-unsplash.jpg\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" data-original-height=\"1090\" data-original-width=\"1600\" height=\"217\" src=\"https:\/\/1.bp.blogspot.com\/-rjmLmTMzJI0\/XbxDasf14PI\/AAAAAAABvxk\/SxKBlIAygIELmNoKN0FQEhjnJbCixchLQCLcBGAsYHQ\/s320\/sarah-dorweiler-x2Tmfd1-SgA-unsplash.jpg\" width=\"320\" \/\u003E\u003C\/a\u003EOne final story. A patient who had lived at home ended up moving to a facility due to increased care needs. I visited her a week after she had moved and I personally felt sad that she didn’t have pictures or personal items. She, however, looked around the room devoid of belongings and said, “maybe this is how things are supposed to be. Maybe we don’t need a lot of stuff.”\u0026nbsp; I had no idea she used to be a hoarder. She didn’t know it, but she was embracing the new minimalist trend.\u003Cbr \/\u003E\u003Cbr \/\u003EWe decorate rooms and put pictures on walls at the nursing home because we are the ones who are still attached to belongings and things. Part of growing older is shedding the past and the stuff. If you ask any resident in a nursing home of what they want most, it is not their china or their figurines and sometimes not even their pictures, but rather to be with those they love. Yes, there are those elders who built their home with their bare hands and they are attached to “place” but most of the time, it ends up not being about the place but the fear of being forgotten. Consider this though: in a facility, elders have much more human interaction and attention to emotional needs than they do at home with a single exhausted caregiver who is at their wits end.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ca href=\"https:\/\/1.bp.blogspot.com\/-BWMErJt7pyI\/XbwtJtcKPcI\/AAAAAAABvwU\/0Lv-hfdLIJQ-x7lO9cfsQYk9zwti7ja7QCLcBGAsYHQ\/s1600\/rod-long-y0OAmd_COUM-unsplash.jpg\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" data-original-height=\"1067\" data-original-width=\"1600\" height=\"212\" src=\"https:\/\/1.bp.blogspot.com\/-BWMErJt7pyI\/XbwtJtcKPcI\/AAAAAAABvwU\/0Lv-hfdLIJQ-x7lO9cfsQYk9zwti7ja7QCLcBGAsYHQ\/s320\/rod-long-y0OAmd_COUM-unsplash.jpg\" width=\"320\" \/\u003E\u003C\/a\u003E\u003Cbr \/\u003E\u003Cb\u003ELove and companionship can take place anywhere.\u0026nbsp;\u003C\/b\u003E\u003Cbr \/\u003E\u003Cbr \/\u003EHospice personnel can help family members have these conversations. We lead the way by how we frame it. We can talk about anticipated care needs and why moving may be the best option for care. We can share stories about attentive, compassionate care and the activities that the facility has.\u0026nbsp; We can remind the patients and families that we’ll be there with them too.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003ELanguage matters. Words matter.\u003C\/b\u003E\u003Cbr \/\u003E\u003Cbr \/\u003ELet's talk about RESPITE\u003Cbr \/\u003E\u003Cbr \/\u003EIf you’re talking about a temporary respite with a patient, how do you bring it up?\u0026nbsp; Is it because the caregiver is exhausted? How would you feel if you were the patient and someone told you that you were “exhausting?”\u0026nbsp; Imagine hearing, “I need a break from you.” The caregiver needs to be firm with the patient about their needs but they can do it in a way that doesn’t come across in a way that makes someone feel like a burden.\u003Cbr \/\u003E\u003Cbr \/\u003EConsider saying something along the lines of “I want you to have the best care possible and right now I don’t feel I am able to do that for you. Please - I would like to take a few days to rest and recharge my batteries. It will only be until x day and then you will be back home again.”\u003Cbr \/\u003E\u003Cbr \/\u003EIf the respite is for night time relief and the caregiver is planning on visiting during the daytime, say so. “I’ll come visit you so we can catch up on the news\/family\/whatever.”\u003Cbr \/\u003EWhen families are in the midst of caregiving, we can sometimes forget about the relationship we used to have with the patient. If we take time to consider the way in which we talk about caregiving needs with the patient in a way that demonstrates the love that we have, we may be able to alleviate some of the sadness or feelings of abandonment.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ci\u003ELizzy Miles, MA, MSW, LSW is a hospice social worker in Columbus, Ohio and regular contributor to Pallimed.org. Lizzy authored a book of happy hospice stories:\u0026nbsp;\u003Ca href=\"https:\/\/www.amazon.com\/Somewhere-Between-Chocolate-Shared-Experience\/dp\/1937574024\/ref=tmm_pap_swatch_0?_encoding=UTF8\u0026amp;qid=\u0026amp;sr=\" style=\"border: 0px; color: #1f5a09; margin: 0px; padding: 0px;\" target=\"_blank\"\u003ESomewhere In Between: The Hokey Pokey, Chocolate Cake and the Shared Death Experience.\u003C\/a\u003E\u0026nbsp;Lizzy is best known for bringing the\u0026nbsp;\u003Ca href=\"https:\/\/deathcafe.com\/\" style=\"border: 0px; color: #1f5a09; margin: 0px; padding: 0px;\" target=\"_blank\"\u003EDeath Cafe\u003C\/a\u003E\u0026nbsp;concept to the United States.\u003C\/i\u003E\u003Cbr \/\u003E\u003Ci style=\"background-color: white; border: 0px; font-family: \u0026quot;Helvetica Neue\u0026quot;, Arial, sans-serif; font-size: x-small; margin: 0px; padding: 0px;\"\u003Ephotocredit:\u003C\/i\u003E\u003Cbr \/\u003E\u003Ci style=\"background-color: white; border: 0px; font-family: \u0026quot;Helvetica Neue\u0026quot;, Arial, sans-serif; font-size: x-small; margin: 0px; padding: 0px;\"\u003Ehands\u0026nbsp;Photo by Rod Long on Unsplash\u003C\/i\u003E\u003Cbr \/\u003E\u003Ci style=\"background-color: white; border: 0px; font-family: \u0026quot;Helvetica Neue\u0026quot;, Arial, sans-serif; font-size: x-small; margin: 0px; padding: 0px;\"\u003Eplant photo by Sarah dorweiler on Unsplash\u003C\/i\u003E\u003Cbr \/\u003E\u003Ci style=\"background-color: white; border: 0px; font-family: \u0026quot;Helvetica Neue\u0026quot;, Arial, sans-serif; font-size: x-small; margin: 0px; padding: 0px;\"\u003Eall other photos via author\u003C\/i\u003E\u003Cbr \/\u003E\u003Cinsert here=\"\" picture=\"\"\u003E\u003Cbr \/\u003E\u003C\/insert\u003E\u003Cinsert here=\"\" picture=\"\"\u003E\u003Cbr \/\u003E     \u003C\/insert\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/5855576081533146022"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/5855576081533146022"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2019\/11\/community-living-for-hospice-patients.html","title":"Community Living for Hospice Patients: Don't \"Put\" People in Nursing Homes"}],"author":[{"name":{"$t":"Lizzy Miles"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/06871018407337559011"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"https:\/\/1.bp.blogspot.com\/-ENKDNeYbAGE\/Xbw6vKaZyyI\/AAAAAAABvw8\/04FYULY0B7gN9vvyhQW2U0Hwh4rDGNPKgCLcBGAsYHQ\/s72-c\/20130725_144941.jpg","height":"72","width":"72"}},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-7720082855556645135"},"published":{"$t":"2018-09-17T07:00:00.001-05:00"},"updated":{"$t":"2018-09-17T10:45:04.555-05:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"arnold"},{"scheme":"http://www.blogger.com/atom/ns#","term":"dementia"},{"scheme":"http://www.blogger.com/atom/ns#","term":"journal