Pub Date : 2004-01-01DOI: 10.1177/104990910402100117
G., Ljunggren, E. Topinkova, N. J., Morris, T. Rabinowitz
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Pub Date : 2004-01-01DOI: 10.1177/104990910402100104
Despite the fact that the five-year mortality rate for COPD is 50 to 60 percent, in a recent study 83 percent of patients with advanced chronic obstructive pulmonary disease (COPD) had never discussed end-of-life plans with their physicians. A team of researchers at Staten Island University in New York reviewed the pulmonary function tests of all patients admitted to their hospital over a two-year period. Inclusion was based on a forced expiratory volume at 1 second (FEV1) that was 50 percent less than predicted. Smokers, patients with asthma or cancer, and patients younger than 50 were excluded. Eighty-three patients in all completed the study. According to lead researcher Michel Chalhoub, MD, one quarter (26 percent) of patients not only were unaware of their diagnosis but had no idea what it meant. “These patients have worse mortality than patients with stage 1 lung cancer,” Dr. Chalhoub said. “Telling a patient ‘you have emphysema’ is not good news; it’s bad news.” Fully 83 percent of patients in the study had not discussed end-of-life issues with their physicians, although 78 percent would have welcomed such a discussion. “We discuss [endof-life] issues with cancer patients and AIDS patients but not with COPD patients,” said Dr. Chalhoub. Dr. Chalhoub presented his results at the 69th Annual Conference of the American College of Chest Physicians in October (CHEST 2003). “There is a problem on both sides,” said session moderator Robert McCaffree, MD, from the Veterans Affairs Medical Center in Oklahoma City, Oklahoma. “There is a mistrust on the part of many populations for the medical system, and studies show that physicians don’t initiate the discussion often enough. We may need to push it a little bit.” (Source: CHEST 2003 slide presentation, October 27, 2003.)
{"title":"Hospice news","authors":"","doi":"10.1177/104990910402100104","DOIUrl":"https://doi.org/10.1177/104990910402100104","url":null,"abstract":"Despite the fact that the five-year mortality rate for COPD is 50 to 60 percent, in a recent study 83 percent of patients with advanced chronic obstructive pulmonary disease (COPD) had never discussed end-of-life plans with their physicians. A team of researchers at Staten Island University in New York reviewed the pulmonary function tests of all patients admitted to their hospital over a two-year period. Inclusion was based on a forced expiratory volume at 1 second (FEV1) that was 50 percent less than predicted. Smokers, patients with asthma or cancer, and patients younger than 50 were excluded. Eighty-three patients in all completed the study. According to lead researcher Michel Chalhoub, MD, one quarter (26 percent) of patients not only were unaware of their diagnosis but had no idea what it meant. “These patients have worse mortality than patients with stage 1 lung cancer,” Dr. Chalhoub said. “Telling a patient ‘you have emphysema’ is not good news; it’s bad news.” Fully 83 percent of patients in the study had not discussed end-of-life issues with their physicians, although 78 percent would have welcomed such a discussion. “We discuss [endof-life] issues with cancer patients and AIDS patients but not with COPD patients,” said Dr. Chalhoub. Dr. Chalhoub presented his results at the 69th Annual Conference of the American College of Chest Physicians in October (CHEST 2003). “There is a problem on both sides,” said session moderator Robert McCaffree, MD, from the Veterans Affairs Medical Center in Oklahoma City, Oklahoma. “There is a mistrust on the part of many populations for the medical system, and studies show that physicians don’t initiate the discussion often enough. We may need to push it a little bit.” (Source: CHEST 2003 slide presentation, October 27, 2003.)","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"7 1","pages":"13 - 15"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88320470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-11-01DOI: 10.1177/104990910302000602
According to a report in the September 30 Federal Register, the Centers for Medicare & Medicaid Services (CMS) will raise total payments for hospice services by 0.6 percent in 2004—a $24 million increase over fiscal year 2003. The new rates go into effect on October 1.The wage index is based on the most recent data for hospital wage scales and reflects local differences in pay levels as well as changes to the definitions of metropolitan statistical areas. In 1997, the CMS regulations were changed for hospices, implementing a new method for calculating the hospice wage index based on the recommendations of a negotiated rule-making committee. Updates to the wage-index rules were as follows:
{"title":"Hospice news","authors":"","doi":"10.1177/104990910302000602","DOIUrl":"https://doi.org/10.1177/104990910302000602","url":null,"abstract":"According to a report in the September 30 Federal Register, the Centers for Medicare & Medicaid Services (CMS) will raise total payments for hospice services by 0.6 percent in 2004—a $24 million increase over fiscal year 2003. The new rates go into effect on October 1.The wage index is based on the most recent data for hospital wage scales and reflects local differences in pay levels as well as changes to the definitions of metropolitan statistical areas. In 1997, the CMS regulations were changed for hospices, implementing a new method for calculating the hospice wage index based on the recommendations of a negotiated rule-making committee. Updates to the wage-index rules were as follows:","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"99 8","pages":"411 - 413"},"PeriodicalIF":0.0,"publicationDate":"2003-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91447801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-11-01DOI: 10.1177/104990910302000611
