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Showing posts from October, 2012

SNF’s - the discharge pathway of choice for those at the end of life

Few details are actually known about the proposed settlement of a nationwide class-action lawsuit against Medicare that would do away with the requirement to show a likelihood of medical or functional improvement before Medicare would pay for skilled services such as physical therapy.    However, unless there is a monumental change in how we deliver skilled care to Medicare enrollees, there are two conclusions that I feel safe in making:
More individuals will be using the Medicare Skilled Nursing (SNF) benefit at the end of lifeThe ability to provide high quality palliative care to these individuals will be diminished
Why will more individuals use Medicare SNF Benefit at the end of life?

There will be little incentive to prevent more and more individuals with limited ability to improve with skilled care to move quickly from hospitals to SNFs. It is easier, quicker, and often feels "safer" to send someone to a SNF from a hospital than it is to spend hours on having difficult …

The Landscape for Rehab After the Landmark Medicare Class-Action Lawsuit

A landmark settlement of a class-action lawsuit against Medicare may change how patients with chronic disabling conditions receive care. Until now, patients with chronic progressive conditions are considered ineligible for, or discharged from, rehabilitative services such as physical therapy and occupational therapy if they are deemed "unable to improve" or to have "plateaued".

The following New York Times articles describe the class-action lawsuit and the settlement which is pending judge approval:
Settlement Eases Rules for Some Medicare PatientsWhat Medicare Will Cover Even if You’re Not Likely to Get Better
Several patient, healtlh, and legal advocacy groups joined together in the lawsuit against Medicare. The decision, if accepted by the judge, will have profound consequences for patients whose conditions are expected to follow a course of progressive decline. The advocates argue that for certain conditions--maintaining an individual's functional stabili…

Most Patients with Incurable Cancer Think Chemo Might Cure Them

I'm at the National Palliative Care Research Center's Annual Foley Retreat in Deer Valley, Utah - rough life of the researcher, I know - and all the buzz is about the study published today in the New England Journal of Medicine.

In this study, Jane Weeks and colleagues surveyed 1,193 patients with incurable stage IV lung or colon cancer receiving chemotherapy.  They asked patients if they thought the chemotherapy might cure them.  They then tried to figure out if certain groups of patients were more likely to think that chemotherapy might cure them.  The remarkable findings:

69% of patients with metastatic lung cancer and 81% of patients with metastatic colorectal cancer thought the chemotherapy might cure themNon-white patients were more likely to believe chemotherapy might cure them than white patientsPatients who rated communication with their physician highly were more likely to believe chemotherapy was curative
That last sentence is not a typo!  Phrased differently, patie…

Poetry Slam

Seems like there's been a lot of poetry in the blogosphere recently.  See for example GeriPal's Haiku contest (short-long-short allowed) and Pallimed's Haiku contest (strictly 5-7-5).

And then I read a gem of a poem in today's JAMA titled, "Do Not Resuscitate," by Brenda Butka.  I'm not going to plagarize the journal, you should go read the full poem for free.  Here are the last tantalizing lines:

I can say we should not do this. He will never be the same. I can say if it were my father. I can say do not confuse resuscitation with resurrection, although neither works particularly well. You look like you are drowning, pallid and slow in the waiting room’s underwater light. So. Tell me. Tell me again. Tell me about your father.
What struck me about this poem was the true-to-life interior rush of thoughts that goes through one's head caring for a patient and family member in a situation like this.

And most importantly, that she brings it back to the patient's fath…

COO of the American Geriatrics Society @nlundebjerg on Twitter

It's time to up the ante on the push to get more GeriPal readers on twitter. Today, we have Nancy Lundebjerg (@nlundebjerg), Deputy Executive Vice President and Chief Operating Officer of the American Geriatrics Society, answering some questions on why twitter matters. She also just gave me word that all Reynolds Grantees Attending #DWRF12 can win an iPad by tweeting and successfully answering short daily questions via @theBlueCast (for more info on the game check out AGS's website here.



Widera: In your opinion, why should we get on twitter?

Lundebjerg: It’s a very powerful tool for getting the word out about geriatrics and palliative care You can use it to communicate to the world and with each other. Most politicians are on twitter and we have not yet begun to tap the power of including a mention of them in our twitter messages.

Widera: Can you give an example of an interesting way twitter can be used in geriatrics or palliative care?

Lundebjerg : There are two deba…

Christian Sinclair on Why We Should Get on Twitter

Are you still not convinced that you should sign-up for twitter?  Will take more than a "genius" for you to understand the value of a 140 character haiku?  Well, maybe Christian Sinclair can convince you as part of our second installment in our series to encourage uptake of twitter in both geriatrics and hospice & palliative medicine (especially at this years Reynolds meeting via the hashtag #dwrf12).