article"},{"scheme":"http://www.blogger.com/atom/ns#","term":"nursing home"},{"scheme":"http://www.blogger.com/atom/ns#","term":"pallimed writing group"},{"scheme":"http://www.blogger.com/atom/ns#","term":"surgery"},{"scheme":"http://www.blogger.com/atom/ns#","term":"trauma"}],"title":{"type":"text","$t":"Hip Fracture Decisions for Nursing Home Residents with Dementia"},"content":{"type":"html","$t":"\u003Cdiv class=\"separator\" style=\"clear: both; text-align: left;\"\u003Eby Bob Arnold (\u003Ca href=\"https:\/\/twitter.com\/rabob\" target=\"_blank\"\u003E@rabob\u003C\/a\u003E)\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ca href=\"https:\/\/2.bp.blogspot.com\/-V2ZPLiNq81c\/W5_JFHQWqGI\/AAAAAAACaVw\/8fv4Zu3axS4-92_ykKcU_-f4Pg4luaQBACLcBGAs\/s1600\/pallimed%2Bwriters%2Bgroup.png\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" data-original-height=\"800\" data-original-width=\"800\" height=\"320\" src=\"https:\/\/2.bp.blogspot.com\/-V2ZPLiNq81c\/W5_JFHQWqGI\/AAAAAAACaVw\/8fv4Zu3axS4-92_ykKcU_-f4Pg4luaQBACLcBGAs\/s320\/pallimed%2Bwriters%2Bgroup.png\" width=\"320\" \/\u003E\u003C\/a\u003EGood things come in threes. I was on service this week and saw a patient with Lewy Body dementia in the emergency room after he fell and broke his hip. His niece was his surrogate and trying to decide what to do. She asked me whether he should have his hip repaired. In looking through the literature I came across Sarah Berry’s article “\u003Ca href=\"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2680317\" target=\"_blank\"\u003EAssociation of Clinical Outcomes of Surgical Repair of Hip Fractures versus Nonsurgical Management in Nursing Home Residents with Advanced Dementia\u003C\/a\u003E”. Even better, there was an \u003Ca href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29801116\" target=\"_blank\"\u003Eeditorial in the same issue of \u003Ci\u003EJAMA Internal Medicine\u003C\/i\u003E\u003C\/a\u003E placing the article in context. Second, as I was reading the article, I heard the trauma surgeon talking about the same article with her residents. Finally, this morning I woke up and read \u003Ca href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29792735\" target=\"_blank\"\u003EBree Johnston’s fabulous special report in JPM on hip fractures in the setting of limited life expectancy\u003C\/a\u003E, “The importance of considering goals of care and prognosis”. Yahtzee! (My children would point out that only a true nerd would find this trio of events a cause for celebration). While I would recommend you read both the editorial and Dr. Johnston’s fabulous special report, the purpose of this Pallimed series is to look at the data so I’ll be reviewing Berry’s article.\u003Cbr \/\u003E\u003Cbr \/\u003EThe aim of the article was to assess outcomes for nursing home residents with advanced dementia who did and did not undergo surgical repair of a broken hip. Advanced dementia was defined as a \u003Ca href=\"http:\/\/www.interrai.org\/assets\/files\/Scales\/cognitive-performance-scale-2014.pdf\" target=\"_blank\"\u003ECognitive Performance Scale (CPS)\u003C\/a\u003E of 5 or 6 and diagnosis of “dementia” or “Alzheimer disease.” By outcomes they meant survival (the primary outcome), pain, anti-psychotic use, physical restraints, pressure ulcers, and ambulatory status. The authors used the \u003Ca href=\"https:\/\/en.wikipedia.org\/wiki\/Minimum_Data_Set\" target=\"_blank\"\u003EMDS (Minimum Data Set)\u003C\/a\u003E assessment and linked this to Medicare claims to conduct a cohort study of 3,083 long-staying nursing home residents with advanced dementia and hip fracture.\u003Cbr \/\u003E\u003Cbr \/\u003EThey found, as have other studies of nursing home residents with hip fractures, that patients who underwent surgery had lower mortality rates (the literature stressed the importance of surgery within the first 24 hours). While 35% died within 6 months, and 61% within two years, the mortality was significantly greater in patients who did not have surgery. These results were greatest in the first 30 days; 11% mortality with surgery, 30% without surgery, and resulted in a median survival of 1.4 years with surgery versus 0.4 years if the patient did not undergo surgery. Adjustment attenuated the findings, but they remained significant.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ca href=\"https:\/\/3.bp.blogspot.com\/-QIa-k4umXv8\/W5_GneNE1WI\/AAAAAAACaVk\/HLqB6jsEE90JT2tFW7BEqXBXqCocgsPKQCLcBGAs\/s1600\/m_ioi180017f2.png\" imageanchor=\"1\" style=\"margin-left: 1em; margin-right: 1em;\"\u003E\u003Cimg border=\"0\" data-original-height=\"625\" align=\"center\" data-original-width=\"810\" height=\"246\" src=\"https:\/\/3.bp.blogspot.com\/-QIa-k4umXv8\/W5_GneNE1WI\/AAAAAAACaVk\/HLqB6jsEE90JT2tFW7BEqXBXqCocgsPKQCLcBGAs\/s320\/m_ioi180017f2.png\" width=\"320\" \/\u003E\u003C\/a\u003E\u003Cbr \/\u003E\u003Cbr \/\u003EResidents who underwent surgical repair also had less pain, less anti-psychotic drug use, physical restraint use and pressure ulcers; although once these results were adjusted for differences between the two groups there were no differences according to surgical repair. Interestingly the inverse probability of treatment waiting models, which adjusted for differences in characteristics before the hip fractures, suggested that there was less pain and fewer pressure ulcers among patients managed with surgery. (I need someone who knows more about statistics than me to explain why two different ways of statistical correction resulted in different secondary outcomes).\u003Cbr \/\u003E\u003Cbr \/\u003ESo, the question is how I should use these results in my patient:\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003E\u003Ci\u003E1. Are the patients in this population relevant to the ones I care for?\u003C\/i\u003E\u003C\/b\u003E Well, as a hospital-based palliative care doctor these are exactly the kinds of patients for which I am consulted.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003E\u003Ci\u003E2. Are the outcomes that the authors measured the correct ones? \u003C\/i\u003E\u003C\/b\u003EWell, it seems to me that pain, survival, and restraints are all things that my patients’ families want to know about. Sadly, for these secondary outcomes they could only look at one point in time. Also, to have data on the secondary outcomes, the patient had to live at least six months (it has to do with when MDS data is collected). Thus, for a lot of the patients we do not have these secondary outcomes.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003E\u003Ci\u003E3. Were the two groups similar in characteristics prior to the operation?