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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\/-\/randomized+control+trial?alt=json-in-script\u0026max-results=6"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/search\/label\/randomized%20control%20trial"},{"rel":"hub","href":"http://pubsubhubbub.appspot.com/"}],"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":{"$t":"3"},"openSearch$startIndex":{"$t":"1"},"openSearch$itemsPerPage":{"$t":"6"},"entry":[{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-1748383983610982529"},"published":{"$t":"2015-02-28T08:56:00.001-06:00"},"updated":{"$t":"2015-02-28T08:56:18.898-06:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"AAHPM"},{"scheme":"http://www.blogger.com/atom/ns#","term":"cards\/chf"},{"scheme":"http://www.blogger.com/atom/ns#","term":"non-pain symptoms"},{"scheme":"http://www.blogger.com/atom/ns#","term":"pain"},{"scheme":"http://www.blogger.com/atom/ns#","term":"pulmonary\/copd"},{"scheme":"http://www.blogger.com/atom/ns#","term":"randomized control trial"},{"scheme":"http://www.blogger.com/atom/ns#","term":"research"},{"scheme":"http://www.blogger.com/atom/ns#","term":"symptoms"}],"title":{"type":"text","$t":"AAHPM Assembly State of the Science 2015"},"content":{"type":"html","$t":"As David Currow said when he received his Excellence in Research award, hospice and palliative medicine researchers need to meticulously measure toxicity in addition to benefits of palliative interventions.  How do you think the State of the Science studies did with this goal?   What do you think about the conclusions of each of the studies?  Any changes in your practice? Thanks to the presenters Jay Horton, Kimberly Johnson,Nick Dionne-Odom, and Cardinale Smith for reviewing and presenting.  Always a fun presentation.  \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003ENeurolytic sympathectomy in management of cancer pain-time effect: a prospective, randomized multicenter study \u003Ca href=\"http:\/\/t.co\/fdqI1A2meB\"\u003Ehttp:\/\/t.co\/fdqI1A2meB\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571670862375596032\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003EComparative effectiveness-senna to prevent problematic constipation in peds onc patients receiving opioids:\u003Ca href=\"http:\/\/t.co\/rYyx3xY7jI\"\u003Ehttp:\/\/t.co\/rYyx3xY7jI\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571672408442077185\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003ERandomized Controlled Trial of Expressive Writing for Patients With Renal Cell Carcinoma \u003Ca href=\"http:\/\/t.co\/2reY7q5CM0\"\u003Ehttp:\/\/t.co\/2reY7q5CM0\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571673788460359680\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003ESafety of benzodiazepines and opioids in very severe respiratory disease: national prospective study \u003Ca href=\"http:\/\/t.co\/CsbkLEa0jF\"\u003Ehttp:\/\/t.co\/CsbkLEa0jF\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571675418668875776\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003EAn integrated palliative and respiratory care service for patients with advanced disease: An RCT \u003Ca href=\"http:\/\/t.co\/awhOMOKRAy\"\u003Ehttp:\/\/t.co\/awhOMOKRAy\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571676886910160896\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003EInpatient palliative care for patients with acute heart failure: outcomes from a randomized trial. \u003Ca href=\"http:\/\/t.co\/HCRVaXRIw4\"\u003Ehttp:\/\/t.co\/HCRVaXRIw4\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571678668436713472\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003EIntervention to improve care at life\u0026#39;s end in inpatient settings: the BEACON trial. \u003Ca href=\"http:\/\/t.co\/Ht7MwhzIYF\"\u003Ehttp:\/\/t.co\/Ht7MwhzIYF\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571680700027568129\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003EAssociation of experience with illness and end-of-life care with advance care planning in older adults \u003Ca href=\"http:\/\/t.co\/S04ifi57iM\"\u003Ehttp:\/\/t.co\/S04ifi57iM\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571682819963006976\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E         "},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/1748383983610982529"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/1748383983610982529"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2015\/02\/aahpm-assembly-state-of-science-2015.html","title":"AAHPM Assembly State of the Science 2015"}],"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"}}]},{"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$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}]},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-8631752077660717445"},"published":{"$t":"2011-01-03T18:20:00.002-06:00"},"updated":{"$t":"2011-01-03T23:30:49.663-06:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"mcmichael"},{"scheme":"http://www.blogger.com/atom/ns#","term":"non-pain