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I compiled this list of helpful hints from my own experiences and from peers input over the past few years. I think it may be helpful to first timers but also to veterans of national/regional medical meetings like the AAHPM Annual Assembly.

This was originally posted to the AAHPM Professionals-in-Training Special Interest Group email list.

Any updates or additions would be appreciated.

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Christian Sinclair's Handy Hints for a National Meeting
Originally written Jan 2005

* Bring your CV (multiple copies, and UPDATED) and business cards, regardless of whether you are looking for a job. Many people may want to know more about you for networking reasons, not just job offers.
* Talk to people. Don't sit by yourself unless you are the first person in the room. Sit next to someone and then introduce yourself.
* Don't stay in your room too much, you'll miss too many opportunities
* Stay in your room sometimes. Take some time to unwind and be yourself.
* There is a bulletin board in a central place where people post messages: Llook there for any messages regarding you or get-togethers you are interested in.
* The bulletin board is a good place to post a flyer with your picture on it, with a sign that says "Will provide good end-of-life care for food", if you want people to contact you about a job. (Trust me there will be a lot of people there looking for fresh new trainees.)
* When you go out with other people, you do not HAVE to talk about medicine (The people at the table next to you may appreciate that); find out what really makes someone tick (just like talking to patients)
* You should make dinner plans with other people (outside the group you came with, but invite them along too)
* Write down key facts you have learned towards the end of the day. The facts may be about topics you have learned about or people you have met. You may meet so many people it may be difficult to remember everyone and their interests. (The back of the business card is a good start)
* Don't be afraid to introduce yourself to any of the 'hospice celebrities'. Most of the well-known people in hospice and palliative medicine are very friendly and willing to talk, just make sure they are not in a rush for somewhere else. A lot of people would like to have their attention.
* Go to the poster session and talk to the people who made the posters. A lot of hard work went into most of these, and everyone likes to hear when they have done a job well.
* If you are bringing family or a significant other, make sure to spend some time with them.
* Reconnect with old friends.
* After a session, if you talk with a speaker, make your point or ask your question, and then allow others to interact. Nothing is worse, than trying to make a quick point after a session, then the know-it-all who wants to take up all the time of the presenter without regards to other people's interest. If you are presenting and you find this know-it-all who wants all of your time, make sure to set limits, and let others ask you questions.
* Turn in your session evals in a timely manner.
* Thank the coordinators who are organizing the meeting if you find them, they have put a lot of hard work and seldom get recognized.
* Try and get out and see the city you are in, since you never know when you will be back there or if it will be devastated by a major hurricane.
* When you come back to work schedule a educational session with interested parties to share everything you learned there.
* Go to at least one paper session. The concurrent sessions are great but you can find out some interesting up and coming things in the paper sessions. (Same goes for the Professionals-in-Training Case Conferences!)

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NY Times has a positive article about "open-access" model hospices. (For those of you not familiar with this it is a model where hospices provide/pay for costly and even disease-modifying treatments like chemotherapy, hospitalizations, etc.) Most interesting, to me, is that it seems several private insurers are trialling open-access in an effort to increase the number of hospice enrollees and lengthen hospice length of stay (one also hopes they are planning on publishing their findings on enrollment, LOS, cost, and patient/family satisfaction).

Open-access is not without criticism, much of it about cost of course but also about it changing the nature (or at least the flavor) of hospice. Instead of opining on that I think I'll do my taxes instead and let commenters share their thoughts.

(Multiple readers emailed us about the article--thanks!)
(NY Times articles are usually available free for a week.)

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It should be noted that with Christan's flurry of posts the last couple of weeks Pallimed has now exceeded the 300 post mark.

Several things in brief:

1)
BMJ reports that over half of complaints against Britain's NHS regarding hospital care were to do with deaths:

"In many cases, families complained that they had received contradictory or confusing information from different staff caring for a relative. In other cases, relatives felt that they were unprepared for the death or had no time to arrange for family members to be present."

Sound familiar?