\u003C\/i\u003E\u003C\/b\u003E Sadly, the answer is no. Residents treated non-operatively were much more impaired at baseline. For example, 26% of the non-operative residents were completely dependent in activities of daily living as opposed to only 5% of the surgical residents. Moreover, despite the large number of variables in the MDS, it is likely there were differences between the two groups that were unmeasured that led the surgeons to choose not to do surgery. In addition, it is unclear whether the decision to do surgery was based on patient\/family preferences. Thus, one does not know if the reason for the difference in outcomes was based on surgery or whether other variables led both to the decision to have surgery and the outcomes. This is a limitation of not doing a RCT. Finally, the outcomes could be due to a self-fulfilling hypothesis. Given the non-surgical patients’ greater illness\/morbidity, there may have been a decision only to focus on comfort. Given this, the treatment these patients received was less focused on prolonging life and thus they died sooner. (This would have nothing to do with the impact of surgery on survival or clinical outcomes).\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003E\u003Ci\u003E4. Were the circumstances and methods for detecting the outcome similar? \u003C\/i\u003E\u003C\/b\u003EThe answer here is yes. The MDS is a very complete way of detecting the outcomes of interest. Although pain was evaluated by the health care provider rather than the patients, there is no reason to think that there would be differences based on which group they were in.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003E\u003Ci\u003E5. Was follow-up sufficiently complete?\u003C\/i\u003E\u003C\/b\u003E Again, the answer seems to be yes, although as previously noted, for patients who did not live six months we do not have any of the secondary outcomes.\u003Cbr \/\u003E\u003Cb\u003E\u003Ci\u003E\u003Cbr \/\u003E\u003C\/i\u003E\u003C\/b\u003E\u003Cb\u003E\u003Ci\u003E6. Are the differences big enough that I should care? \u003C\/i\u003E\u003C\/b\u003EAgain, the answer is at least with the primary outcome the difference did seem quite large as noted before, the secondary outcomes, differences, particularly after adjustment, are much smaller.\u003Cbr \/\u003E\u003Cbr \/\u003ESo, what does this mean? In the end, as\u003Ca href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29792735\" target=\"_blank\"\u003E Johnston et al. summarized,\u003C\/a\u003E the decision to have surgery depends a great deal on the surrogate decision-maker’s view about the patient’s quality of life preoperatively and what is most important postoperatively. I have to say that this article would, for many of my patients, lead me to do surgery and continue aggressive palliative care (the increased rate of ambulation postoperatively -10.7% in the patients with surgery versus 4.8% in those without surgery - would be a big factor for many families). While a randomized controlled file would be better, it is unlikely that one will ever be conducted. (I am given pause by the mostly negative data presented by Johnston on hip fracture repair. She points out, for example, there is the Cochran review of five randomized controlled trials that shows no difference in medical complications, mortality or long-term pain in conservative care versus surgery. While this is not a study of demented patients, it made me realize the data is controversial).\u003Cbr \/\u003E\u003Cbr \/\u003EA coda: What I and the editorial found distressing were the high rates of pain and the low rates of hospice in severely demented patients even after they have hip fractures (particularly in the non-operative patients). It also was quite curious that the median time to utilize hospice was 56 days. Given this article, I wonder whether hospice should be discussed and\/or recommended for all patients who have severe dementia and a hip fracture. This article should lead you to talk to your trauma surgeons and\/or orthopedists to develop a routine palliative care or hospice consultation for these patients.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ci\u003ERobert Arnold, MD is a palliative care doctor at the University of Pittsburgh and a co-founder of \u003Ca href=\"http:\/\/vitaltalk.org\/\" target=\"_blank\"\u003EVitalTalk\u003C\/a\u003E (\u003Ca href=\"https:\/\/twitter.com\/VitalTalk\" target=\"_blank\"\u003E@VitalTalk\u003C\/a\u003E). He loves both high and low brow comedy (The Good Place and Nanette), pop culture (the National Enquirer and Pop Culture Happy hour) and music of all kinds (not opera tho!) You can find him on \u003Ca href=\"https:\/\/twitter.com\/rabob\" target=\"_blank\"\u003ETwitter at @rabob.\u0026nbsp;\u003C\/a\u003E\u003C\/i\u003E\u003Cbr \/\u003E\u003Cbr \/\u003EMore \u003Ca href=\"https:\/\/www.pallimed.org\/search\/label\/arnold\" target=\"_blank\"\u003EPallimed posts from Bob Arnold can be found here.\u003C\/a\u003E\u0026nbsp;More \u003Ca href=\"https:\/\/www.pallimed.org\/search\/label\/journal%20article\" target=\"_blank\"\u003Ejournal article reviews can be found here.\u0026nbsp;\u003C\/a\u003E\u003Cbr \/\u003E\u003Cbr \/\u003EReferences\u003Cbr \/\u003E\u003Cbr \/\u003E1. Berry SD, Rothbaum RR, Kiel DP, Lee Y, Mitchell SL. \u003Ca href=\"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2680317\" target=\"_blank\"\u003EAssociation of clinical outcomes with surgical repair of hip fracture vs nonsurgical management in nursing home residents with advanced dementia \u003C\/a\u003E[published online May 7, 2018]. JAMA Intern Med. \u003Ca href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29801122\" target=\"_blank\"\u003Edoi:10.1001\/jamainternmed.2018.0743\u003C\/a\u003E\u003Cbr \/\u003E\u003Cbr \/\u003E2. Mehr DR, Tatum PE, Crist BD. \u003Ca href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29801116\" target=\"_blank\"\u003EHip Fractures in Patients With Advanced Dementia What Treatment Provides the Best Palliation? \u003C\/a\u003EJAMA Intern Med. 2018;178(6):780–781. doi:10.1001\/jamainternmed.2018.0822\u003Cbr \/\u003E\u003Cbr \/\u003E3. Johnston CB, Holleran A, Ong T, McVeigh U, Ames E. \u003Ca href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29792735\" target=\"_blank\"\u003EHip Fracture in the Setting of Limited Life Expectancy: The Importance of Considering Goals of Care and Prognosis\u003C\/a\u003E. Journal of Palliative Medicine 2018 21:8, 1069-1073\u003Cbr \/\u003E\u003Cbr \/\u003E4. Morrison RS, Siu AL. \u003Ca href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10872012\" target=\"_blank\"\u003ESurvival in end-stage dementia following acute illness.\u003C\/a\u003E JAMA. 2000;284(1):47-52\u003C\/div\u003E\u003Cbr\u003E\u003Cmeta name=\"twitter:card\" content=\"summary\" \/\u003E\u003Cmeta name=\"twitter:site\" content=\"@pallimed\" \/\u003E\u003Cmeta name=\"twitter:title\" content=\"Hip Fracture Decisions for Nursing Home Residents with Dementia\" \/\u003E\u003Cmeta name=\"twitter:description\" content=\"The decision to have surgery depends a great deal on the surrogate decision-maker’s view about the patient’s quality of life preoperatively and what is most important postoperatively.