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Take the Hospice and Palliative Medicine Board Exam This Fall
Between now and 2012 physicians can sit for the American Board of Medical Specialties (ABMS) exam without having to complete a 12-month fellowship. The next ABMS hospice and palliative medicine certification exam is scheduled for November 16, 2010. You can prepare by taking the new HPM PASS, a 150-question online practice test. Developed by the American Academy of Hospice and Palliative Medicine (AAHPM), it's designed to simulate the board certification exam and help you assess your understanding of hospice and palliative medicine. AAHPM designates this educational activity for AMA PRA Category 1 CreditsTM. More information is available at: www.aahpm.org/certification/index.html.
NHPCO Issues Statement about Palliative Sedation Therapy
The National Hospice and Palliative Care Organization issued a statement clarifying the groups' positions about palliative sedation therapy. NHPCO said that health care providers, patients, and families should consider the treatment option for a very limited number of imminently dying patients whose pain is intolerable and unresponsive to other palliative interventions. Sedation should be titrated to reduce consciousness to the minimum level necessary to render symptoms tolerable. A physician with expertise in palliative care must lead the intervention. NHPCO said that “palliative sedation is categorically distinct from euthanasia and assisted suicide.” Further information: www.nhpco.org/i4a/pages/index.cfm?pageid=5847.
CMS to Test Allowing Concurrent Care for Children
Health care reform includes a provision that instructs Children's Health Insurance Programs and Medicaid plans to begin covering curative and hospice care for children with terminal illnesses. In addition, the Department of Health and Human Services will conduct a Medicare demonstration project of concurrent care for Medicare patients to assess whether it helps patients and saves federal dollars. Depending on the results of the 3-year study, Congress could change the hospice-care benefit. Further information is available at American Medical News: www.ama-assn.org/amednews/2010/05/24/prsb0524.htm (link checked 7/7/10).
FDA Changes Tramadol Labeling
The U.S. Food and Drug Administration has changed the language in the warning section of the prescribing information for tramadol, a synthetic opioid analgesic, to emphasize the risk of suicide in addiction-prone patients or those also taking tranquilizers or antidepressant drugs. The changes also warn about the risk of overdose, potentially resulting in central nervous system (CNS) depression, respiratory depression, and death. Tramadol used in conjunction with alcohol, other opioids, or illicit drugs causing CNS depression may be expected to have additive effects. Tramadol-related deaths have occurred in patients with previous histories of emotional disturbances or suicidal ideation or attempts, as well as histories of misuse of tranquilizers, alcohol, and other CNS-active drugs. FDA website link: www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm213264.htm (link checked 7/7/10).
Heart Rhythm Society Issues Defibrillator Deactivation Guidelines
The Heart Rhythm Society, in collaboration with the American Heart Association and other organizations, issued the first consensus statement for managing cardiovascular implantable electronic devices in patients nearing the end-of-life. The guidelines affirm that a patient with decision-making capacity has the legal right to request withdrawal of medical treatment and that carrying out such a request is not physician-assisted suicide or euthanasia. However, a clinician cannot be compelled to carry out a deactivation if it goes against his or her values. “The goal of this document is to provide clinicians with an understanding of the ethical and legal principles underlying device deactivation as well as guidance on communication about device deactivation with patients,” said lead author of the statement, Rachel Lampert, MD, FHRS, Yale University School of Medicine in New Haven, Conn. Further Information is available at: www.hrsonline.org.
New Project To Improve Palliative Care in the ICU
IPAL-ICU—a new project to improve palliative care in the ICU— launched June 16 at www.capc.org. IPAL-ICU provides a wide range of important and up-to-date tools and resources for clinicians to implement this new paradigm.
The idea that palliative care should be provided along with intensive care for critically ill patients, regardless of prognosis, has rapidly evolved from a novel formulation to a clinical practice guideline. From the time of admission to the ICU, all critically ill patients and their families can benefit from palliative care. Access practical—and necessary—tools through IPAL-ICU. Enhance the integration of palliative care into the ICU as a highly effective, day-to-day practice.
CAPC Palliative Care Leadership Centers: Intensive Training and Year-Long Mentoring
Palliative Care Leadership Centers (PCLC) are leading palliative care programs that provide customized, hands-on operational training—and yearlong mentoring—for palliative care programs at every stage of development and growth. The PCLCs represent diverse settings including health systems, community-based hospitals, hospices, academic medical centers, cancer centers, children's hospitals, VA and safety-net hospitals. Each offers a close, hands-on experience, as well as a 12-month mentoring follow-up to guide you through the challenges of program growth and sustainability. PCLC faculty are physician and nurse leaders in the field and experts in applying the most effective palliative care program models. You will benefit from their deep experience, knowledge, and mentoring in all matters of program development. There is a type of PCLC training to address the specific needs of each and every program—whether you are starting a program (PCLC Core), whether you are a pediatric palliative care program, or whether you are an active program up and running for at least 1 year (PCLC Custom and PCLC Consult).
For training sites and dates, and to learn more: www.capc.org
AAHPM Accepting Applications: Clinical Scholars Program
The AAHPM is now accepting applications from physicians for this 1-week observership program at select HPM sites across the United States. The program is designed to provide a focused clinical experience in hospice and palliative medicine to physicians. For more information please visit www.aahpm.org/education/clinicaltraining.html.
Clinical Fellowships Available
The Center for Palliative Studies at San Diego Hospice & Palliative Care offers 10 one-year clinical fellowships leading to eligibility for certification by the American Board of Hospice and Palliative Medicine, beginning July 1 each year. Two second-year research positions are available for physicians preparing for an academic career. Preferred candidates will BE or BC by an ABMS-recognized board. Combined training in geriatrics, hematology oncology is possible. For more information, please contact Charles F. von Gunten, M.D., Ph.D., at cvongunten@sdhospice.org or 619-278-6225. San Diego Hospice & Palliative Care is a teaching and research affiliate of the University of California, San Diego School of Medicine.