2)
BMJ also has an interesting look at the role of NGOs in physician assisted suicide. It examines two organizations in detail (Exit in Switzerland and Compassionate Choices in the US). Both function as patient advocacy groups, assisting people seeking PAS--Exit volunteers will even physically help people fill and administer the lethal prescription. The authors'--whose tone is neutral--take is that these organizations help people overcome the physician obstacles to PAS (the fact that many physicians want nothing to do with it). Oregon aside, the article is most relevant to the UK where there is a very active national debate about 'assisted death.' If you're interested Compassionate Choices website is quite interesting, especially in how it uses a lot of palliative-care type language (although my sense is that most palliative care clinicians in the US are neutral about PAS at best--many, myself included, feel quite negative about it--there are notable exceptions of course). The other interesting thing about CC is its use of consumerist language..."choice" etc. As if one can pick from a buffet of choices about end of life care (leather or vinyl seats?)--something that doesn't reflect the reality of dying at all.

3)
NEJM this week has an article about religion, conscience, and controversial clinical practices (full-text available for free). The article is base on a survey of American physicians and their attitudes towards religion and controversial practices. Most of the context for this is reproductive issues (abortion, contraception) but terminal sedation is also specifically included. Basically they found that most physicians feel it is appropriate to disclose their moral objections to a medical therapy, but that they should still inform their patients of all available medical options, and refer a patient to a physician willing to help the patient (86% and 71% for the last two obligations). The more religious the physician was, however, the less likely they were to endorse an obligation to informing/referring their patient. And those physicians who morally objected to a specific practice were much more likely to say that they had no obligation to inform or refer. (Only 15% of physicians personally objected to terminal sedation compared to ~half for reproductive issues.) It should be noted that only 63% of physicians responded to the survey. The lesson, I guess, is caveat emptor, and particularly regarding reproductive issues one cannot assume that your physician has your best interests in mind/agrees with you about your best interests/or will even engage with you about this.

I wish the authors had asked the physicians if they believed they should promote their own religious beliefs to their patients--my guess is that only a tiny minority of physicians, even the most religious ones, would endorse this. This, to me, raises the question of whether there is an active/passive element at play here--that it is ok for your religious beliefs to "passively" effect your patients (not mentioning to them legal and effective medical therapies based on your religious beliefs) but actively proselytizing is not ok. Of course active/passive distinctions are frequently invoked in palliative care as being morally valid....

4)
In a laterally related article The Hastings Center has just published a report on patient religious belief and medical-decision making capacity (free .pdf here). It is a long argument (that I can't really summarize) that religious beliefs may lead to patients lacking medical decision-making capacity, but that this does not necessarily mean that those patients are incompetent to make decisions. Incompetent in the sense of patients having their (legal and ethical) right to autonomy and to decide what is done to their body taken away from them. Are certain patients due to strongly held religious beliefs incapable of rationally understanding medical information and making decisions on that? Yes. Does this mean their right to make decisions should be forfeited? No (not necessarily). This is the crux of the author's argument. A problem, which is addressed in the article, is that one person's religious beliefs may be another's psychosis, and does cultural sanctioning of religious beliefs ( i.e. there are a lot of believers in X therefore it's ok versus a small fringe-cult's beliefs) make a difference in what is, well, crazy (my words, not the authors) and what is faith?

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Charlie Norwood, a congressman from Georgia, had a press release yesterday that he is foregoing further treatment for his NSCLC. He is a 7-term Republican who is not resigning his seat, and has said in some new reports that he may consider further treatment if he becomes better. The press release states that he will also receive 24-hour nursing care at his home.

I am glad to see the public mention of hospice care for public figures. I always have wondered when you hear about a famous person dying at home if they had hospice services or if they were able to hire their own nurses and physicians to come and visit them. I wished that the hospice philosophy could benefit from more public mentions like this and Art Buchwald.

(Although it should be noted that 24-hour in-home nursing care is not part of the Medicare Hospice Benefit (obviously barring continuous care for crisis), nor of most commercial insurance that I am familiar with. Just don't want any misconceptions since this is public knowledge).

NY Times had a great article about cancer in people under 40. The tone of the article is 'isn't this shocking' mixed in with a little 'but the outlook is good.' I think the best quote is from Lauren Terrazzano when she says, "Cancer is the ultimate form of identity theft." They also link to a site http://imtooyoungforthis.org/ which highlights how to live with a cancer diagnosis at a young age. For those of us in the hospice field, I know we have all seen our share of patients that seemed way too young for cancer. But then is any age a better age for cancer? There is no good age to have cancer. We should caution against being ageist.