\" \/\u003E\u003Cmeta name=\"twitter:image\" content=\"https:\/\/2.bp.blogspot.com\/-V2ZPLiNq81c\/W5_JFHQWqGI\/AAAAAAACaVw\/8fv4Zu3axS4-92_ykKcU_-f4Pg4luaQBACLcBGAs\/s1600\/pallimed%2Bwriters%2Bgroup.png\" \/\u003E\u003Cmeta name=\"twitter:url\" content=\"https:\/\/www.pallimed.org\/2018\/09\/hip-fracture-decisions-for-nursing-home.html\" \/\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/7720082855556645135"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/7720082855556645135"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2018\/09\/hip-fracture-decisions-for-nursing-home.html","title":"Hip Fracture Decisions for Nursing Home Residents with Dementia"}],"author":[{"name":{"$t":"Pallimed Editor"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/11358791266969988517"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"https:\/\/2.bp.blogspot.com\/-V2ZPLiNq81c\/W5_JFHQWqGI\/AAAAAAACaVw\/8fv4Zu3axS4-92_ykKcU_-f4Pg4luaQBACLcBGAs\/s72-c\/pallimed%2Bwriters%2Bgroup.png","height":"72","width":"72"}},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-4091876544148954649"},"published":{"$t":"2014-12-23T08:00:00.000-06:00"},"updated":{"$t":"2018-08-06T20:11:30.784-05:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"geriatrics"},{"scheme":"http://www.blogger.com/atom/ns#","term":"hospice"},{"scheme":"http://www.blogger.com/atom/ns#","term":"nursing home"},{"scheme":"http://www.blogger.com/atom/ns#","term":"okon"},{"scheme":"http://www.blogger.com/atom/ns#","term":"The profession"},{"scheme":"http://www.blogger.com/atom/ns#","term":"tv"}],"title":{"type":"text","$t":"Getting On​​​: HBO sleeper comedy not shy about delicate topics"},"content":{"type":"html","$t":"\u003Ci\u003E\u003Cspan style=\"font-size: x-small;\"\u003E(Note: we have a \u003Ca href=\"http:\/\/goo.gl\/forms\/kfZ2k7F2I9\" target=\"_blank\"\u003Eshort poll about your thoughts on this show\u003C\/a\u003E. It doesn't matter if you have seen it or not. Let us know what you think - Ed.) \u003C\/span\u003E\u003C\/i\u003E\u003Cbr \/\u003E\u003Ci\u003E\u003Cbr \/\u003E\u003C\/i\u003E\u003Cbr \/\u003Eby Chris Okon\u003Cbr \/\u003E\u003Ci\u003E\u003Cbr \/\u003E\u003C\/i\u003E\u003Cbr \/\u003E\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"http:\/\/4.bp.blogspot.com\/-uKVlsEqCauU\/VJpVuThQ47I\/AAAAAAAAmwI\/JWklqeW-7s8\/s1600\/getting%2Bon.PNG\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/4.bp.blogspot.com\/-uKVlsEqCauU\/VJpVuThQ47I\/AAAAAAAAmwI\/JWklqeW-7s8\/s1600\/getting%2Bon.PNG\" height=\"262\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003Ca href=\"http:\/\/www.hbo.com\/getting-on#\/\" target=\"_blank\"\u003E\"Getting On\" is an HBO series\u003C\/a\u003E about the daily and often absurd experiences of nurses, doctors, attendants, and patients in the \"Billy Barnes\" extended care wing of the fictional Mt. Palms hospital in southern California. ​Some viewers may be offended by the gallows humor that threads through each scenario, and so viewer discretion is advised. For others who don't mind, and in fact appreciate, the dark humor that's possible with any human interaction, be prepared for sudden bouts of the laughter of recognition.  \u003Cbr \/\u003E\u003Cbr \/\u003EWhile trying to sustain some level of compassion for the elderly, frail and sometimes dying patients, the overworked clinicians and staff must work under the knuckles of a red-taped hospital administration which in turn is squeezed by the larger powers-that-be of a broken and somewhat Kafkaesque healthcare system, CMS\/Medicare, digital technology, hospice service salespeople, and other monkey wrenches.  \u003Cbr \/\u003E\u003Cbr \/\u003EAdd the personal goals, quirks and challenges of each character and you get unexpected and hilarious situations that may ring very true for those involved in palliative care, long-term care, and hospice.  \u003Cbr \/\u003E\u003Cbr \/\u003EFor example, floor nurse Dawn Forchette (Alex Borstein) knows her profession well but is insecure and so hungry for love that she foists a zero-to-sixty commitment on the unwitting supervising nurse Patsy de La Serda (Mel Rodriguez) who is still in the dark about his own sexual preferences.  \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ciframe allowfullscreen=\"\" frameborder=\"0\" height=\"315\" src=\"\/\/www.youtube.com\/embed\/jHo_vhTswZw\" width=\"560\"\u003E\u003C\/iframe\u003E​\u003Cbr \/\u003ENurse DiDi (Niecy Nash) is probably the most likable and steady character, keeping a level head and caring compassion while navigating the chaos of quirky protocols, emotional meltdowns of coworkers, and the overarching bureacracy. In once scene, DiDi lets the family enter the room of the mother who just died. \"Take as long as you want,\" DiDi says, quickly followed by Dawn's whisper of \"we actually need that bed by 11.\"  \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ciframe allowfullscreen=\"\" frameborder=\"0\" height=\"315\" src=\"\/\/www.youtube.com\/embed\/VzXbFZ_FDm0\" width=\"560\"\u003E\u003C\/iframe\u003E \u003Cbr \/\u003EThe frazzled department lead Dr. Jenna James (Laurie Metcalf​), in denial that she has reached a career dead-end, still clings to the dream of producing groundbreaking research about fecal anomalies, so much so that she chastises a nurse for removing a critical study sample of \"feces, not a turd\" left on a chair by one of the more impish dementia patients.  \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ciframe allowfullscreen=\"\" frameborder=\"0\" height=\"315\" src=\"\/\/www.youtube.com\/embed\/WqL_utXOIA4\" width=\"560\"\u003E\u003C\/iframe\u003E \u003Cbr \/\u003ESeveral ancillary characters add depth, such as the sweet and eager hospice volunteer; the mixed batch of ornery, sweet, or just plain vacant patients; the ingratiating saleswoman for a profit-driven hospice care enterprise; the steady stream of various family members who argue, compete, cajole, or cry over the mother, father, sister, in the hospital bed.  \u003Cbr \/\u003E\u003Cbr \/\u003EBased on the BBC series of the same name, the American version of Getting On just completed its second season but can be viewed on \u003Ca href=\"http:\/\/www.hbo.com\/getting-on#\/\" target=\"_blank\"\u003EHBO or HBO Go\u003C\/a\u003E. ​Start from the beginning with Season 1 to see how character dynamics are established, although any episode presents hilarious and familiar situations. \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ci\u003E\u003Cspan style=\"font-size: x-small;\"\u003E(Note: we have a\u0026nbsp;\u003Ca href=\"http:\/\/goo.gl\/forms\/kfZ2k7F2I9\" target=\"_blank\"\u003Eshort poll about your thoughts on this show\u003C\/a\u003E. It doesn't matter if you have seen it or not. Let us know what you think - Ed.)\u003C\/span\u003E\u003C\/i\u003E\u003Cbr \/\u003E\u003Cbr \/\u003ESeason 1 Trailer \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ciframe allowfullscreen=\"\" frameborder=\"0\" height=\"315\" src=\"\/\/www.youtube.com\/embed\/PhGQxLFS_P4\" width=\"560\"\u003E\u003C\/iframe\u003E \u003Cbr \/\u003ESeason 2 Trailer \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ciframe allowfullscreen=\"\" frameborder=\"0\" height=\"315\" src=\"\/\/www.youtube.com\/embed\/77WKR27-u-M\" width=\"560\"\u003E\u003C\/iframe\u003E \u003Cbr \/\u003E\u003Ci\u003E\u003Cspan style=\"font-size: x-small;\"\u003EAs a volunteer with\u0026nbsp;\u003Ca href=\"http:\/\/www.hospicebythebay.org\/\" target=\"_blank\"\u003EHospice by the Bay\u003C\/a\u003E, ​Christine Okon​ offered ​gentle bodywork to many people at the end of life, feeling privileged to hear their stories. She learned much from Les Morgan who founded Growth House, ahead of its time for using technology to build a social network for those involved with EOL. Christine lives in San Francisco and works for Kaiser Permanente on the patient safety aspects of their EHR.