Image of Marco Pappagallo, MD is from stoppain.org

B. Eliot Cole, MD, MPA, CPE, and Marco Pappagallo, MD, Present Partnering Primary Care Physicians with Pain Specialists.

Las Vegas, NV (PRWEB) September 12, 2009 -- PAINWeek® 2009, the national conference for frontline practitioners, featured Dr. B. Eliot Cole, MD, MPA, CPE, and Dr. Marco Pappagallo, MD, teaching a Master Class that addressed the need for pain mentorship among physicians practicing pain management. Dr. Cole is Executive Director of the American Society of Pain Educators and Dr. Pappagallo is Director of Pain Medicine at the Mount Sinai School of Medicine in New York City.

There is a proverb that says: It takes a village to raise a child. If it takes a village to raise a healthy child than what does it take to care for and raise a seriously ill child? It takes palliative care.

Walk With ME is a palliative care program for seriously ill children.

When your child is facing a serious illness, the whole family needs relief and comfort; from the symptoms and from the pain, both physical and emotional. The whole family needs to understand the condition and improve the ability to carry on with everyday life. Pediatric Palliative care is comfort care that focuses on increasing quality of life for children, from the unborn to early adulthood.

Posted by Drew Rosielle, Pallimed.org

As a change of pace, and for some lighter July reading: some academic all-star wrestling about palliative care & CHF.... Social Sciences & Medicine has a series of articles about problems with the interface of specialist palliative care with cardiology for heart failure patients (main article here; commentary here; rebuttal of commentary here).

Posted by Drew Rosielle MD, Pallimed.org

Annals of Oncology has a paper trying to look at whether palliative sedation is associated with shorter survival. It's a prospective, multi-center, single-country (Italy) study which prospectively matched ~270 cases (cancer patients admitted to hospice units who received palliative sedation) with similar 'controls' (similar cancer patients admitted to the same hospice units during the same period). Controls were matched for gender, age class (less than 65 and greater than 65 years), reason for admission (psychosocial, uncontrolled symptoms, and terminal phase), and Karnofsky performance status (KPS) subdivided into three classes (10–20, 30–40, and 50 or more). Patients who received PS did so based on standard practice by their treating physicians; there was also no standardization of PS treatments.

Posted by Christian Sinclair, Pallimed.org

Dr. Jeffery Parks is a popular medical blogger from Ohio who writes at Buckeye Surgeon. He has written in the past about end-of-life issues relating to whether or not to extubate a patient for comfort care. He advocated for never extubating a patient, which was in opposition to palliative care standards of care I understood. More recently he published a post about the clinical inertia of the American health care system which would be very familiar to many palliative care clinicians.

Posted by Drew Rosielle, Pallimed.org

Research on Aging has a study about older adults' understanding of their spouses' end of life preferences. The data come from the Wisconsin Longitudinal Study - a large, decades long study of many thousands of people who graduated from Wisconsin high schools in 1957 (nearly all participants are white). This study involves ~2700 married couple, all approximately 65 years old, who were surveyed in 2004 and were asked, among other things, questions about EOL treatment preferences: the scenarios given were basically 'you're dying and in severe constant pain - would you/spouse want to continue/not all life-prolonging treatments?' & 'you have limited ability to speak/walk/recognize others - would you/spouse want to continue/or not life-prolonging treatments?' Respondents said what they'd want and what they thought their spouse would want.

Posted by Drew Rosiell, Pallimed.org

Annals of Oncology has an article about the use of chemotherapy at the end of life. It's a retrospective cohort study from a single cancer center in Australia, looking at all patients who had died (N=750; median age 67 years; 20% with lung cancer and the rest with a smattering of everything else) from incurable solid tumor malignancies between 2005 and 2007 (patients who died while receiving treatment with curative intent were excluded).

Posted by Lyle Fettig, Pallimed.org

A New York Times reporter writes about the experience of her sister's death and not pursuing an autopsy. She also reports on Dutch research of family members' experiences with autopsy (from Family Practice). Based on the details provided, the author's sister died after what sounds like an unfortunately precipitous infectious disease and multisystem organ failure. A week before she died, she had seen a doctor, was sent home, then returned to the hospital the following day critically ill. After the death, a nurse (not a physician ?!?) approached the author and another sister to discuss autopsy, which they declined. The author later regretted not pursuing an autopsy because she had unanswered questions about the cause of death.