MSNBC (via the AP) has a good story on a young mother who has been diagnosed with ALS. I appreciate the highlights on the children coping with their mother as well as links to how to help children grieve. Great acknowledgements of the Pediatric Voice (a title from a talk at the AAHPM)

The Washington Post had an editorial from someone who has been diagnosed with "life-threatening diseases four times." The editorial focuses very well on the patients perspective of being a "blunter" or a "monitor.' New terms to me but the article goes on to talk about how different people want different amounts of information when it comes to their medical care.

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HospiceGuy over at HospiceBlog (a good read if you have not been over there yet) has posted on the NHPCO alert about Bush's new budget and the implications to Medicare and therefore the Medicare Hospice Benefit.

A favorite quote from his post:

That decision will force people like me to focus my energy on the nursing home market in hopes of having enough big profit nursing home patients to finance my admirable but financially unsustainable home patient habit.

He is a pretty clever writer. Much more than me. He gives Drew a good run on being witty.

Why the short post Christian?

Well I also wanted to tell you about the new feature on the left hand column that features stories that come to my RSS/Atom feed through Google Reader. I mark them to 'share' with you the Pallimed readers because it may be of interest to you. Not always so interesting to post a long soliloquy but interesting nonetheless. I promise not to just check everything. I will filter it for you. Unfortunately this service will not come through with the email updates via Feedblitz.

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This is the fifth post in a series previewing the sessions at the American Academy of Hospice & Palliative Medicine's Annual Assembly.

You can see all the posts in the series below:
2/14 - Pre-conferences
2/15 - AM Sessions
2/15 - PM Sessions
2/16 - AM Sessions
2/16 - PM Sessions
2/17 - AM Sessions
2/17 - PM Sessions

Click here for the AAHPM Annual Assembly Brochure 2007 (pdf)

Register soon if you have not already!

(Note: I am not commenting on the lunch time activities. No particular reason.)

Friday, February 16th - PM Sessions
2:15pm-3:15pm

There are a couple of interesting talks with interesting titles here and the one that has me most intrigued is the 'Risks and Benefits of Terminal Illness Acknowledged.' Very cryptic but very interesting. I hope it offers a unique perspective as the title implies. Have not heard the speakers before, but sounds really interesting. This title has me interested: 'A Session for those Not Ready for Self-Care.' Will we learn about caring for ourselves or about how to help others who are not ready to care for themselves, or is this about the loss of independence at the EOL. I am not sure, but Martha Twaddle is a pretty good speaker, so good vibes on this one. Another slightly cryptic title is the one about the 'Pediatric Voice.' I presume this is focusing on making sure that children are involved in EOL issues, but I am not sure if this means 'pediatric hospice' or 'adults at EOL when children are present.' I find both issues interesting but would have to read the detail on the talk before deciding to go to this one or not.

Glad to see there is a methadone talk. i think this is a good idea for beginners to intermediates in this field, and probably a topic that should be present every year, given that palliative practitioners should be well familiar with this opioid as a tool for difficult pain situations. This talk is given by tow doctors from Excellerx (parent of Hospice Pharmacia), so I am guessing this will focus mostly on oral methadone. I am curious about their input on intravenous/subcutaneous methadone, given its lack of availability but possibly better cost-benefit ratios.

I am not sure about the educational value of the PC-FACS talk alone, but I think this is a great service from the AAHPM, and Amy has done a great job putting this out.

There is also a talk on brain tumors in this time slot, but I hear there is a much better one later that day...(shameless plug)

3:30-4:30pm

A little more weight towards policy issues with this session with some of the big guns weghing in (Von Gunten, Herbst, Casarett, Teno, Storey). All probably good talks if these policy areas (Medicare denials, QI, Pandemic Plans) are of interest to you.

