Saturday, July 23, 2016

Thursday, July 21, 2016

Delirium in Advanced Cancer Patients Often Goes Undetected in the Emergency Department

I wrote about this issue in my book, which few have read.
The ER is no place to look after issues such as this one.

Delirium in Advanced Cancer Patients Often Goes Undetected in the Emergency Department
A new study indicates that delirium is relatively frequent and underdiagnosed by physicians in patients with advanced cancer visiting the emergency department. Delirium was similarly common among older and younger patients, which suggests that in the setting of advanced cancer, all patients should be considered at higher risk for delirium. The findings are published early online in CANCER, a peer-reviewed journal of the American Cancer Society.

Full Citation: “Delirium Frequency Among Advanced Cancer Patients Presenting to an Emergency Department: A Prospective Randomized Observational Study.” Ahmed F. Elsayem, Eduardo Bruera, Alan Valentine, Carla L. Warneke, Sai-Ching J. Yeung, Valda D. Page, Geri L. Wood, Julio Silvestre, Holly Holmes, Patricia A. Brock, and Knox H. Todd. CANCER; Published Online: July 25, 2016 (DOI: 10.1002/cncr.30133).

Editorial: “Cancer Patients With Delirium in the Emergency Department: A Frequent and Distressing Problem That Calls for Better Assessment.” Peter G. Lawlor. CANCER; Published Online: July 25, 2016(DOI: 10.1002/cncr.30132).

Saturday, July 16, 2016

Changing the Culture of Prescribing in Ontario Nursing Homes

Researchers at the Women's College Hospital Institute for Health System Solutions and Virtual Care suggest that educating professionals who work in nursing homes and giving them feedback on how their practices compare to others could improve the high anti-psychotic prescribing rates for seniors in Ontario.

Read more

Tuesday, July 12, 2016

PART L: Urologist follow-up

He's continuing on his naturopathic immunity boosters. His PSA has risen a tad in 6 months. It's what we hoped for, a slow trajectory.

Visit #50 for healthcare

10:30 appointment

8:20 left house Construction River Rd. Manotick, took Limebank, backed up into the intersection. Passed a factory building that caught fire at 10:45-ish.
10:00 arrived at waiting room "I", although hubby wanted to try "H" It's funny how I remember the right room, he doesn't!
10:40 Intern came and got us. Dr. C. is in a meeting. He's head of urology.
Dr. C. Is working with a target for 5 - 10 PSA level until anti-androgen treatment.
Intern asked about symptoms.
If stomach or colon issues it'd be consistent, likely diet is causing the issue. Constipation, stool softener helps. Colonoscopy was negative, likely not cancer. Maybe need to increase fluids, urine should be lighter than a post-it note. We have noted, in our non-flushing drought period, this isn't the case! No leakage, bladder frequency sometimes, 5 - 6 times/hour. No blood in urine.
Happy Pills for anxiety helps the frequency. No bone pain, weight the same, which is good. Back in 6 mos. for PSA: January!
Saw Vanessa, appointment made. Back on the road. Much construction in spots. We anticipated coming down Limebank, again, but there was a massive fire. The dashcam pooched out on me, no photos. Lots of buzz on social media regarding the fire, though.
12:00 Arrived at The Swan for lunch. Went to Merrickville for sorbet ice cream cone for hubby.
2:30 home again. Deep breath.

Thursday, July 7, 2016

Seniors with access to medical marijuana

Saturday, July 2, 2016

high-tech operation room

Friday, June 17, 2016

Educational Online Event: Medical Assistance in Dying (MAID) in Canada from CHPCA

Educational Online Event: Medical Assistance in Dying (MAID) in Canada from CHPCA on Vimeo.
The federal legislation is currently before Parliament and the Senate and the plan is to have it passed prior to the June 6th, 2016 deadline. That process is currently in process but we need to start the conversation around what comes next. Come learn about the federal legislation Medical Assistance in Dying (previously referred to as Physician Assisted/Hastened Death (PAD) process and content. How does it impact the hospice palliative care community? What comes next as it plays out in the provinces and territories?

Participants will:
- Learn about the status of Bill C-14 and how potential legislative outcomes will impact the practical application of MAID.
- Learn about the impact of MAID legislation on hospice palliative care in Canada, and how to approach policy-makers in the context of Health Accord negotiations between the Federal/Provincial/Territorials governments.
- Discuss potential stumbling blocks for the hospice palliative care community when deciding facility or individual practitioner approaches.

