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Showing posts from March, 2014

3 Blogs Waiting to be Started: PediPal, PalliTech, and GeriPal EM

Every once and a while Eric and I are contacted by people hoping to start a blog.  Sometime people follow through and start a new blog.  One terrific example is GeriTech, a blog about technology to improve care of older adults, started by Leslie Kernisan, MD.  See her recent post about the need for a good blood pressure monitoring app.

Here are 3 blogs that are just waiting for the right dedicated people to get started.  Some of these are ideas that have been talked about but haven't taken off yet.  Maybe you, dear reader, will be the one to get one of these blogs going?

PediPal - A Pediatric Palliative Care Blog.  We've carved out a niche by focusing on the intersection of Geriatrics and Palliative Care.  Pediatrics is in a remarkably similar position.  In part our success was born out of some existing tensions between the fields of Geriatrics and Palliative Care.  I suspect (though I'm not in the know) that some degree of tension may exist between pediatric and adult pal…

New treatments for hep C: aging patients, unconscionable prices, missing voices

"We have a cure we cannot afford" - so said Dr. Steve Pearson at yesterday's meeting of the California Technology Assessment Forum, or CTAF.  I was a first time panelist.  See this story in the Washington Post about the meeting.

New treatments for hepatitis C are pretty amazing.  Old treatments included injections that made people pretty sick (basically like having the flu for months) and were about a coin flip as far as effectiveness.  New treatments may include pills alone.  We still need more data on these medications, particularly for subgroups of patients such as those with advanced liver disease, but the early results are very encouraging - 80 to 90+% cure rates in some patients.

Several problems complicate the good news story here.

The treatments are remarkably expensive, about $1,000 per pill.  As one panelist noted, these prices are unconscionable.  The US Preventive Services Task Force recently recommended that all baby boomers be screened for Hep C.  About 3/…

Join the GeriPal & Pallimed party at the AAHPM/HPNA/SWHPN 2014 Annual Assembly

The 8th annual GeriPal / Pallimed party is back on for this year's AAHPM/HPNA/SWHPN 2014 Annual Assembly.   We are going to do a similar progressive party as we did at the 2013 annual meeting in New Orleans.  What does this mean? Basically we will start off at the Field Irish Pub at 9pm on Thursday March 13, and as the evening progresses we will be moving to different locations.  The only way to find out where we are is to use social media and follow on of the GeriPal/Pallimed feeds, or the #HPMparty hashtag.

Date: Thursday, March 13th.  Start time 9pm.  End time TBD

Where: Depends
Only way to find out is to keep up with our twitter and Facebook feeds, or type in #hpmparty in twitter to follow the live feedPallimed Twitter feed / Pallimed Facebook pageGeriPal Twitter feed / GeriPal Facebook page#HPMparty twitter feedFacebook Event Page for the party
Starting location: The Field Irish Pub
544 Fifth Avenue, San Diego, CA 92101.  Between Market Street and Island Avenue (click here for d…

Does citalopram help with agitation in Alzheimer disease?

Most patients with Alzheimer’s disease will develop neuropsychiatric symptoms, including agitation, at some point in their illness. These symptoms have a tremendous impact, as they have been associated with decreased quality of life of both patients and their families, and an increase caregiver burden, and decisions for nursing home placement.  Having dealt with many caregivers trying their best to manage these symptoms, I can attest to the frustration in the lack of any quick fix.

In the recent issue of JAMA, Porsteinsson and colleagues published a multicenter, double-blind, placebo-controlled randomized trial of what appears to be one potential fix, the use of the selective serotonin reuptake inhibitor (SSRI) citalopram.   In short, the conclusion of the article was that the addition of citalopram compared with placebo significantly reduced agitation and caregiver distress among patients with probable Alzheimer disease.   Let's take a closer look to see if we agree.

What they…

Dementia Village: Dignified Care in an Experimental Town

Tragedies at the end of life come in many shapes and sizes. For Betty, an elderly woman with end stage dementia, the last few years were comprised of minor, daily tragedies, finding herself staring out the window of her locked unit, wondering why she couldn’t get out the door to go for a walk. She would pack her bags with her belongings, excited about a day out with her friends to get coffee at the café and her hair done at the salon, only to find that she needed to stay in the white-walled unit. I remember her confusion and anger as the staff, dressed in white coats and nursing scrubs, would correct her on her age and the fact that the man next to her was indeed her husband. She would spend her days watching television and awaiting her meals and medications without pursuing any of her previous interests like baking and gardening. I wondered if there was a better way to do this, a place where she had a home to call her own and where she could safely and freely wander to the gro…

“Honoring Choices” in PACE programs

This is the way it went: a group of familiar faces, some family, some professional care providers, gathered around the man's bedside and talked about his preferences. Aspiration pneumonia or not, he didn't want the feeding tube, and was sick of going to the hospital, so for the next episode of pneumonia, could he please just be treated at home? Notes were made, the decision was repeated aloud to get everyone on the same page, and the preference became the plan. The decision became the default.

This is news because we know the usual defaults in health care run more like this: Panicked relative: "He's getting so sick - shouldn't he be in the hospital?" By-the-book emergency department physician, "Well, I can't send her home like this, can I?" Social worker in hospital, "With so many patient needs, you really ought to consider a nursing home."

Community Life, a Pittsburgh-area provider of comprehensive geriatric care under the Medi…