Two symptom based talks look promising. The intrathecal talk one is pretty important as we will be seeing (or have seen) more and more implanted pumps for symptom control. I heard Dr. Stearns talk 2 years ago. Helpful talk. Best advice, get to know at least one pain interventionalist near you who is willing to work with the hospice field. I am lucky to have one in Rich Morgan here in KC. I am not sure what evidence the DVT talk will bring that will change my management as we have blogged here about DVT's in the past. (here and here)

4:45-5:45pm

Wow this is getting late in the day. I hope you are all sticking around for the best talk of the day: Palliative Care of the Brain Tumor Patient by myself and Dr. Salacz (Who has 3 talks at this conference - simmer down now!) Other than our great talk, there are some good ones in this session, like the one on ''Management of Addiction" by Crossno and 'Creating Deep Lasting Organizational Change.' I have not heard many of these speakers talk except for Chamberlain. No big comments on the other sessions although the Cardiac Program talk would be good for those looking to specialize their palliative care programs.

Phew! There are a lot of talks this day. Guess no going to Alta for me!

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The British Medical Journal published a very good, well-written overview article on Defining Limits in Care of Terminally Ill Patients by Dr. Ursula Braun and her colleagues. It takes a Problem-Based Learning approach to a common medical scenario: the crashing patient with inconsistent documentation of their wishes and a family with sub-optimal communication. Using this case, Dr. Braun covers the best approaches to building a consensus. Some of the key points made include:

...after acknowledging the situation’s difficulty, (doctors should) present their expert opinions and not shy away from making recommendations because of a misplaced fear of upsetting the patient or surrogate.

I frequently instruct medical students, residents and fellows that pass through my hospice agency that patient autonomy does not mean our professional opinion is unimportant. When it comes to prescribing cholesterol medications, we don't always stop to say, "Now what do you think would be best?" Physicians will say, "Your cholesterol is high, diet and exercise did not work as we hoped, and now you should be on Brand X to decrease your risk of cardiovascular complications. Here is your script." Here professional opinion weighs heavily on the situation.

In an effort to seem completely objective (especially in life and death/EOL/terminal cases) we risk abandoning our patients and their families by not offering a suggestion for best medical course that fits with the patients expressed wishes (if known). The "If it were my mother" question always seemed slightly bogus to me, although it does raise a good point. How would a physician decide to care for their loved one? My standard reply to families or patients is that I would find out what was important to her, weigh the risks and benefits of the medical options given and choose the one that fit best with her goals. So on one hand it seems like a cop out because I won't say "I would put a PEG in my mom." But I do try and reflect the words that the patient or family have used to frame the decision. "Well, given what you said about your mother being fiercely independent and wanting to ride her Harley to South Dakota every year, we should/should not do XYZ"

Also this point was great. I need to make a plaque out of this sentence.

Curative and palliative care should not be dichotomous.

One question I had was this sentence:

Additionally, in some US states patients can opt for do not resuscitate orders out of hospital.

Are there really states where you cannot get a Out of Hospital DNR?

One minor beef I had (more a style point if anything):

For example, when discussing cardiopulmonary resuscitation, it is important to explain that ribs may be broken, burns can occur, success is inversely proportional to length of resuscitation, and the likelihood of returning to the former level of functioning may be small.

I agree with most of this sentence but, I really try not to highlight all the bad things (broken ribs, burns, etc.) because it seems a little bit like a scare tactic. And I have had some patients and families use the excuse that if they die, it wouldn't matter anyway. Instead I prefer to bring up the time of death situation and demonstrate we have two main options:

1) Look at the patient, see that the heart has stopped beating or had a fatal rhythm or that the lungs have stopped breathing and say, "Now we have something to fix." Then the scene becomes one of urgency, chaos and strangers trying to fix things.


2)We can look at the patient, understand all they have been through recently and in their life, realize this is a time when the body may say, "I can't be fixed." And instead of emergency, strangers and chaos, we can work on peace, family and comfort. This may be one of the most important times in this person's life.

Most people understand these differences, and brings up similar issues without getting gruesome or gory.

One other small point that was not fully addressed is the often difficult case of differing physician opinions and communications with families.

Overall great article. I would recommend it as a great overview, introduction article to principles of palliative care and patient-physician communication.
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And in typical BMJ fashion they have some cheeky humor at the bottom of the last page of the article about using a CAGE like questionnaire for Blackberry users called the SHAM Screening Test. I have a Blackberry, but I am 0 for 4 on the questions. Phew!

• Do you get annoyed if you are asked to Stop using your hand held device?
• Do you take your hand held device on Holiday with you?
• Do you get Anxious if you cannot find your hand held device?
• Do you ever Misperceive a sound as the ring tone or call sign of your hand held device?