Presented by Dr. Susan MacDonald, Dr. Christina Vadeboncoeur, MD FRCPC, Pediatrician, Palliative Care Program, Children’s Hospital of Eastern Ontario, and Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association

Wednesday, June 15, 2016

Assisted Dying news in Canada

Assisted Dying in Canada by Udo Schuklenk

HealthcarePapers, 14(1) April 2014: 38-43.doi:10.12927/hcpap.2014.23969


This paper makes an affirmative ethical case in favour of the decriminalization of assisted dying in Canada. It then proceeds to defending the affirmative case against various slippery-slope arguments that are typically deployed by opponents of assisted dying. Finally, a recent case of questionable professional conduct by anti-euthanasia campaigners cum academics is flagged as a warning to all of us not to permit the quality of the professional debate to deteriorate unacceptably, despite the personal emotional investments involved on all sides of the debate. 

Assorted articles

Sunday, June 12, 2016

Caregiving demonstration videos by Canadian Virtual Hospice

Check out Caregiving Demonstrations (short video clips) where you can see:
  • How to give medications – by mouth, under the tongue, by patch, etc.
  • How to safely assist someone moving from a bed or chair
  • How to give someone a bed bath, wash their hair, or clean their mouth

Caregiving Demonstrations

Saturday, June 11, 2016

So, where do Canadians die?

Yes, this is a start. More funding has been announced in Ontario for residential hospices.

Province Strengthens End-Of-Life Care With $75 Million ... 

This investment would improve community-based hospice and palliative care services including:
  • Supporting up to 20 new hospices across Ontario and increasing the funding for existing facilities
  • Increasing supports for caregivers that will help families and loved ones support palliative patients at home and in the community
  • Promoting advance care planning so that families and health care providers understand patients' wishes for end-of-life care
  • Establishing the Ontario Palliative Care Network, a new body to advance patient-centred care and develop provincial standards to strengthen services.
Sadly, most of us do not want to die in hospital, and hospices are few and far between. Too many die in acute care, or the ER, despite a predictable disease trajectory, and research-based information that would clarify and support the deaths of a loved one in dignity and peace and quiet.

My husband, who volunteers with Meals on Wheels, gets mileage when he delivers meals. I, as a hospice volunteer providing respite, do not. There isn't enough money for this, despite the need for caregivers to get respite, and volunteers whose  mileage costs could be $65,000. I am rarely aknowledged, nor do clients offer to donate to my hospice group. We are never mentioned in obituaries as good places to donate in memory of a loved one.

It depends on where you die! Settings of care in Canada

Jun 18, 2012 - Currently, only 16-30% of Canadians have access to hospice palliative care.[ii]
 It is essential to understand the places in which Canadians are dying before we can improve the access to and quality of hospice palliative care.
  1. Acute Care. Most Canadians are dying in acute care hospital settings[iii].  Too many people who are dying end up in emergency departments during the last months and weeks of life, an indicator of poor quality end-of-life care.[iv] 
  2. Long Term Care (LTC). Some LTC have hospice palliative care training for staff, but many LTC residents also end up visiting the emergency room in the last weeks of life. Having a formalized palliative care program is not mandatory under the LTC act. Almost 50% of residents in LTC Homes are dying in the facility each year.
  3. At home. Home care costs in the last six months of life are roughly double what are required for all other home care recipients, and not all of these costs are covered by Medicare or private insurance plans.[v] A recent Ontario study showed that people with life-limiting illnesses who receive care at home early and receive more hours of care at home, are less likely to visit emergency rooms in the last weeks of life.[vi]
  4. Residential Hospice. Only 16 - 30% of us have access.
  5. In shelters/on the street. There is a marginalized homeless population who die in shelters or on the streets, with little care. There are now a small number of hospice programs for the homeless in Canada. 

Ontario is giving more money to publicly-funded hospices, adding $4.9 million to the $26 million a year it already gives them, a big increase to a budget that's still much smaller than ... Ontario is giving more money to publicly-funded hospices, adding $4.9 million to the $26 million a year it already gives them, a big increase to a budget that’s still much smaller than it ought to be. So the government is increasing funding to adult hospices by $15,000 a bed and to children’s hospices by $22,400 a bed. A decade ago, the government didn’t fund hospices at all. Now it’s promising to help build 20 more besides the 39 hospices Ontario already has, in addition to Friday’s by-the-bed funding increase.
4. The category "Place of death, non-hospital" includes deaths that occurred in private homes, in health care institutions such as nursing homes and other long-term care facilities, nursing stations and other short-term care facilities and other health care facilities not licensed to operate as hospitals by provincial, territorial or federal governments and at other specified sites.

Health Council of Canada. Seniors in need, caregivers in distress. April 2012