Question: What are the Pros and Cons of Medical Marijuana?

The debate over medical marijuana is festering and coming to a head. Fourteen U.S. states have active medical marijuana laws but the federal government still classifies it as a Class I controlled substance, which is illegal to possess. With strong supporters on each side of the debate and a new administration, the arguments for and against the legalization or marijuana are hot topics.

Stephanie Bruno

About a week ago I attended an information session regarding pediatric palliative care. My experience and knowledge regarding palliative care prior to going to this session was very limited. During my three years working in early intervention I've only had one situation with a little boy who was receiving palliative care. From all that I saw and heard about their service, I knew that it had been a very positive experience for both the family and the child. The little boy was extremely ill and did pass away before the age of three from his illness; however I believe that the difficult days and months leading up to his death were eased by the presence of the palliative care providers.

Posted by Christian Sinclair, MD, Pallimed.org

We don't cover the quarterly reports of hospice companies here, and to date have only blogged about the stock market happenings of these companies once before. But recently two of the publicly traded hospice companies have run into some speed bumps with the stock market. I follow the news feeds for the three well known companies (VITAS, Odyssey and Gentiva) to see if they have broader insights into how hospice is faring nationally. For example, the recent rollback of the wage index cut made all these stocks rise quite nicely. "Buy! Buy!" The market is listening to hospice providers apparently. They care what we do!

Stephanie Bruno

The Journal of Supportive Oncology (my favorite free journal with excellent practical palliative care articles) published a fantastic review of taste and odor dysfunction in cancer patients. If you read this article you could become a local expert because so few clinicians appreciate the implications or understand the treatment options for these significant quality of life markers. Obviously with this kind of endorsement it qualifies as a teaching file article.

Posted by Drew Rosielle, Pallimed.org

JCO has a fascinating and frustrating study about physician-patient agreement about treatment goals predicting having a discussion about limiting life-prolonging treatments.

There is often confusion between the terms hospice and palliative care. In the United States, hospice services and palliative care programs share similar goals of providing symptom relief and pain management. The most important distinction between hospice and palliative care programs in the United States, however, is that hospice is a Medicare Part A benefit, thus requiring many aspects of hospice care such as enrollment to be regulated by the United States federal government. Non-hospice palliative care, however, is appropriate for anyone with a serious, complex illness, whether they are expected to recover fully, to live with chronic illness for an extended time, or to experience disease progression.

Posted by Drew Rosielle, Pallimed.org

Tom recently posted on another major publication from the Coping With Cancer Study. Psycho-Oncology, a couple months back, also published a CWC analysis that I overlooked until recently - looking into whether rates of psychological illness increase as cancer patients approach death.

The deaths from cancer are about 130 thousand each year in Italy. Of these, at least 100 thousand would need palliative care in terminal stage. At home, if the environment and family permit. If you are alone or with family witness the end of the life is not always emotionally sustainable. For this reason there are Hospice. Now emerging from silence, because in one of these centers Eluana Englaro was hospitalized in the last days of his life.

Drew Rosielle, Pallimed.org

...is the snappy title of a recent publication on public perception of resuscitation outcomes in Resuscitation. The data come from a survey of ~1800 people administered in Ohio & Pennsylvania in a 'variety of community settings' (airports, bus stations, and clinic waiting rooms). They don't give any further details as to how these people were found/screened; that said, there does not appear to be even an attempt to get at a random cross section of a population.

Posted by Thomas Quinn, Pallimed.org

A new study just published online in Cancer by the MD Anderson palliative care group asked this question of medical oncologists, nurse practitioners, and physician assistants at their institution in an anonymous web-based survey. Interestingly, there was a 70% response rate to the questionnaire among the 200 practitioners to whom it was sent.

Posted by Christian Sinclair, MD, Pallimed.org

The USA Today had a feature article this week highlighting the careful use of words to construct the order to no longer initiate CPR. (Don't miss the 170+ comments, very enlightening about how th epublic feels) The author focuses on the growth of the "Allow Natural Death" phrase as a compassionate alternative to "Do Not Resuscitate."

Posted by Thomas Quinn, Pallimed.org

I'm guessing that most of our readers do not peruse Bone Marrow Transplantation every month, but you might want to check out this article. It was written by the BMT & palliative care folks at the Massey Cancer Center, Virginia Commonwealth University. Yes, that would include Tom Smith, well known oncologist & palliative care doc at VCU.