Dr. Sinclair (@CTSinclair) is the National Hospice Medical Director at Gentiva Health Services and is one of AAHPM's Board of Directors.  He is the co-editor for the blog Pallimed and has convinced many people in our field to take the plunge into social media.




Widera: Why should we get on twitter?

Sinclair: Communicating good information about health care to the general public is challenging and tools which are free and quick to learn should encourage us to at least become familiar with the potential benefits. And because communication is a two-way street, we could alway…

Interview with Diane Meier on Why We Should Use Twitter

In a little over a week, geriatricians and some palliative care physicians will be converging in St. Louis for the 10th Annual Reynolds Grantee Meeting. The Reynolds meeting is one of my favorite meetings of the year to network with colleagues and advance both geriatric and palliative care education.  This year we are trying to encourage attendees to use twitter throughout the meeting via the hashtag #dwrf12.

In order to convince attendees to sign-up for twitter, we will be posting interviews with some of the most notable leaders in the field about one simple question: “Why should we use twitter?”  Who better to start the conversation than a true “genius” - Diane E. Meier, MD – the MacArthur “genius grant” awardee, palliative care leader/guru, and geriatrician.




Widera: In your opinion, why should we get on twitter and what good could we do on twitter?

Meier: Twitter is an effective means of improving the general palliative care literacy of a very large audience- what is it and why sh…

"Good evening. Hello. I have cancer. How are you?"

Tig Notaro was diagnosed just three days before a standup comedy set with invasive cancer in both of her breasts. What happened afterwards is quickly becoming the stuff of Internet legend. She decided to get up on stage and deliver a half and hour act that quickly make the social media rounds.

It started off with comedian Lewis C.K.’s tweet: “in 27 years doing this, I've seen a handful of truly great, masterful standup sets. One was Tig Notaro last night at Largo.” The larger media outlets came quickly after, including interviews on NPR and This American Life.

So what’s all the fuss about?

Notaro was brutally honest and open about a subject that is often taboo to talk about in many settings. During the set she talks about a stream of personal tragedies that led up to the diagnosis of cancer including a pneumonia, a C. difficile infection, a traumatic death of her mother from a fall, and a breakup from a longstanding relationship. She does this in such a way that is so raw …

An Advance Directive for When Driving Becomes Unsafe

One of the tougher challenges in a busy clinical encounter is the older driver who is potentially unsafe. While clinicians may screen for unsafe driving using the tools previously reviewed here in GeriPal, the encounter involves a delicate dance between maintaining patient independence and protecting patient safety, as well as public safety. When a patient appears unsafe, a recommendation against driving should be made and at times a formal reporting to authorities of suspected unsafe driving is necessary.

But what happens after you make a formal recommendation of no driving? A recent New England Journal of Medicine article provides a pretty good look into the impact of a no driving recommendation.

The authors examined the impact of formal reporting of a no driving recommendation in Ontario where patients had easy access to medical services and a data reporting system that could link to emergency room records. Ontario's reporting system began paying providers for completing …

Good Luck on the Hospice and Palliative Medicine Boards!!!

We just want to wish good luck to all those taking the 2012 Hospice and Palliative care board exams today and tomorrow.  We know you'll rock the test! 
We also want to say thanks for taking the time to read through the Blogs 2 Boards questions developed by GeriPal and Pallimed.  We have had nearly 11,000 views of the Blogs 2 Boards webpage and plenty of more hits to the other Blogs 2 Board posts.  
If you have any feedback on how we can make the questions better for the next round of tests, please feel free to email me.
Thanks and good luck!
by: Eric and the rest of the blogs to boards team.




Delirium in NYTimes and introducing GeriTech.org

I was thrilled to see this week that delirium is getting some love in the NY Times. If you haven't seen it yet, check out Jane's Brody's article, especially since it features GeriPal's very own Bree Johnston!

As a person interested in improving geriatric care, I've been very interested in delirium. There is just so improvement bang for the buck available when we help caregivers and other providers prevent, recognize, evaluate, and treat delirium.

Better tools to help us provide education and guidance on delirium would certainly benefit America's elders.

In fact, I am so interested in tools and technology to support geriatrics that I've just launched a blog on the subject, at www.geritech.org. (It also helps that Eric and Alex and the community here have inspired me!)

Just as GeriPal.org has provided a forum for people in geriatrics and palliative care to share ideas, I'm hoping that GeriTech.org will become a vibrant forum for sharing and discussing te…