K. Doka
Despite the fact that more than twothirds of those who die in the United States are age sixty-five and older, aging and dying has long been neglected. Many of the pioneers in the discipline of gerontology wanted to emphasize that older persons were vital and active—living beings. Many of the groundbreakers in thanatology became interested in the field because of their personal experiences with untimely, “out-of-order” deaths. Even today, there are far more books and journal articles on children and death than there are on older persons and death. This is one reason why Geriatric Palliative Care is so welcome. Happily, there is also a second reason. It is an exceptional work. Geriatric Palliative Care is a contributed book covering a broad spectrum of issues characterizing care of older adults near the end of life. Beginning with the social and cultural context of old age and frailty, this volume details specific aspects of palliative care relevant to particular disorders (e.g., cancer, strokes, and dementia) as well as individual symptoms (pain, fatigue, anxiety, etc.). Communication between caregivers and patients, in a variety of settings, is also discussed. Although any edited book has some variance in quality and content, it is a significant mark of the knowledge and dedication of the authors and editors that each chapter is of high quality. That fact makes it hard to highlight only some chapters. In a book of this caliber, what is pointed out is far more an indication of the reviewer’s interest than anything else. While each chapter makes a significant and specific contribution to the literature on geriatric end-of-life care, what makes the book extraordinary is the integration of key themes throughout the chapters. The book’s approach is highly holistic—a clear reflection of the philosophy of palliative care but one that is often not as well integrated in fact as in theory. These chapters demonstrate that philosophy in exemplary style. Moreover, a deep respect for the personhood of older people permeates the pages. Finally, there is an abiding interest in ethical issues that arise in the care of older persons. Again, these themes reflect my interests. Those who look for more specific medical interventions for various diseases, syndromes, or symptom management also will find them well discussed here. In short, this book is destined to be a classic. It not only deserves a place on the shelf of every hospice and geriatric facility and practitioner; it needs to be read—and practiced.
{"title":"Book Review: Geriatric Palliative Care","authors":"K. Doka","doi":"10.1177/104990910302000611","DOIUrl":"https://doi.org/10.1177/104990910302000611","url":null,"abstract":"Despite the fact that more than twothirds of those who die in the United States are age sixty-five and older, aging and dying has long been neglected. Many of the pioneers in the discipline of gerontology wanted to emphasize that older persons were vital and active—living beings. Many of the groundbreakers in thanatology became interested in the field because of their personal experiences with untimely, “out-of-order” deaths. Even today, there are far more books and journal articles on children and death than there are on older persons and death. This is one reason why Geriatric Palliative Care is so welcome. Happily, there is also a second reason. It is an exceptional work. Geriatric Palliative Care is a contributed book covering a broad spectrum of issues characterizing care of older adults near the end of life. Beginning with the social and cultural context of old age and frailty, this volume details specific aspects of palliative care relevant to particular disorders (e.g., cancer, strokes, and dementia) as well as individual symptoms (pain, fatigue, anxiety, etc.). Communication between caregivers and patients, in a variety of settings, is also discussed. Although any edited book has some variance in quality and content, it is a significant mark of the knowledge and dedication of the authors and editors that each chapter is of high quality. That fact makes it hard to highlight only some chapters. In a book of this caliber, what is pointed out is far more an indication of the reviewer’s interest than anything else. While each chapter makes a significant and specific contribution to the literature on geriatric end-of-life care, what makes the book extraordinary is the integration of key themes throughout the chapters. The book’s approach is highly holistic—a clear reflection of the philosophy of palliative care but one that is often not as well integrated in fact as in theory. These chapters demonstrate that philosophy in exemplary style. Moreover, a deep respect for the personhood of older people permeates the pages. Finally, there is an abiding interest in ethical issues that arise in the care of older persons. Again, these themes reflect my interests. Those who look for more specific medical interventions for various diseases, syndromes, or symptom management also will find them well discussed here. In short, this book is destined to be a classic. It not only deserves a place on the shelf of every hospice and geriatric facility and practitioner; it needs to be read—and practiced.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"12 1","pages":"474 - 474"},"PeriodicalIF":0.0,"publicationDate":"2003-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85506750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-09-01DOI: 10.1177/104990910302000505
