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Showing posts from March, 2016

Respecting Choices or penalizing them: do DNR orders affect quality ratings?

by: Lena Makaroun, @LenaKMakaroun Since 2010, the Center for Medicaid and Medicare Services (CMS) has been reporting hospital quality measures for a number of common medical conditions. Intended to provide health care consumers (patients and their families) with information that may guide where they seek care, these measures have undergone multiple iterations in attempts to inch closer and closer to measuring true “quality”. Mortality, a measure as inherently basic as it is complex, has remained a core measure throughout the past decade, and is showing no signs of retreat. With both US hospitals and the patient populations they serve being hugely diverse, efforts to identify factors contributing to mortality statistics independent of the medical care delivered are important and ongoing. In a recent article in JAMA Internal Medicine this past January, Walkey et al. ask a probing question – are hospitals being penalized on mortality quality measures for valuing patient prefere

Top 25 Studies in Hospice and Palliative Care (#HPMtop25)

by: Kara Bishoff ( @kara_bischoff ) Back in 2015 we wrote a post asking for input on what articles should belong on a list of the top 25 articles in hospice and palliative care.   We decided to focus on hospice palliative care studies and trials - as opposed to review articles, consensus statements and opinion pieces. Here’s what we came up with. It was hard to pick just 25! We highly prioritized clinical utility and tried to achieve diversity & balance. Many others are worthy of inclusion. Take a look and let us know if you have suggested changes for next year. Module 1: Symptom Management Randomized, Double-Blind, Placebo-Controlled Trial of Oral Docusate in the Management of Constipation in Hospice Patients. Tarumi Y et al. JPSM, 2013 . Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study. Currow DC et al. JPSM, 2011 . Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a dou

Pressure Ulcers: An Underappreciated Public Health Issue

by Jeffrey M Levine MD As a geriatric fellow back in the 1980's I became intrigued by the wide prevalence of pressure ulcers and how little literature there was on this disease.  Three decades later, they have not gone away and it amazes me that they are not on the list of recognized public health threats.   According to the Agency for Healthcare Quality and Research , pressure ulcers affect up to 2.5 million patient per year, and related costs range from $9.1 to $11.6 billion per year in the US. Complications include pain, scarring, infection, prolonged rehabilitation, and permanent disability. They are largely preventable, and 60,000 patients die as a direct result of pressure ulcers each year. They are common across the healthcare continuum, and as many as 42% of patients in ICUs and 28% of hospice patients have pressure sores. According to a recent NPUAP monograph , pressure ulcer prevalence in long-term care ranges from 4.1% to 32.2%.  Pressure ulcers are closely

Chronic Cancer versus Non-Cancer Pain: A Distinction without a Difference?

Eric Widera, MD ( @ewidera ) In 1824, Jeremy Bentham published the " Book of Fallacies " in which he criticized fifty arguments used in political debate and explained the sinister interests that led politicians to use them. One of these fallacies he describes as the "sham distinction", now known better as a " distinction without a difference ". This logical fallacy appeals to a distinction between two two things that ultimately cannot be explained or defended in a meaningful way.  When it comes to cancer and non-cancer pain, one really must question why we are drawing a distinction between these two entities and whether it is science or politics that that demands there be a difference. The Origins of the Distinction The term " cancer pain " is relatively new, appearing in greater frequency over the last three decades in both medical journals (Figure 1) and in printed books (Figure 2).  Cancer was viewed as the emperor of all maladies, and

10th Annual GeriPal / Pallimed Party

Plot Summary: A palliative care provider must leave her safe suburban surroundings and head for the heart of the big city to rescue a stranded colleague, unaware of the perilous adventures that await her and the fellow bloggers she's looking after who have tagged along. Details: Come one, come all to the 10th annual GeriPal / Pallimed party at the Annual Assembly of AAHPM, HPNA, and SWHPN.  We will start at Cindy's around 9 PM. After that we will head to Plymouth Rooftop bar at 10 and Kasey's at 11pm.   This are rough estimates of time, so if you want to know the details, follow the hashtag #HPMparty or our Facebook pages where we will be posting updates on the next location. Who: All are welcome, this is no exclusive crowd. There will be many writers from both websites at the party and we always like to meet readers and hear your feedback. When: Thursday, March 10th. Start time 9 pm. End time TBD Where:   We have a little schedule to keep this time, but if