GeriPal - Geriatrics and Palliative Care Blog

Do you think palliative care is important for patients and families?
Do you think palliative care is essential for the US health system?
Then isn't it time that you acted politically to advance palliative care?

Well, this Wednesday April 27th you can join the American Academy of Hospice and Palliative Medicine (AAHPM) and other supporters of palliative care in a virtual lobbying effort to raise awareness in the US Congress about the Palliative Care and Hospice Education and Training Act (PCHETA.)  PCHETA (H.R. 3119 / S. 2748) is a bill developed by AAHPM which would expand opportunities for interdisciplinary education and training in palliative care, implement an awareness campaign to inform patients and health care providers about the benefits of palliative care and hospice, and direct funding toward palliative care research to strengthen clinical practice and health care delivery. (Access a bill summary).

The bill is supported by over 35 organizations including Geripal and AAHP…

By Alex Smith, @AlexSmithMD

Hospice has taken some tough blows in the last few years. Funding cuts. A reporter at the Washington Post seemingly on a mission to discredit hospice (Washington Post has recently balanced this with some nice reporting, such as this story by Brigham primary care resident Ravi Parikh).

So outside of the headlines and within academia, it’s a relief to see the science falling squarely in favor of hospice in a new study from a well-respected group.

This study, by Shayan Cheraghlo, uses data from the Precipitating Events Project, or PEP study out of Yale, run by Tom Gill. For those of you not familiar with this study, you should be, whether you’re in geriatrics or palliative care. They enrolled 754 community-dwelling non-disabled adults age 70+ and followed them with monthly interviews until death. Enrollment ended in 1999, and only about 100 or so participants are still alive. That is a treasure trove of data about people’s function and symptoms near the …

by: Alex Smith, @AlexSmithMD

We're thrilled to announce that our other major project (other than GeriPal, that is) has undergone a radical transformation.  ePrognosis 2.0 is here!

The new site features an easier to use modern interface based on our cancer screening website, now incorporated throughout.

The major new innovation is a whole new section, ePrognosis: Communication.  This section features teaching videos with expert communicators: Sei Lee, Mara Schonberg, and Eric Widera.  The major focus are discussions around prognosis, as viewed through 3 common clinical scenarios: cancer screening, setting diabetes targets, and goals of care/code status for people with a short prognosis.  We have detailed take home teaching points and words to use for key skills, such as how to explain lag time to benefit, addressing uncertainty, and discussing tradeoffs.



Why did we add the ePrognosis: Communication section?  We've heard time and time again from practicing clinicians that they…

Case
As a geriatrician it is not uncommon to have patients present in clinic with signs of infection like cellulitis, an infection of the skin. My patient, who I will call Mr. Sa, is a 79 year old man with a history of hypertension, high cholesterol, and COPD who struggled with recurrent cellulitis of his right lower leg. Despite two prior clinic visits and completed courses of antibiotics, the infection would heal but return several months later.

Clinical Question
In patients with recurrent lower extremity cellulitis, do prophylactic antibiotics, compared to no treatment, reduce the recurrence rate of lower extremity cellulitis?

Best Available Evidence
A search of the literature found a systemic review and meta-analysis of antibiotic prophylaxis for preventing recurrent cellulitis1. The systemic review used the Cochrane Collaboration tool for assessing the risk of bias and the meta-analysis was used to calculate a weighted treatment effect across trials. Five studies met the inclusi…

by: Eric Widera (@ewidera) and Alex Smith (@AlexSmithMD)

In other merger and acquisition news today, palliative care was bought today by former hedge fund manager and current pharmaceutical executive Martin Shkreli (previously known as PharmaBro, now penned PalliBro).

Apparently Mr. Shkreli got the idea for the acquisition from Dr. Atul Gawande.  In his AAHPM/HPNA annual assembly plenary, Dr. Gawande noted that, "Palliative care has amazing outcomes.  If palliative care were a drug owned by the pharmaceutical industry, they would be mass marketing it and making billions."

Sources close to Shkreli state that he carefully pondered how much it could raise the price of this decades old intervention before buying it today. Overnight, the price per dose of palliative care increased by 525 percent, and there are further plans to increase the dose to what the market can bear.

Mr. Shkreli practically gloated about the potential profits in an email he sent out this morning:

“…

by: Alex Smith, @AlexSmithMD, and Eric Widera, @EWidera

We know this will come as a surprise to many of our readers.  We want to make sure that we are clear on the reasons why we at GeriPal have agreed to be bought out by Pallimed:
Pallimed and GeriPal will be better combined than separate.  Think of this dream team lineup of bloggers, all on the court at the same time: Widera, Sinclair, Roseille, Smith, Covinsky.By being bought out, we can eliminate redundant posts.  Remember when GeriPal and Pallimed both posted about the Temel Study in NEJM showing that palliative care improves quality of life and might prolong life?  Awkward.  We can eliminate this redundancy.  You the readers win by not having to read two posts.The market is becoming increasingly competitive.  With major new geriatrics and palliative care focused blogs appearing almost daily, it was becoming increasingly hard to compete for scarce readers.They offered us a lot of money.  "As President of AAHPM, having access…