April 2017 - “The point of prognostication is not to be right, but to help people prepare” - Atul Gawande, M.D. Asking -"Would I be surprised if this patient died in the next year?"—can improve end-of-life care by identifying patients with a poor prognosis who would...
March 2017 - Frail elders can be disabled for days after a “non-injury fall”. A 7 day dexamethasone burst can improve function, mobility and comfort dramatically, easing pain with respiration, improving mobility and relieving other musculoskeletal pain, without the...
February 2017 - Agitation in dementia may be a result of untreated pain. Use of scheduled acetaminophen has been demonstrated to reduce agitation significantly in nursing home populations of patients with dementia. Try acetaminophen 650 mg tid or qid on a schedule as...
September 2019 - Showering often becomes the most difficult physical exertion in these patients. Asking one of the following questions can quickly help assess whether a patient may be hospice eligible, may need their blood pressure medications reduced to reduce the...
August 2019 - DNAR is NOT a prerequisite to hospice admission. Most patients admitted to hospice as “Full Code” transition to “Do Not Attempt Resuscitation” while receiving hospice care. Patients begin to understand that we offer treatments that make sense to their...
July 2019 - Helping families understand a timeline for elders with dementia can relieve suffering and help with planning. Dementia Mitchell Mortality Risk Index Score Points/Risk factor 1.9 Complete dependence with ADLs 1.9 Male gender 1.7 Cancer 1.6 Congestive heart...
June 2019 - We find “Futility” is not a useful term when discussing treatment options. It is not well defined and tends to be inflammatory. It can mask value judgments by clinicians. It can pit clinicians against each other and against the patient and family, making...
May 2019 - Another new study showed inhaled isopropyl alcohol significantly reduced nausea, this time in patients in the ED. Several studies have shown that inhaled isopropyl alcohol can provide rapid relief of nausea. It may perform well enough to avoid systemic...
April 2019 - When you would not be surprised if your patient died in the next year, it is time to take action to provide care that makes medical sense and is aligned with realistic patient goals. 1. Try to improve prognostic awareness. “In my experience, patients with...
March 2019 - Many patients in your practice may be interested in a palliative approach to care. Patients living with a serious or a life-threatening illness may be more interested in the quality of life than quantity of life. They need our help to match care to their...