symptoms"},{"scheme":"http://www.blogger.com/atom/ns#","term":"pain"},{"scheme":"http://www.blogger.com/atom/ns#","term":"randomized control trial"}],"title":{"type":"text","$t":"RCT of Palliative Medicine Consultations on Admission"},"content":{"type":"html","$t":"\u003Ca href=\"http:\/\/1.bp.blogspot.com\/_AToKolhn8no\/TQq2UPrAdiI\/AAAAAAAAADg\/uYRa5F0bP6A\/s1600\/Issue%2BCover.jpg\" onblur=\"try {parent.deselectBloggerImageGracefully();} catch(e) {}\"\u003E\u003Cimg alt=\"\" border=\"0\" id=\"BLOGGER_PHOTO_ID_5551449949608113698\" src=\"http:\/\/1.bp.blogspot.com\/_AToKolhn8no\/TQq2UPrAdiI\/AAAAAAAAADg\/uYRa5F0bP6A\/s320\/Issue%2BCover.jpg\" style=\"cursor: hand; cursor: pointer; float: right; height: 243px; margin: 0 0 10px 10px; width: 184px;\" \/\u003E\u003C\/a\u003E\u003Cspan class=\"Apple-style-span\" style=\"font-family: inherit;\"\u003EIn the current issue of \u003Ca href=\"http:\/\/archinte.ama-assn.org\/content\/vol170\/issue22\/index.dtl\"\u003EArchives of Internal Medicine\u003C\/a\u003E, under the category, \"Health Care Reform\" is a Research Letter entitled, \u003Ca href=\"http:\/\/archinte.ama-assn.org\/cgi\/content\/full\/170\/22\/2038\"\u003EHospital-Based Palliative Medicine Consultation: A Randomized Controlled Trial\u003C\/a\u003E. 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.\u003Cbr \/\u003E\u003C\/span\u003E\u003Cbr \/\u003E\u003Ca name='more'\u003E\u003C\/a\u003E\u003Cspan class=\"Apple-style-span\" style=\"font-family: inherit;\"\u003E\u003Cbr \/\u003EPatients were randomly assigned to the intervention or usual care group. The intervention group received a physician-based palliative medicine consultation (PMC) on enrollment and was followed up every weekday during hospitalization. The patients were routinely assessed for symptoms as well as psychosocial and spiritual needs. The PMC physician discussed treatment preferences, and consulted a pharmacist and chaplain as needed. The PMC physician communicated with the patient's team via a medical chart note and by telephone. The usual care group received a brief visit from the PMC physician who gave them a packet of information on diet and exercise. Patients were rated as dependent or independent for Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales, and were rated on the 15-item Geriatric Depression Scale (GDS-15) for depression. Pain, dyspnea, and anxiety were assessed daily by a research assistant who was blinded to group assignment. All patients completed a telephone survey 2 weeks after discharge to reassess symptoms, rate physician and nursing care, and recall discussions of preferences. Medical records were reviewed to determine patients' primary diagnosis on admission.\u003Cbr \/\u003E\u003Cbr \/\u003E107 patients were enrolled; 81 patients completed follow-up surveys. Most patients were male (62%) and white (71%) and had some college education (56%). The mean (SD) age was 76 (7.5) years, and 45% were married or partnered. The primary diagnoses were heart failure (51%); cancer (22%); chronic obstructive pulmonary disease (20%); and cirrhosis (6%). The mean (SD) hospital length of stay was 5.5 (5.8) days. Most participants were dependant in 1 or more ADL (71%), and 21% had a GDS-IS score of 6 or higher. The groups differed in mean age (77 and 74 years in the intervention and usual care groups, respectively; P = .007) but not in other characteristics.\u003Cbr \/\u003E\u003Cbr \/\u003ESymptom scores for all subjects improved from baseline to follow-up for pain (4.2 vs 2.3; P \u0026lt;.001), dyspnea (3.8 vs 2.0; P  \u0026lt;.001), and anxiety (4.8 vs 2.4; P \u0026lt;.001). There was no additional improvement in pain (P = .30), dyspnea (P = .50), or anxiety (P = .08) for patients assigned to the intervention at any assessment period. At follow-up, most patients believed that the staff understood what they were going through and that physicians and nurses listened to their hopes, fears, and beliefs. However, a minority of patients reported that the physician discussed their preferences for care (43%), their chance of surviving hospitalization (42%), or their religious beliefs (31%). There were no differences between groups for any of these items.  The writers point out that the subjects, of this single-institution study, were not those that would otherwise be referred for PMCs and thus may have lacked issues that a PMC would affect. They wondered whether palliative care may have an impact on different outcomes or require ongoing engagement. Also, the intervention was not by interdisciplinary team.  \u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan class=\"Apple-style-span\" style=\"font-family: inherit;\"\u003E\u003Cbr \/\u003E\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan class=\"Apple-style-span\" style=\"font-family: inherit;\"\u003ESome thoughts:\u003Cbr \/\u003EI agree that the physician-based intervention made over a short-course with patients who were not necessarily into end-stage disease was not likely to make significant effect over usual care. Right patient, right treatment, right dose, right time, etc. What we seem to have here is equivalence or a failure to show inferiority for inclusion of PMCs, at least with respect to the trial design and tested parameters. But they present and discuss pooled data for symptom-levels and then note that there is no significant additional improvement for PMC, rather than testing the difference between group means.\u003Cbr \/\u003E\u003Cbr \/\u003ENow, in the category of retrospective data-mining:\u003Cbr \/\u003EAccording to the \u003Ca href=\"http:\/\/archinte.ama-assn.org.\/cgi\/content\/full\/170\/22\/2038\/ILD05037F1\"\u003EFigure\u003C\/a\u003E there were no significant intergroup differences (with respect to 95% CIs) between usual care and PMC for interval-matched measurements of pain, dyspnea and anxiety. However, I did note that for the usual-care group, between baseline to follow-up, there was no significant difference (with respect to 95% CIs) in the levels of pain [3.5 (2.4 - 4.8) vs. 2.1 (1.1 - 3.1)], dyspnea [3.0 (1.8 - 4.2) vs. 1.6 (0.6 - 2.5)] and anxiety [3.8 (2.7 - 5.0) vs. 2.5 (1.3 - 3.6)]. One could suggest that for these patients their usual-care admissions had no effect on these symptoms.\u003Cbr \/\u003E\u003Cbr \/\u003EAlternatively, for the PMC group, between baseline to follow-up, there was significant difference in the levels of pain [4.9 (3.8 - 6.0) vs. 2.4 (1.4 - 3.4)], dyspnea showed equivalence at the lower and upper values of the 95% CI [4.4 (3.3 - 5.5) vs. 2.4 (1.5 - 3.3)], and again there was significant difference for anxiety [5.5 (4.2 - 5.5) vs. 2.5 (1.5 - 3.6)].\u003Cbr \/\u003E\u003Cbr \/\u003EI think there is food for thought here in terms of future trial design. Is this difference real? For these chronically ill patients, from admission to follow-up, do hospitalizations with PMCs show significant decreases in symptoms compared to no significant difference in symptoms with usual-care admissions? Do admissions with PMCs using interdisciplinary-team interventions show significant differences over usual-care admissions?\u003Cbr \/\u003E\u003C\/span\u003E\u003Cspan style=\"float: left; padding-bottom: 5px; padding-left: 5px; padding-right: 5px; padding-top: 5px;\"\u003E\u003Ca href=\"http:\/\/www.researchblogging.org\/\"\u003E\u003Cspan class=\"Apple-style-span\" style=\"font-family: inherit;\"\u003E\u003Cimg alt=\"ResearchBlogging.org\" src=\"http:\/\/www.researchblogging.org\/public\/citation_icons\/rb2_large_gray.png\" style=\"border: 0;\" \/\u003E\u003C\/span\u003E\u003C\/a\u003E\u003C\/span\u003E\u003Cspan class=\"Apple-style-span\" style=\"font-family: inherit;\"\u003E\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cbr \/\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=Archives+of+Internal+Medicine\u0026amp;rft_id=info%3Adoi%2F10.1001%2Farchinternmed.2010.460\u0026amp;rfr_id=info%3Asid%2Fresearchblogging.org\u0026amp;rft.atitle=Hospital-Based+Palliative+Medicine+Consultation%3A+A+Randomized+Controlled+Trial\u0026amp;rft.issn=0003-9926\u0026amp;rft.date=2010\u0026amp;rft.volume=170\u0026amp;rft.issue=22\u0026amp;rft.spage=2038\u0026amp;rft.epage=2040\u0026amp;rft.artnum=http%3A%2F%2Farchinte.ama-assn.org%2Fcgi%2Fdoi%2F10.1001%2Farchinternmed.2010.460\u0026amp;rft.au=Pantilat%2C+S.\u0026amp;rft.au=O%27Riordan%2C+D.\u0026amp;rft.au=Dibble%2C+S.\u0026amp;rft.au=Landefeld%2C+C.\u0026amp;rfe_dat=bpr3.included=1;bpr3.tags=Medicine%2CHealth%2CMedicine\"\u003EPantilat, S., O'Riordan, D., Dibble, S., \u0026amp; Landefeld, C. (2010). Hospital-Based Palliative Medicine Consultation: A Randomized Controlled Trial \u003Cspan style=\"font-style: italic;\"\u003EArchives of Internal Medicine, 170\u003C\/span\u003E (22), 2038-2040 DOI: \u003Ca href=\"http:\/\/dx.doi.org\/10.1001\/archinternmed.2010.460\" rev=\"review\"\u003E10.1001\/archinternmed.2010.460\u003C\/a\u003E\u003C\/span\u003E\u003C\/span\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/8631752077660717445"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/8631752077660717445"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2011\/01\/rct-of-palliative-medicine.html","title":"RCT of Palliative Medicine Consultations on Admission"}],"author":[{"name":{"$t":"Brian McMichael, M.D."},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/16324454830426406867"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"21","height":"32","src":"https:\/\/images-blogger-opensocial.googleusercontent.com\/gadgets\/proxy?url=http:\/\/2.bp.blogspot.com\/-yVKgadEpJzc\/UvePJ8jZ1NI\/AAAAAAAAATE\/U7AeFhDYP-s\/s113\/PicturePeopleBMcMedium.jpg\u0026container=blogger\u0026gadget=a\u0026rewriteMime=image\/*"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"http:\/\/1.bp.blogspot.com\/_AToKolhn8no\/TQq2UPrAdiI\/AAAAAAAAADg\/uYRa5F0bP6A\/s72-c\/Issue%2BCover.jpg","height":"72","width":"72"}}]}});