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Wednesday, October 8, 2014

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AAN declares opioids’ risks outweigh benefits for chronic pain
The American Academy of Neurology (AAN) has declared in a position statement that the risks associated with prescription opioids outweigh the benefits for patients with chronic non-cancer conditions, such as headache and chronic low-back pain. AAN recommended that physicians consult a pain medicine specialist if opioid dosages exceed 80 to 120 mg of the morphine-equivalent dose in a day, especially if pain and function has not significantly improved. The Academy also recommended that physicians who prescribe opioids create an opioid-treatment agreement, screen for depression and current or past drug abuse, refrain from also prescribing sedatives or benzodiazepines, assess for tolerance and effectiveness, track daily morphine-equivalent dosing, and use state Prescription Drug monitoring programs. Link to source>>
FDA approves opioid-induced constipation indication for Relistor
The U.S. Food and Drug Administration approved a new indication for Relistor® (methylnaltrexone bromide). The subcutaneous injection drug can now be marketed for opioid-induced constipation in patients taking Relistor for non-cancer pain. Relistor is a peripherally acting mu opioid receptor antagonist, designed to block opioid effects in the gastrointestinal track while not interfering with the analgesic properties of the opioid, due to its molecular structure. Patients, typically, move their bowels within 30 minutes of taking Relistor and describe the sensation as similar to a normal bowel movement. Link to source>>
Dad's wish to die at home pits daughter against healthcare system
Maureen Stefanides has shared with The New York Times her long struggle to arrange for the discharge of her dying father, Joseph Andrey - a struggle that ended without success with his death Feb. 1, three weeks short of his 92nd birthday. Over two years, Andrey was treated at several nursing homes, as declining reimbursement for home care presented obstacles to returning home. Home care agencies balked at admitting a patient needing significant care. Andrey ultimately died at Haven, a hospice inside New York’s Bellevue Hospital Center run by Visiting Nurse Service of New York. “He didn’t die in his bed, and that’s what he wanted,” Stefaindes lamented. “I still feel that I let him down.” Link to source>>
High-dose opioid prescribing by Canadian physicians jumps 23%
Prescribing by Canadian physicians of high-dose opioids increased 23% between 2006 and 2011, according to a study from St. Michael's Hospital and the Institute for Clinical Evaluative Sciences. The rise in high-dose prescriptions occurred despite clinical guidelines recommending that most patients should not receive them. More than 180 million units of high-dose opioid tablets and patches were dispensed across Canada during the six-year study period. Prevalence differed among provinces, with rates relatively stable in Alberta and British Columbia but rising substantially in other providences, such as Newfoundland and Labrador, up 84.7% and Saskatchewan up 54%. The findings were published in Canadian Family Physician. Link to source>>
Training fills nurses' knowledge gaps about advanced directives
An educational program can help reduce gaps in knowledge about advance directives for nurses, allowing them to better ensure that their patients’ wishes are respected at the end of life. Many health professionals, according to the study, lack the understanding and confidence to teach patients about advance directives. Maureen Kroning, EdD, RN, of Nyack (N.Y.) College and Good Samaritan Hospital, detailed in the Journal of Christian Nursing her hospital's experience with developing an in-service educational module, and the outcomes observed after nurses completed the two-hour, interactive training program. Link to source (Subscription required)>>
Australia sees specialist shortage despite rising palliative care use
The use of palliative care increased 52% from 2002-2003 to 2011-2012, according to a report from the Australian Institute of Health and Welfare. In the third in a planned series of annual reports on the nation’s response to its palliative care needs, the government-run institute found that Australians aged 75 and older accounted for nearly half of discharges among palliative care patients. However, specialists in palliative care represent just 0.53% of Australia’s employed medical professionals—even though the benefits paid for palliative medicine specialist services more than doubled during the five years prior to 2012–2013. Link to source>>
Counseling builds relationships, cuts costs for end-of-life patients
Vital Decisions offers non-directed, end-of-life counseling to terminally ill patients. Insurance companies pay for the service, which employs social workers who call the patients, with the intent of building relationships with them. The social workers engage the patient in conversation and start them thinking about discussing end-of-life care with them and with their family members and healthcare team. The talks help patients receive care that reflects their wishes, and often result in reduced costs—an average $10,000 savings per patient, CEO Mitchell Daitz estimates. Link to source>>
Program offers interdisciplinary pediatric palliative care training
The Hospice and Palliative Care Association of New York State will offer an interdisciplinary pediatric palliative care training program November 20–21, 2014, in Rochester, N.Y. The presenters will discuss how an interdisciplinary team approach works to the benefit of patients and family members and how members of the team can support each other to provide optimal care. Sessions also will cover massage therapy, pain management, spiritual care, ethics and public policy in New York, among other topics. Link to source>>
Hospice completes office renovation in Iowa City's Towncrest
Iowa City Hospice on October 9 will celebrate the completion of the renovation of its offices, at 1025 Wade St., about a year after work began. The project—part of the Towncrest neighborhood urban renewal project—was intended to accommodate future growth, promote team collaboration and provide a welcoming space for visitors from the community. Both the exterior and interior were renovated using funds accumulated for the purpose over several years. The hospice plans an open house where visitors can meet hospice staff and volunteers. Link to source>>

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