\u003C\/span\u003E\u003C\/i\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/4091876544148954649"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/4091876544148954649"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2014\/12\/getting-on-hbo-sleeper-comedy-not-shy.html","title":"Getting On​​​: HBO sleeper comedy not shy about delicate topics"}],"author":[{"name":{"$t":"Unknown"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"http:\/\/4.bp.blogspot.com\/-uKVlsEqCauU\/VJpVuThQ47I\/AAAAAAAAmwI\/JWklqeW-7s8\/s72-c\/getting%2Bon.PNG","height":"72","width":"72"}},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-6770304358988542347"},"published":{"$t":"2014-12-06T14:30:00.000-06:00"},"updated":{"$t":"2014-12-06T14:49:08.282-06:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"dentistry"},{"scheme":"http://www.blogger.com/atom/ns#","term":"home"},{"scheme":"http://www.blogger.com/atom/ns#","term":"hospice"},{"scheme":"http://www.blogger.com/atom/ns#","term":"nursing home"},{"scheme":"http://www.blogger.com/atom/ns#","term":"sinclair"}],"title":{"type":"text","$t":"How Hard Is It To Get Dental Care at Home?"},"content":{"type":"html","$t":"\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"http:\/\/2.bp.blogspot.com\/-j5FXIbSiXQI\/VHV0w-5pERI\/AAAAAAAAjvU\/ugzRzOKXS9g\/s1600\/dentidrill.PNG\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/2.bp.blogspot.com\/-j5FXIbSiXQI\/VHV0w-5pERI\/AAAAAAAAjvU\/ugzRzOKXS9g\/s1600\/dentidrill.PNG\" height=\"235\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003Ci\u003E\u003Cspan style=\"font-size: x-small;\"\u003E(Originally posted on \u003Ca href=\"http:\/\/www.geripal.org\/\" target=\"_blank\"\u003EGeripal\u003C\/a\u003E as part of the World Series of Blogs Payback-Ed.)\u003C\/span\u003E\u003C\/i\u003E\u003Cbr \/\u003E\u003Cbr \/\u003EHave you ever had a patient at home who was in need of dental care?  Perhaps they were receiving hospice services or maybe they were just discharged from the hospital not on hospice, but still too frail to get to the dentist. Of course the focus is often on the medical issues, yet the most significant issue was broken rotted teeth, which made oral intake nearly impossible without pain.  Clearly, the answer here is not opioids for pain control, but rather to take care of the root problem: access to dental care.   \u003Cbr \/\u003E\u003Cbr \/\u003EClearly dentists and their staff are not part of a hospice or palliative care IDT, but when you need them, boy do you need them.  If the short case I outlined is not clear enough for you, I would really encourage you to read \u003Ca href=\"http:\/\/annals.org\/article.aspx?articleid=1935067\" target=\"_blank\"\u003E“Love” by Jean-Noel Vergnes, DDS, PhD recently published in the Annals of Internal Medicine (paywall).\u003C\/a\u003E Written by a dentist in France caring for his wife who had a stroke and was desperately in need of dental care he himself could not provide, it illustrates the anguish of not being able to provide care you know someone needs.  \u003Cbr \/\u003E\u003Cblockquote class=\"tr_bq\"\u003E“And little by little, it got difficult to clean her teeth with a toothbrush, too; she made little animal noises all the time, as if we were hurting her. So, it’s true that I didn’t take that much care of her mouth.”\u003C\/blockquote\u003EYet in the end there is a deep satisfaction when a dentist is found who will come to the home and provide the much needed care for his wife.\u003Cbr \/\u003E\u003Cblockquote class=\"tr_bq\"\u003E“Knowing that such a possibility existed made me change my mind. Actually, I’d always had this little voice in my head telling me that I wasn’t doing what was best for her, that I might be convincing myself that it was useless just because I didn’t have the strength to get on with it.”\u003C\/blockquote\u003EReading this story makes me reflect on the access to home visit dentists in my metro service area.  When we need a dentist, the team works frantically to find someone willing to come out.  So what are the barriers for a dentist? Is it malpractice insurance out of the office? Lack of access to the ever more complicated tools while in someone’s home? Lack of adequate reimbursement? Lack of time? I know many dentists do charitable activities in urban and foreign locations (usually for children), so I know the barrier is not likely to be a cold, uncaring heart. How can we as palliative care providers strengthen this relationship with dentists so the care is not needlessly delayed?  The answers are likely complex and different in every community, and I know the answer is \u003Ca href=\"http:\/\/dentidrill.com\/\" target=\"_blank\"\u003Enot the \u003C\/a\u003E\u003Ca href=\"http:\/\/dentidrill.com\/\" target=\"_blank\"\u003EDe\u003C\/a\u003E\u003Ca href=\"http:\/\/dentidrill.com\/\" target=\"_blank\"\u003EntiDrill\u003C\/a\u003E\u003Ca href=\"http:\/\/dentidrill.com\/\" target=\"_blank\"\u003E Home Dentistry Kit.\u003C\/a\u003E\u0026nbsp;Yet, I’m hopeful by asking this question of our great communities we might find a better answer together. Then maybe more people can have memories like this:\u003Cbr \/\u003E\u003Cblockquote class=\"tr_bq\"\u003E“She gave me a wonderful, broad smile. She was beautiful, so very beautiful. Ah, how can I put it? I knew that smile would be her last. I smiled back at her, savoring the moment . . . a moment that I couldn’t even try to describe. And that smile was, indeed, her last. I’ll remember it every day that I have left to live.”\u003C\/blockquote\u003E\u003Cspan style=\"float: left; padding: 5px;\"\u003E\u003Ca href=\"http:\/\/www.researchblogging.org\/\"\u003E\u003Cimg alt=\"ResearchBlogging.org\" src=\"http:\/\/www.researchblogging.org\/public\/citation_icons\/rb2_large_gray.png\" style=\"border: 0;\" \/\u003E\u003C\/a\u003E\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan class=\"Z3988\" title=\"ctx_ver=Z39.88-2004\u0026amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal\u0026amp;rft.jtitle=Annals+of+Internal+Medicine\u0026amp;rft_id=info%3Adoi%2F10.7326%2FM14-1076\u0026amp;rfr_id=info%3Asid%2Fresearchblogging.org\u0026amp;rft.atitle=Love\u0026amp;rft.issn=0003-4819\u0026amp;rft.date=2014\u0026amp;rft.volume=161\u0026amp;rft.issue=10\u0026amp;rft.spage=758\u0026amp;rft.epage=\u0026amp;rft.artnum=http%3A%2F%2Fannals.org%2Farticle.aspx%3Fdoi%3D10.7326%2FM14-1076\u0026amp;rft.au=Vergnes%2C+J.\u0026amp;rfe_dat=bpr3.included=1;bpr3.tags=Medicine%2CHealth%2CMedicine%2C+dentistry%2C+hospice%2C+home+care%2C+palliative%2C+caregiver\"\u003EVergnes, J. (2014). \"Love\",\u0026nbsp;\u003Cspan style=\"font-style: italic;\"\u003EAnnals of Internal Medicine, 161\u003C\/span\u003E (10) DOI: \u003Ca href=\"http:\/\/dx.doi.org\/10.7326\/M14-1076\" rev=\"review\"\u003E10.7326\/M14-1076\u003C\/a\u003E\u003C\/span\u003E\u003Cmeta name=\"twitter:card\" content=\"summary_large_image\"\u003E\u003Cmeta name=\"twitter:site\" content=\"@pallimed\" \/\u003E\u003Cmeta name=\"twitter:creator\" content=\"@ctsinclair\"\u003E\u003Cmeta name=\"twitter:title\" content=\"How Hard Is It To Get Dental Care at Home?