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September 15, 2010
Opioids safe for Hospital at Home cancer patients
Cancer patients can safely take high-dose opioids in a Hospital at Home setting without reducing survival, according to a Spanish study published in Journal of Palliative Medicine. Researchers reviewed the clinical records of 223 cancer patients, some admitted to an inpatient unit and others who died at home, to determine the safety and survival effects of opioids administered at high or increasing dosages. They found that median survival was greater for patients who received more than two-fold increases in their initial doses of the drugs than those who did not. Further Information
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Palliative oxygen no better than room air for relief of dyspnea
An international study led by Amy P. Abernethy, MD, at Duke University Medical Center in North Carolina, and reported in The Lancet, compared the outcomes of palliative oxygen therapy delivered by nasal canula with room air for 239 patients with dyspnea at the end-of-life and found little difference in the relief of breathlessness. Quality of life and frequency of side effects were similar in the two cohorts. The authors concluded that since oxygen provided no additional symptomatic benefit compared to room air, other less burdensome strategies should be considered after a brief assessment of oxygen therapy. Further Information
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CMS announces Medicaid hospice rates
The Centers for Medicare & Medicaid Services released the federal fiscal year 2011 Medicaid rates for hospices. The rates are effective for services provided from October 1, 2010, through September 30, 2011. The daily rate for routine home care is $146.82. The wage component subject to index is $100.88, and the unweighted amount $45.94. The continuous home care rate is $856.12, wage component subject to index is $588.24, and unweighted amount $267.88. Inpatient respite care is $159.65, with wage component subject to index at $86.42 and unweighted amount $73.23. The general inpatient care rate is $652.27, with the wage component subject to index at $417.52 and the unweighted amount at $234.75. Further Information
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St. John's wort reduces oxycodone levels
A Finnish study investigating the potential of St. John's wort to alter the metabolism of oxycodone found that it greatly reduced oral oxycodone's plasma concentrations. Patients also reported that the opioid's effects were significantly decreased. In a small study, with 12 healthy participants, the team completed a placebo-controlled, randomized, cross-over trial. The participants received St. John's wort or a placebo three times per day for 15 days and then were given oral oxycodone hydrochloride 15 mg on day 14. Investigators measured plasma drug concentrations from zero to 48 hours, and behavioral and analgesic effects from zero to 72 hours. Further Information
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NHPCO issues suspicious invoice alert
The National Hospice and Palliative Care Organization (NHPCO) has warned hospice providers that an outfit called the National Home Care and Hospice Palliative Care Association, which has no Web site, is faxing invoices for dues in the amount of $475. NHPCO wants to raise awareness that these invoices are not coming from their organization. NHPCO will mail providers renewal notices in December. The organization is investigating the source of the faxes and has filed a complaint with the Massachusetts Attorney General. Additional complaints should be sent to Sara.Rau@state.ma.us. Further Information
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Spanish researchers identify barriers to palliative care
A lack of clarity about the patient's prognosis, a curative focus, avoidance of discussions about end-of-life, and a desire to cheat death present barriers to palliative care for people with long-term, life-threatening diseases other than cancer, according to research from Spain. The team interviewed patients, family caregivers, and healthcare professionals with the objective of identifying barriers to a palliative care approach and ways to overcome them. The investigators concluded that therapeutic and palliative care could be rendered simultaneously. Further Information
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HPNA offers new practice driver educational program
The Hospice and Palliative Nurses Association announced the addition of a North American Cultures practice driver educational program, with patient family teaching sheets, a position statement, and copies of articles related to the care of people in North America. The association offers five evidence-based practice drivers on flash drives. Further Information
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Guidelines issued for opioid therapy for refractory headaches
A U.S. committee of physicians and allied health professionals reviewed available evidence associated with the use of continuous opioid therapy for refractory daily headaches and issued guidelines in the journal Headache. The guidelines help identify candidates for opioid therapy and those who should be disqualified due to an Axis I DSM-IV diagnosis, addictive disease, evidence of prescription drug abuse, personality disorders, psychosis, or a family environment with a known substance abuser. It also outlines appropriate monitoring. The committee concluded that only a small group of refractory headache patients who meet the criteria for daily opioid therapy will respond to the drugs and experience fewer headaches and improved functioning long term. Further Information
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2011 Hastings Center Cunniff-Dixon Physician Awards
The Hastings Center is accepting nominations through September 30, 2010, for the 2011 Hastings Center Cunniff-Dixon Physician Awards, given to physicians who have provided exemplary care to patients, are good role models, and have advanced end-of-life care as a basic part of the doctor-patient relationship. Recipients will receive one of five prizes, totaling $95,000. One senior physician will receive $25,000, one mid-career physician gets $25,000, and three early-career physicians will receive $15,000 each. Further Information
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Hospice wins mesothelioma case
A court in the United Kingdom ruled that the company that exposed a former worker to asbestos should pay for a portion of his hospice care. St Joseph's Hospice in Hackney, east London had sued to obtain payment for services it provided to the patient who died in 2007. The National Health Service pays for about 35% of the cost of hospice care, with the balance coming from charitable donations. The symptoms of mesothelioma may not become evident until many years after the exposure and cases of the disease are expected to peak at over 2,450 per year in the next decade. The court's decision could lead to many more claims from hospices. Further Information
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People on the Move
Garrett Chan, PhD, APRN, FPCN, FAEN, nurse practitioner, clinical nurse specialist, and associate clinical director, Stanford Emergency Department Clinical Decision Unit and associate clinical professor, Department of Physiological Nursing, University of California, San Francisco, will be inducted as a Fellow in the American Academy of Nursing (FAAN) in November, 2010. Dr. Chan is recognized for his contributions in advancing palliative care in emergency care…Abhijit Kanti Dam, MD, FCCP, FPM, received a letter of commendation from The CHEST Foundation which is the philanthropic arm of the American College of Chest Physicians for “outstanding leadership in end-of-life & palliative care” for his pioneering work in palliative care in the tribal state of Jharkhand in India…John Pagana, MD, who was instrumental in launching the first hospice program in central Pennsylvania - SUN Home Hospice - and now practices as a family physician in Sunbury, will receive the first Hospice Award for Excellence…Harbor Grace Hospice announced the opening of its 22-bed inpatient facility on the Atlanta Medical Center campus in Georgia. Medical director Torey B. Clark, MD, and director of nursing Mary Jo Wilson, RN, serve as part of the leadership team for the hospice…MaryBeth Salama, MD, has joined Family Hospice & Palliative Care of Pittsburgh, Pennsylvania as a medical director…Please send us your People on the Move news.
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