Kudos to Mark Taylor for the submission to BMJ.

(Thanks to Tom Quinn for the idea for submission.)

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This is the fourth post in a series previewing the sessions at the American Academy of Hospice & Palliative Medicine's Annual Assembly.

You can see all the posts in the series below:
2/14 - Pre-conferences
2/15 - AM Sessions
2/15 - PM Sessions

Click here for the AAHPM Annual Assembly Brochure 2007 (pdf)

Register soon if you have not already!

Friday, February 16th - AM Sessions

Plenary Session
8–9:45 am

Team as a Living Organism: Healthy and Terminally Ill?
Nessa Coyle, NP PhD FAAN & David Giansiracusa, MD
Memorial Sloan Kettering Cancer Center

I think this is a really good idea for a plenary topic because what person has not been in a meeting and thought that the meeting could be going better, more efficiently, more focused, more whatever, and then the thoughts go to what person is somehow impeding your ideal of a perfect meeting (whether that be short, long, whatever). But this talk is likely much more than the team meeting which I like to think of as the family dinner. The focus of this talk seems to be the whole dynamic of the team in all settings, but obviously I picked on the team meeting because that is one aspect that the medical director really gets to see the team in action. I hope there are some good insights here because I think team building and looking out for one another happens in a few special teams, but it takes work. A lot of work to stay 'healthy.' I guess they should have some good analogies given their title. This talk wins second prize for best title. David is a good speaker as well and an all around good guy so this should be a good talk.

10:15-11:15am
Concurrent Sessions

Well there has always gotta be one session that really doesn't get you particularly excited, although this time has a diverse range of topics, not one particularly grabs me and some I have heard in other venues. The Training Program Accreditation is the one that best fits my needs as a Fellowship Director, so I will be there. Lupu and Portenoy have done some great things to move this process forward and any information from them will be helpful for me to hear. The Children's Legacy talk and the Hurricane Katrina talk should both have some great stories and some particular insight if those areas interest you. Bailey and Ritchie's Evidence Based Order Set talk was pretty insightful last time I went to it, but not much has changed in the past few years in EOL EBM. This session is surely recommended for those entering the field or starting new programs.

11:30-12:30 - AAHPM Business Meeting

If you have never been to this, but are planing to be in this field a while, I reccommend you go to this at least once every few years. Great insight into where we have been and where our professional field is going.

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Probably one of the most important palliative care articles to come around in a long time was published last week in the New England Journal of Medicine. It's from a project to improve communication with families of dying ICU patients (article here; supporting editorial here). It's important in a variety of ways, but first--a summary.

The project was a French, multicenter, randomized trial of a communication intervention for families of dying ICU patients. 126 patient/family units were enrolled. Basically the only enrollment criteria was that the ICU attending believed death was inevitable (only 1 patient, in fact, survived) and that some form of limitation of life-prolonging treatment was indicated. At that time the families either received a routine end-of-life conference (held the way it happened to normally be held at that institution) or the family was randomized to the intervention. Their goal was to see if the intervention decreased bereaved family members psychologic symptoms (including PTSD symptoms, depression, and anxiety). The intervention involved giving the family a brochure on death/bereavement as well as having the intervention family meeting. The family meeting intervention is loosely described in a supplement available online (you need access to full-text to see it), was multidisciplinary, and is based on the VALUE framework developed by JR Curtis (Value and appreciate things family said, Acknowledge emotions, Listen, ask questions that allow you to Understand who the patient is as a person, and Elicit questions from the family). You may say that this sounds a little vague and in addition to that you may be skeptical that the docs had a hard time going back and forth from a routine family meeting to a VALUE one. You may be right about this but the researches can say that despite these limitations they found real differences in how the family meetings went, and about the outcomes...

...Including: Intervention group meetings took 50% longer than control meetings (average of 30 vs. 20 mins); families spoke almost 3 times as long in the intervention group meetings ( 13.5 vs. 5 mins). The care patients received after the meetings seems to be pretty similar--median survival was 1-2 days--the intervention group had slightly fewer life-prolonging interventions continued for what's that worth--this is important because it seems that the intervention group family members had better outcomes not because the patients received different care but because of the communication differences. Interestingly both groups felt like they spent sufficient in the meetings and that they had clear information. As for the study's primary outcomes: the intervention group family members did significantly better symptom-wise 90 days after their loved-one's death (lower score on a screening scale for PTSD, and significantly lower scores on the HADS depression and anxiety scales). These improvements were modest, but likely real, particularly given the relatively low N of this study.