\"\u003E\u003Cmeta name=\"twitter:description\" content=\"We hope that it doesn't come down to DIY dental care at home for our patients.\"\u003E\u003Cmeta name=\"twitter:image:src\" content=\"http:\/\/2.bp.blogspot.com\/-j5FXIbSiXQI\/VHV0w-5pERI\/AAAAAAAAjvU\/ugzRzOKXS9g\/s1600\/dentidrill.PNG\"\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/6770304358988542347"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/6770304358988542347"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2014\/12\/how-hard-is-it-to-get-dental-care-at.html","title":"How Hard Is It To Get Dental Care at Home?"}],"author":[{"name":{"$t":"Christian Sinclair"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/14685043408496367587"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"http:\/\/2.bp.blogspot.com\/-j5FXIbSiXQI\/VHV0w-5pERI\/AAAAAAAAjvU\/ugzRzOKXS9g\/s72-c\/dentidrill.PNG","height":"72","width":"72"}},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-4678461645903844806"},"published":{"$t":"2014-11-21T09:52:00.000-06:00"},"updated":{"$t":"2017-12-17T23:47:38.213-06:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"disaster"},{"scheme":"http://www.blogger.com/atom/ns#","term":"emergency preparedness"},{"scheme":"http://www.blogger.com/atom/ns#","term":"home"},{"scheme":"http://www.blogger.com/atom/ns#","term":"hospice"},{"scheme":"http://www.blogger.com/atom/ns#","term":"nursing home"},{"scheme":"http://www.blogger.com/atom/ns#","term":"sinclair"},{"scheme":"http://www.blogger.com/atom/ns#","term":"weather"}],"title":{"type":"text","$t":"Epic Buffalo Snow Storm Impacts Hospice Work"},"content":{"type":"html","$t":"\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"http:\/\/4.bp.blogspot.com\/-OzHExz7D3As\/VG79eiBKKYI\/AAAAAAAAjgc\/B6Hoff2Dnyw\/s1600\/6929445403_20b5f0b8a7_b.jpg\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/4.bp.blogspot.com\/-OzHExz7D3As\/VG79eiBKKYI\/AAAAAAAAjgc\/B6Hoff2Dnyw\/s1600\/6929445403_20b5f0b8a7_b.jpg\" height=\"255\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/div\u003EWatching the news of the tremendous amount of snow falling in Buffalo and Western New York this week, I could not help but think about the challenge facing patients and families served by local hospices. Thankfully, there was some warning about the enormity of the snowfall coming which provided time for hospice organizations to call their patients to check on medication and oxygen supplies. \u0026nbsp;I spoke Thursday morning with Dr. Beth Calkins, a hospice physician with \u003Ca href=\"https:\/\/www.hospicebuffalo.com\/\" target=\"_blank\"\u003EHospice Buffalo\u003C\/a\u003E. \"I wish you would have written a story about emergency preparedness two weeks ago. This is a really tough situation for our patients and families.\" As many news outlets highlighted, some in the Buffalo area were either confident they had seen 'bad snowstorms' in the past, or potentially dismissing the unbelievable forecasts as unlikely and part of weather forecasting hype. Thankfully most people prepared ahead of time, but what do you do about someone who is frail and on hospice?\u003Cbr \/\u003E\u003Cbr \/\u003EDr. Calkins praised the work of the nurse managers who called each patient ahead of the storm to verify important areas like safety, medications and emergency plans. \"We are calling our patients every day, more if needed. \u0026nbsp;But new issues arise when a patient suddenly has severe symptoms or begins to enter an active dying phase.\" She noted calling several pharmacies to find many of them closed. The two she found open (with pharmacists stuck there when they could not get home) were able to fill medications, but the patients nor families could not necessarily get to the pharmacies!\u003Cbr \/\u003E\u003Cbr \/\u003E\"What about walking?\", I asked. \u0026nbsp;\"Impossible in many areas because the snow is too deep and there are no safe areas to walk,\" she replied. \"We have some of our emergency services using snowmobiles. We are really appreciative the ambulance service has given priority to our patients when needed.\"\u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cdiv style=\"text-align: center;\"\u003EImagine being greeted by this when you head out to get the milk! More crazy \u003Ca href=\"https:\/\/twitter.com\/hashtag\/snow?src=hash\"\u003E#snow\u003C\/a\u003E scenes in NY state \u003Ca href=\"https:\/\/twitter.com\/hashtag\/Buffalo?src=hash\"\u003E#Buffalo\u003C\/a\u003E... \u003Ca href=\"http:\/\/t.co\/GYjnwKKyEx\"\u003Epic.twitter.com\/GYjnwKKyEx\u003C\/a\u003E\u003C\/div\u003E\u003Cdiv style=\"text-align: center;\"\u003E— Simon King (@SimonOKing) \u003Ca href=\"https:\/\/twitter.com\/SimonOKing\/status\/535694368246886400\"\u003ENovember 21, 2014\u003C\/a\u003E\u003C\/div\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E Another issue hospices may overlook when transportation is cut off because of natural disaster is the complications of after-death care and safe removal of someone who died. Since funeral homes are unable to arrive, ambulance service may be the only option, which is not a customary choice when you think about a death on hospice.\u003Cbr \/\u003E\u003Cbr \/\u003EMost of the staff have been handling crises by phone, but the staff are not immune to the effects of the storm. \"Both our patients and our Team 6 staff live in the south Buffalo area which was hit hardest.\" If staff cannot get out of their homes, they are not going to be able to get to patients obviously. In addition, they may be primary caregivers for children or adult family members in an already stressful situation.\u003Cbr \/\u003E\u003Cbr \/\u003EDr. Calkins is hopeful the upcoming warm weather will provide relief from the snow, but is aware the risk of flooding remains high, which may put the integrity of houses at risk even more than the potential of a snow-collapsed roof.\u003Cbr \/\u003E\u003Cbr \/\u003EWhen these natural disasters hit, the attention almost always focuses on hospitals, fire and police, but it is critical to support home-based medical services as well. A big thank you for the strong work by all hospice and home health professionals in Buffalo.