Based on findings published in the July 26 issue of the British Medical Journal, the longer a doctor cares for dying patients, the more distressed he or she is after their deaths. However, acknowledgment of the loss and emotional support for these doctors is significantly lacking. Ellen Redinbaugh and colleagues of the University of Pittsburgh Cancer Institute in Pittsburgh conducted a cross-sectional study of 188 physicians who had treated 68 patients who died while being treated. Twenty-one physicians (11 percent) reported feeling very close to the patient, and 139 (74 percent) found the experience of caring for the patient as “satisfying or very satisfying.” Says Dr. Redinbaugh, “They derived satisfaction from helping those patients be comfortable, and if possible, to enable them to spend comfortable and meaningful time with their families. We found that physicians can feel a sense satisfaction in being an important part of this person’s quality of life as they were dying, but at the same time, being very distressed that the person has died, creating a hole in that person’s family,” she added. Roughly one-third of the physicians in the study rated the death as having a strong emotional impact, and this impact was directly related with the length of time they had provided care. Female physicians generally reported more grief symptoms than their male counterparts. The physicians who experienced loss coped primarily by seeking emotional support, keeping busy, and “trying to see the death in a different light to make it seem more positive.” Although many reported that they had received support from colleagues, about one-third reported that their emotional needs were not met. Interestingly, only one physician attended the patient’s funeral. “Physicians recognize that they need to put some closure on their experience,” summarizes Dr. Redinbaugh, but time limitations often prevent this. (Source: Reuters Health News, July 25, 2003.)
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Pub Date : 2003-09-01DOI: 10.1177/104990910302000515
B. Cole
{"title":"Book Review: A Clinician’s Guide to Palliative Care","authors":"B. Cole","doi":"10.1177/104990910302000515","DOIUrl":"https://doi.org/10.1177/104990910302000515","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"2015 1","pages":"395 - 396"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83400321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-09-01DOI: 10.1177/104990910302000516
J. Weiner
{"title":"Book Review: When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families","authors":"J. Weiner","doi":"10.1177/104990910302000516","DOIUrl":"https://doi.org/10.1177/104990910302000516","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"56 1","pages":"397 - 398"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84547037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-07-01DOI: 10.1177/104990910302000416
K. Nelson
{"title":"Book Review: Issues in Palliative Care Research","authors":"K. Nelson","doi":"10.1177/104990910302000416","DOIUrl":"https://doi.org/10.1177/104990910302000416","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"20 1","pages":"317 - 317"},"PeriodicalIF":0.0,"publicationDate":"2003-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86266456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-07-01DOI: 10.1177/104990910302000403
As more and more healthcare products that patients at one time could only get through hospitals for use under a doctor’s supervision become available for home use, manufacturers, insurers, and physicians face an increased risk of potential litigation. Patients are now able to self-administer once complicated treatments and operate medical devices, such as dialysis machines or blood testing kits. However, along with the convenience and reduced healthcare costs associated with these products comes the likelihood that some patients will use them incorrectly. If injuries occur, lawsuits are likely not far behind. “It’s a fairly challenging type of risk to underwrite for us,” said Jill Wadlund, vice-president and casualty manager with Chubb & Son, Whitehouse Station, New Jersey. According to Ms. Wadlund, at-home healthcare products have been in use for decades, but the segment has grown substantially over the last three or four years. “It’s not going to go away. If anything, it’s going to get bigger.” Ms. Wadlund said manufacturers need to keep a number of factors in mind when designing products for use in patients’ homes. Chubb works with clients through the testing and clinical trials, FDA approval process, and product introduction phases. “We like to start with them at the very beginning when they’re in the R & D phase,” Ms. Wadlund said. “They need to demonstrate to us when they design the product that they understand the