It's important because:

1) I'll go ahead and say it: because the NEJM published it--an ICU outcomes trial in which the outcome was the emotional well-being of bereaved family members! This underlies the reality that medical culture is changing into one which more or less supports the integration of palliative care/palliative-care-type approaches to severely ill people. And, like it or not, the NEJM has a certain normative effect--like the NY Times--in defining what is important.

2) While most of us think what we do--you know, talking to patients/families, hearing their stories, supporting them in their grief--actually helps people in real ways, it is nevertheless extremely important to prove that what we do really does help people. Or else why would institutions, payers, policy-makers, and other physicians change or support us?

3) Caveats (below) aside, what was studied here was well-accepted principles of medical communication that are the foundation of all the expert recommendations on communicating difficult information with patients/families, running family meetings, etc: find out what people understand and find important, value emotions/emotional reactions, let people speak. Wisdom and experience have shown that this is a much more humane and effective approach to communication but as per #2 above it is extremely important to empirically support this.

4) Carrying #3 further the trial is important because it's a sort of proof of principle--that you can do this sort of investigation and find meaningful, and important, results.

Caveats, because there are always caveats:

1) There are certainly cultural differences between France and, say, North America and I'm not sure how to interpret this.

2) I don't want to oversell the findings as these are the first of their kind (as far as I know--if I'm wrong PLEASE leave a comment).

3) Beware that people may interpret this as something like "we should spend 30 minutes in family meetings and families should speak for 13.5 of those minutes" (the editorial does promote the idea of increased time). One, the results don't support this, although they do suggest the more time the better. This is my own personal gloss on this but the message from this trial should be the promotion of the family/emotions/values-centered family meeting and not any pre-conception about time or minutes spent doing X. It's how you spend that time--and I guess who does the talking--that matters. At least I'd like to think so...because...

4) It's possible that all the talking did nothing and that it was the brochure that had the beneficial effects. No way of knowing this from the trial. They should have given the brochure to everyone. Giving two separate interventions to the same group makes it impossible to figure out which one was the effective one....

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We are glad you found us and hope you enjoy the information and commentary we provide. If you are here we presume you have a basic understanding of the field of hospice and palliative medicine, and are likely part of the professional field. (Here is a good description of palliative medicine).

Our target audience is the professionals (MD, DO, RN, LPN, LVN, Home Health Aide, ARNP, SW, Chaplain, Administrators, PT, OT, Speech, Pharmacy, etc.) working in hospice & palliative medicine, but we welcome all readers to this blog, including patients, families and other medical professionals outside of this field.

Our goal is to review current palliative medicine, hospice, end-of-life research with a particular focus on publications not from the major palliative care journals. We also highlight important events in end-of-life care from the news media and entertainment arenas. Pallimed is not intended to replace the patient-physician relationship.

Drew Rosielle, MD
drosielle (at) gmail (dot) com

Christian Sinclair, MD
ctsinclair (at) gmail (dot) com

Lyle Fettig, MD
lypafe (at) gmail (dot) com

Thomas Quinn, APRN, CHPN
tquinn152 (at) gmail (dot) com
(former contributor)

Click here if you want to know more about us.

Please email Drew, Christian or Tom to let us know about things we may have missed but should blog about, or to give us general feedback on the site.


We do this in our spare time, for fun and for the pursuit of knowledge and truth (sounds noble!). We have a standard disclaimer that the views we express here do not represent the views of our employers or former employers or institutions that we are affiliated with. Please see the disclaimer and copyright information at the very bottom of our homepage. Our effort here is not to provoke but to inform and have open conversation about some potentially thorny issues. Our clinical care is enhanced by being able to comprehend as much information in our field as possible, which is part of the reason we do this blog. We use our real names and not pseudonyms, because we feel it imparts credibility and responsibility for our words.