\u003Cbr \/\u003E\u003Cdiv style=\"text-align: center;\"\u003E\u003Cbr \/\u003E\u003C\/div\u003E\u003Cdiv style=\"text-align: center;\"\u003E\u003Ciframe allowfullscreen=\"\" frameborder=\"0\" height=\"315\" src=\"\/\/www.youtube.com\/embed\/A1rlqKWN3YY?t=1m6s\" width=\"560\"\u003E\u003C\/iframe\u003E\u003C\/div\u003E\u003Cbr \/\u003EHere are some pictures provided to us from Hospice Buffalo:\u003Cbr \/\u003E\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"http:\/\/4.bp.blogspot.com\/-d4t-1YopjdM\/VHCz0VSSeUI\/AAAAAAAAjjc\/f6qF9JTcnB4\/s1600\/unnamed%2B(1).jpg\" imageanchor=\"1\" style=\"margin-left: 1em; margin-right: 1em;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/4.bp.blogspot.com\/-d4t-1YopjdM\/VHCz0VSSeUI\/AAAAAAAAjjc\/f6qF9JTcnB4\/s1600\/unnamed%2B(1).jpg\" height=\"106\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003Cbr \/\u003E\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"http:\/\/3.bp.blogspot.com\/-1ONaaeLJ9lo\/VHCz0uUYTNI\/AAAAAAAAjjk\/7hvUdL4y8QU\/s1600\/unnamed%2B(2).jpg\" imageanchor=\"1\" style=\"margin-left: 1em; margin-right: 1em;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/3.bp.blogspot.com\/-1ONaaeLJ9lo\/VHCz0uUYTNI\/AAAAAAAAjjk\/7hvUdL4y8QU\/s1600\/unnamed%2B(2).jpg\" height=\"320\" width=\"239\" \/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003Cbr \/\u003E\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"http:\/\/2.bp.blogspot.com\/-aR3aYtA7_MM\/VHCz0Utuk2I\/AAAAAAAAjjg\/WHb3TI4DvK8\/s1600\/unnamed%2B(3).jpg\" imageanchor=\"1\" style=\"margin-left: 1em; margin-right: 1em;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/2.bp.blogspot.com\/-aR3aYtA7_MM\/VHCz0Utuk2I\/AAAAAAAAjjg\/WHb3TI4DvK8\/s1600\/unnamed%2B(3).jpg\" height=\"240\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003Cbr \/\u003E\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"http:\/\/1.bp.blogspot.com\/-Gnp3DBFKxnY\/VHCz04PohxI\/AAAAAAAAjjo\/Why9D1rYLSo\/s1600\/unnamed%2B(4).jpg\" imageanchor=\"1\" style=\"margin-left: 1em; margin-right: 1em;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/1.bp.blogspot.com\/-Gnp3DBFKxnY\/VHCz04PohxI\/AAAAAAAAjjo\/Why9D1rYLSo\/s1600\/unnamed%2B(4).jpg\" height=\"240\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003Cbr \/\u003E\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"http:\/\/4.bp.blogspot.com\/-CZjSZBFflrI\/VHCz1Of8WgI\/AAAAAAAAjjw\/OuBmL_s2ARk\/s1600\/unnamed.jpg\" imageanchor=\"1\" style=\"margin-left: 1em; margin-right: 1em;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/4.bp.blogspot.com\/-CZjSZBFflrI\/VHCz1Of8WgI\/AAAAAAAAjjw\/OuBmL_s2ARk\/s1600\/unnamed.jpg\" height=\"320\" width=\"239\" \/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003Cbr \/\u003E\u003Cbr \/\u003ECheck out the past stories in our Disaster Preparedness series:\u003Cbr \/\u003E\u003Ca href=\"http:\/\/www.pallimed.org\/2008\/06\/iowa-floods-affecting-hospice-care.html\" target=\"_blank\"\u003EIowa Floods Affecting Hospice Care\u003C\/a\u003E\u003Cbr \/\u003E\u003Ca href=\"http:\/\/www.pallimed.org\/2008\/12\/hospice-care-in-aftermath-of-hurricane.html\" target=\"_blank\"\u003EHospice Care in the Aftermath of Hurricane Ike\u003C\/a\u003E\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003EVideo Credit: \u003Ca href=\"https:\/\/www.youtube.com\/watch?v=A1rlqKWN3YY\" target=\"_blank\"\u003EDrone Footage Storm Day 3\u003C\/a\u003E by James Grimaldi via YouTube\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003EPhoto Credit: \"Buffalo, NY\"\u0026nbsp;\u003Ca href=\"https:\/\/www.flickr.com\/photos\/72124881@N00\/6929445403\/\"\u003Ejilleatsapples\u003C\/a\u003E via \u003Ca href=\"http:\/\/compfight.com\/\"\u003ECompfight\u003C\/a\u003E \u003Ca href=\"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/2.0\/\"\u003Ecc\u003C\/a\u003E\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003EPhoto Credit: All other images courtesy of Hospice Buffalo - All Rights Reserved\u003C\/span\u003E\u003Cmeta name=\"twitter:card\" content=\"gallery\" \/\u003E\u003Cmeta name=\"twitter:site\" content=\"@Pallimed\" \/\u003E\u003Cmeta name=\"twitter:creator\" content=\"@ctsinclair\" \/\u003E\u003Cmeta name=\"twitter:title\" content=\"Epic Buffalo Snow Storm Impacts Hospice Work\"\u003E\u003Cmeta name=\"twitter:description\" content=\"Learn how the monstrous snowfall in Buffalo affected those with serious illness cared for by hospice and their families at home.\"\u003E\u003Cmeta name=\"twitter:url\" content=\"http:\/\/www.pallimed.org\/2014\/11\/epic-buffalo-snow-storm-impacts-hospice.html\" \/\u003E\u003Cmeta name=\"twitter:image0\" content=\"http:\/\/1.bp.blogspot.com\/-Gnp3DBFKxnY\/VHCz04PohxI\/AAAAAAAAjjo\/Why9D1rYLSo\/s1600\/unnamed%2B(4).jpg\"\u003E    \u003Cmeta name=\"twitter:image1\" content=\"http:\/\/2.bp.blogspot.com\/-aR3aYtA7_MM\/VHCz0Utuk2I\/AAAAAAAAjjg\/WHb3TI4DvK8\/s1600\/unnamed%2B(3).jpg\"\u003E    \u003Cmeta name=\"twitter:image2\" content=\"http:\/\/3.bp.blogspot.com\/-1ONaaeLJ9lo\/VHCz0uUYTNI\/AAAAAAAAjjk\/7hvUdL4y8QU\/s1600\/unnamed%2B(2).jpg\"\u003E    \u003Cmeta name=\"twitter:image3\" content=\"http:\/\/4.bp.blogspot.com\/-CZjSZBFflrI\/VHCz1Of8WgI\/AAAAAAAAjjw\/OuBmL_s2ARk\/s1600\/unnamed.jpg\"\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/4678461645903844806"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/4678461645903844806"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2014\/11\/epic-buffalo-snow-storm-impacts-hospice.html","title":"Epic Buffalo Snow Storm Impacts Hospice Work"}],"author":[{"name":{"$t":"Christian Sinclair"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/14685043408496367587"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"http:\/\/4.bp.blogspot.com\/-OzHExz7D3As\/VG79eiBKKYI\/AAAAAAAAjgc\/B6Hoff2Dnyw\/s72-c\/6929445403_20b5f0b8a7_b.jpg","height":"72","width":"72"}},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-9131918627728591405"},"published":{"$t":"2013-03-17T13:00:00.000-05:00"},"updated":{"$t":"2013-05-27T18:45:42.900-05:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"AAHPM"},{"scheme":"http://www.blogger.com/atom/ns#","term":"fettig"},{"scheme":"http://www.blogger.com/atom/ns#","term":"hospice"},{"scheme":"http://www.blogger.com/atom/ns#","term":"non-pain symptoms"},{"scheme":"http://www.blogger.com/atom/ns#","term":"nursing home"},{"scheme":"http://www.blogger.com/atom/ns#","term":"pain"},{"scheme":"http://www.blogger.com/atom/ns#","term":"pediatrics"},{"scheme":"http://www.blogger.com/atom/ns#","term":"randomized control trial"},{"scheme":"http://www.blogger.com/atom/ns#","term":"research issues"}],"title":{"type":"text","$t":"State of the Science from the 2013 AAHPM Annual Assembly"},"content":{"type":"html","$t":"The State of the Science plenary is one of my favorite traditions at the \u003Ca href=\"http:\/\/www.aahpm.org\/2013assembly\/default\/annual-assembly.html\"\u003EAAHPM Annual Assembly\u003C\/a\u003E. \u0026nbsp; This year, Jay Horton and Kim Johnson took the lead in presenting analyses of some of the previous year's most important hospice and palliative medicine research.\u0026nbsp; For those attendees interested in seeing their slides again, you can find them \u003Ca href=\"http:\/\/persweb.connect2amc.com\/SSOAAHPM\/login.aspx\"\u003Ehere\u003C\/a\u003E.\u003Cbr \/\u003E\u003Cbr \/\u003ESome of the research below further confirms our previous understanding of the state of the science (for instance, the studies on the low utility of feeding tubes in many circumstances).\u0026nbsp; Other studies provide quality randomized controlled trial data on questions which have nagged our field but where previous RCT data are minimal or completely lacking (e.g. parenteral fluids near end of life and ketamine for cancer pain).\u003Cbr \/\u003E\u003Cbr \/\u003EWe'd love to hear what you think about each study.