environment in which it’s being used. In a hospital setting, they can be a little more attentive.” Pete DeComo, CEO of Renal Solutions Inc., a manufacturer of kidney dialysis products, said insurance can be a tricky issue for companies that make medical products for home use. Since premiums are usually based on revenue generated, the more units that are sold, the greater the potential liability exposure will be. “I think any company coming into a market like this needs to realize your premiums are going to be high,” Mr. DeComo said. “It is one of the challenges any time you’re using a device that’s considered to be high risk.” Tom Sweeney, a product liability attorney with Eckert Seamans Cherin & Mellott in Pittsburgh who works with manufacturers such as General Motors, warns that litigation can still result when something goes wrong, no matter how much care a manufacturer puts into development or the warning labels that accompany it. “When you have a product like that, in the hands of the consumer . . . you are exposed to being sued, even if it’s that person’s fault,” Mr. Sweeney said. Companies looking to reduce their exposure to litigation should look for ways to build good relationships with their consumers before potential problems arise. “That goodwill tends to reduce, more than anything, litigation,” Mr. Sweeney said. Mr. DeComo realizes having to defend against litigation is a possibility for many companies that make medical products for at-home use. “It’s one of those situations where we’re stuck between a rock and a har
{"title":"Hospice news","authors":"","doi":"10.1177/104990910302000403","DOIUrl":"https://doi.org/10.1177/104990910302000403","url":null,"abstract":"As more and more healthcare products that patients at one time could only get through hospitals for use under a doctor’s supervision become available for home use, manufacturers, insurers, and physicians face an increased risk of potential litigation. Patients are now able to self-administer once complicated treatments and operate medical devices, such as dialysis machines or blood testing kits. However, along with the convenience and reduced healthcare costs associated with these products comes the likelihood that some patients will use them incorrectly. If injuries occur, lawsuits are likely not far behind. “It’s a fairly challenging type of risk to underwrite for us,” said Jill Wadlund, vice-president and casualty manager with Chubb & Son, Whitehouse Station, New Jersey. According to Ms. Wadlund, at-home healthcare products have been in use for decades, but the segment has grown substantially over the last three or four years. “It’s not going to go away. If anything, it’s going to get bigger.” Ms. Wadlund said manufacturers need to keep a number of factors in mind when designing products for use in patients’ homes. Chubb works with clients through the testing and clinical trials, FDA approval process, and product introduction phases. “We like to start with them at the very beginning when they’re in the R & D phase,” Ms. Wadlund said. “They need to demonstrate to us when they design the product that they understand the environment in which it’s being used. In a hospital setting, they can be a little more attentive.” Pete DeComo, CEO of Renal Solutions Inc., a manufacturer of kidney dialysis products, said insurance can be a tricky issue for companies that make medical products for home use. Since premiums are usually based on revenue generated, the more units that are sold, the greater the potential liability exposure will be. “I think any company coming into a market like this needs to realize your premiums are going to be high,” Mr. DeComo said. “It is one of the challenges any time you’re using a device that’s considered to be high risk.” Tom Sweeney, a product liability attorney with Eckert Seamans Cherin & Mellott in Pittsburgh who works with manufacturers such as General Motors, warns that litigation can still result when something goes wrong, no matter how much care a manufacturer puts into development or the warning labels that accompany it. “When you have a product like that, in the hands of the consumer . . . you are exposed to being sued, even if it’s that person’s fault,” Mr. Sweeney said. Companies looking to reduce their exposure to litigation should look for ways to build good relationships with their consumers before potential problems arise. “That goodwill tends to reduce, more than anything, litigation,” Mr. Sweeney said. Mr. DeComo realizes having to defend against litigation is a possibility for many companies that make medical products for at-home use. “It’s one of those situations where we’re stuck between a rock and a har","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"7 1","pages":"255 - 257"},"PeriodicalIF":0.0,"publicationDate":"2003-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74350273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-05-01DOI: 10.1177/104990910302000317
R. Enck
{"title":"Book Review: Palliative Care Formulary, Second Edition","authors":"R. Enck","doi":"10.1177/104990910302000317","DOIUrl":"https://doi.org/10.1177/104990910302000317","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"115 1","pages":"237 - 238"},"PeriodicalIF":0.0,"publicationDate":"2003-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79573770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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