So what is the big deal about these blogs I hear so much about? If you are new to blogs the first thing to do is 'bookmark'/'add to favorites' this site in your browser (Ctrl+D in most browsers). You can even add the bookmark to your toolbars in your browser (Firefox, Internet Explorer) so that you can access Pallimed with one click. This is a great start, but the main problem is you have to actively seek the site to get the information. Wouldn't it be nice if the information just came to you?

To get the information to come to you we have a two different options to subscribe to Pallimed:

1) Email

Using a service called 'Feedblitz', Pallimed can provide you with posts as they are written directly to your email box. Just type in your email and click the button and you are done. No signing up for a new account or anything. Give this a try and if it does not work for you then just unsubscribe.

2) RSS/Atom Feeds

If you are a little more tech savvy you can make use of the RSS/Atom feature present on most blogs or news sites. RSS (Really Simple Syndication) and Atom are very similar. You may be familiar with the orange button on many sites that looks like this:




or the icon that looks like this:


Here is a very helpful 3 minute video to explain RSS.

Click To Play

Basically RSS and Atom are computer languages for universal formating of information. It can be read using a RSS/Atom Reader. Many readers exist as separate programs or add-ons to your browser, but you can use Firefox 3.0, Safari or Internet Explorer 7 to do the same thing (links go to those sites tutorials). Those of you on IE6 need to upgrade to IE7 to get the RSS benefit.

Ours is located in the right column and is supported via Feedburner. If you click on this link it will take you to their site to pick your feed options.

Christian recommends Google Reader (especially if you have a Gmail account). It is very intuitive as are most other RSS readers. If all this talk scares you, it really is not that bad, just try it. You will not break your computer.

3) The articles

Most of these articles are not available in free full-text online. Consult your institution's library for online availability. On an individual basis we should be able to provide .pdf's of most articles - email Drew or Christian. You can always find abstracts at PubMed. In time, some of these links may no longer work - let Drew know if you find any dead ones.

4) Navigating Pallimed

We have a search bar located in the left sidebar under the label cloud.

Each post is labeled by common topics we cover here at Pallimed so you can quickly find other similar posts. On the left hand column you will also find a 'label cloud' which lists all the topic labels associated with our posts. Click on a link and see what you find! Many older posts do not yet have labels.

(Added 2/7/7) Also in the left hand column is a feature from Google reader that allows us to share Hospice & Palliative Medicine related stories that come across our desk, but have not yet or may not ever write about.

In the right hand column we also have a link to the Pallimed Archives (where you can browse blog posts by date).


5) Comments

Pallimed has a comment function (at the bottom of each post) that allows you to give us feedback on each post. Just click on the "comments" link at the end of each post (the link usually tells you how many comments have been left so it says, e.g., "0 Comments" or "1 Comment"). Tell us your opinions and thoughts. This can be a great community for discussion. You can even add comments anonymously, especially if you want to say something controversial. Even something as pithy as 'great post' or 'what are you talking about?' helps us to keep working at the blog day in and day out for you.

We ask that you refrain from providing specific details about cases because of HIPAA restrictions. But if you want to discuss a case more broadly, that would be more appropriate.

If you comment we almost always will comment back. The comment function has a simple verification system to prevent spammers from clogging the site (it has already happened!).

You can find recent comments in the right hand sidebar. (Added 10/4/7)

Comments Policy: The editors of Pallimed reserve the right to remove any comments we deem offensive/hateful, mean-spirited, commercial, or in any other way inappropriate. This blog is intended to foster colleagial, well-informed discussions about research and news relevant to clinicians working with patients facing severe/life-limiting diseases: it is not a forum for discussing individual cases or airing complaints or concerns about specific cases (whether from the clinician, patient, or family perspective). Such comments will be removed at the discretion of the Pallimed editors.

Our full comments policy is here.

6) What Can You Do For Pallimed?

Read the posts, make a few comments, tell others about it. Thanks for reading!

7) Confidentiality/Privacy

Feel free to email us directly at our emails listed above. Subscribers (via RSS or email) are kept private and the information will not be distributed or accessible to anyone but Drew or Christian. Website stats for visitors are tracked by Google Analytics, but no identifiable information is kept which could identify a user. Pallimed uses 'cookies' to track returning visitors, but again this data will not identify a individual user, nor is it kept over time.