\u0026nbsp; Feel free to comment on the blog.\u0026nbsp; If you like a study, you can further disseminate it by Retweeting it directly from this post!\u0026nbsp; \u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\"\u003EAssociations between end-of-life discussion characteristics and care received near death: a prospective \u003Ca href=\"https:\/\/twitter.com\/search\/%23hpm13\"\u003E#hpm13\u003C\/a\u003E \u003Ca href=\"http:\/\/t.co\/ZEVi9LQ2Oc\" title=\"http:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/23150700\/?i=1\u0026amp;from=mack%20discussions%20end%20of%20life\"\u003Encbi.nlm.nih.gov\/m\/pubmed\/23150…\u003C\/a\u003E\u003Cbr \/\u003E— Lyle Fettig, MD (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/312925047708852224\"\u003EMarch 16, 2013\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E \u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\"\u003EA randomized, placebo-controlled trial of acupuncture in patients with COPD \u003Ca href=\"https:\/\/twitter.com\/search\/%23hpm13\"\u003E#hpm13\u003C\/a\u003E state of science \u003Ca href=\"http:\/\/t.co\/pD72gjxQFD\" title=\"http:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/22905352\/?i=1\u0026amp;from=acupuncture%20copd%20suzuki\"\u003Encbi.nlm.nih.gov\/m\/pubmed\/22905…\u003C\/a\u003E\u003Cbr \/\u003E— Lyle Fettig, MD (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/312926133458960384\"\u003EMarch 16, 2013\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E \u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\"\u003EBarriers to conducting advance care discussions for children w\/ life-threatening conditions. \u003Ca href=\"https:\/\/twitter.com\/search\/%23hpm13\"\u003E#hpm13\u003C\/a\u003E state of science \u003Ca href=\"http:\/\/t.co\/WqBRLMZ0kq\" title=\"http:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/22392177\/\"\u003Encbi.nlm.nih.gov\/m\/pubmed\/22392…\u003C\/a\u003E\u003Cbr \/\u003E— Lyle Fettig, MD (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/312927762425995265\"\u003EMarch 16, 2013\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E \u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\"\u003ESurrogate decision makers' interpretation of prognostic information: a mixed-methods study. \u003Ca href=\"https:\/\/twitter.com\/search\/%23hpm13\"\u003E#hpm13\u003C\/a\u003E State of Science \u003Ca href=\"http:\/\/t.co\/N7MD7FCKel\" title=\"http:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/22393131\/?i=3\u0026amp;from=surrogate%20decision%20prognostic%20information\"\u003Encbi.nlm.nih.gov\/m\/pubmed\/22393…\u003C\/a\u003E\u003Cbr \/\u003E— Lyle Fettig, MD (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/312929059434795010\"\u003EMarch 16, 2013\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E \u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\"\u003ERCT to assess the efficacy\/ toxicity of subcutaneous ketamine in management of cancer pain. \u003Ca href=\"https:\/\/twitter.com\/search\/%23hpm13\"\u003E#hpm13\u003C\/a\u003E State of Science \u003Ca href=\"http:\/\/t.co\/fMA88WEfo4\" title=\"http:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/22965960\/\"\u003Encbi.nlm.nih.gov\/m\/pubmed\/22965…\u003C\/a\u003E\u003Cbr \/\u003E— Lyle Fettig, MD (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/312930899635367936\"\u003EMarch 16, 2013\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E \u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\"\u003EFeeding tubes and the prevention or healing of pressure ulcers.\u003Ca href=\"https:\/\/twitter.com\/search\/%23hpm13\"\u003E#hpm13\u003C\/a\u003E State of science \u003Ca href=\"http:\/\/t.co\/v6ymEc9NZH\" title=\"http:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/22782196\/\"\u003Encbi.nlm.nih.gov\/m\/pubmed\/22782…\u003C\/a\u003E\u003Cbr \/\u003E— Lyle Fettig, MD (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/312932597569306625\"\u003EMarch 16, 2013\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E \u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\"\u003EDoes feeding tube insertion and its timing improve survival?\u003Ca href=\"https:\/\/twitter.com\/search\/%23hpm13\"\u003E#hpm13\u003C\/a\u003E state of science \u003Ca href=\"http:\/\/t.co\/WOMlJfMshK\" title=\"http:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/23002947\/\"\u003Encbi.nlm.nih.gov\/m\/pubmed\/23002…\u003C\/a\u003E\u003Cbr \/\u003E— Lyle Fettig, MD (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/312933059387351040\"\u003EMarch 16, 2013\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E \u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\"\u003EParenteral hydration in patients with advanced cancer: a multicenter, double-blind, RCT \u003Ca href=\"https:\/\/twitter.com\/search\/%23hpm13\"\u003E#hpm13\u003C\/a\u003E state of science \u003Ca href=\"http:\/\/t.co\/LWAU4nyobz\" title=\"http:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/23169523\/?i=1\u0026amp;from=parenteral%20hydration%20bruera\"\u003Encbi.nlm.nih.gov\/m\/pubmed\/23169…\u003C\/a\u003E\u003Cbr \/\u003E— Lyle Fettig, MD (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/312934068264239106\"\u003EMarch 16, 2013\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E \u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\"\u003Emeaning of IV\/sq hydration 2 family caregivers \u0026amp; pts with advanced ca receiving hospice care.\u003Ca href=\"https:\/\/twitter.com\/search\/%23hpm13\"\u003E#hpm13\u003C\/a\u003E state of science \u003Ca href=\"http:\/\/t.co\/WAJNnA2XVF\" title=\"http:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/22459230\/?i=3\u0026amp;from=parenteral%20hydration%20bruera\"\u003Encbi.nlm.nih.gov\/m\/pubmed\/22459…\u003C\/a\u003E\u003Cbr \/\u003E— Lyle Fettig, MD (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/312934427443466241\"\u003EMarch 16, 2013\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E \u003Cbr \/\u003E\u003Cblockquote class=\"twitter-tweet\"\u003EInfluence of hospice on NH residents with advanced dementia who received Medicare-SNF near the end of life. \u003Ca href=\"https:\/\/twitter.com\/search\/%23hpm13\"\u003E#hpm13\u003C\/a\u003E \u003Ca href=\"http:\/\/t.co\/ZP6tU0Q6B5\" title=\"http:\/\/www.ncbi.nlm.nih.gov\/m\/pubmed\/23110337\/?i=1\u0026amp;from=influence%20of%20hospice%20dementia\"\u003Encbi.nlm.nih.gov\/m\/pubmed\/23110…\u003C\/a\u003E\u003Cbr \/\u003E— Lyle Fettig, MD (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/312936400196628480\"\u003EMarch 16, 2013\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async=\"\" charset=\"utf-8\" src=\"\/\/platform.twitter.com\/widgets.js\"\u003E\u003C\/script\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/9131918627728591405"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/9131918627728591405"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2013\/03\/state-of-science-from-2013-aahpm-annual_17.html","title":"State of the Science from the 2013 AAHPM Annual Assembly"}],"author":[{"name":{"$t":"Lyle Fettig"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/00710388898582754749"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}]}]}});