End of life: how to avoid hospitalizations?

24% of GPs think that hospitalisations can be avoided in last 3 months of life: http://t.co/EyYCmrKNBP Proactive communication vital. #hpm

— Palliative Medicine (@PalliativeMedJ) abril 9, 2014

Many people are sent to hospital to be attended to during the clinical stage complications they suffer from in the last months of life. We are all aware that we’re not dealing with this issue very well and in addition we haven’t gone to great lengths to improve it. What do these hospitalizations bring? Could they be avoided?

Palliative Medicine magazine just published a timely survey addressed to Dutch family physicians in order to gain insights into their thoughts about hospitalizations during the end of life for their own patients. And the results are quite suggestive:

Colorectal Cancer: prevention strategies

Colorectal cancer is the third most common cancer among men and the second among women. Most of these cancers develop from adenomatous polyps in a period that can be ten years or more. This long progression offers enough time to adopt preventive strategies with reasonable levels of effectiveness in a context of a mucosa where the presence of polyps is fairly common, despite only some of them evolving toward malignancy.

Colonoscopy is a technique that has been proven effective in reducing mortality from colorectal cancer, but no one can ignore the difficulties of applying this technique extensively, given the low adherence to the calls and the high costs of the program, without forgetting the side effects inherent to the practice of colonoscopy. For this reason I thought it opportune the study lead by Dr. Enrique Quintero (Hospital Universitario de Canarias) and Dr. Antoni Castells (Hospital Clínic Barcelona) which compares, in a prospective clinical trial involving more than 50,000 calls, the practice of a one time colonoscopy with the analysis of a stool sample (with immunochemical test) every two years. The work has an expected 10-year follow-up, and aims to measure the impact in terms of deaths avoided, and although it is still evolving, New England has published a progress report.

Complex Chronic Patients: UK progress in funding

good article by Sam Everington on general practice http://t.co/Qk0iIs2ZZQ

— Chris Ham (@profchrisham) marzo 13, 2014

Director of King'sFund, Chris Ham’s tweet, takes us to Sam Everington’s article in The Guardian, about new experiences of financing (commissioning) towards community services deployed to address chronic complex patients in their own homes, even in episodes of clinical exacerbations, and thus avoiding likely unwise hospitalizations.

Chronic Models: the Wagnerian keys

Chris Ham, King's Fund Director, interviews Edward Wagner, Director Emeritus of MacColl Center for Healthcare Innovation Group Health Research Institute and promoter of the chronic patients care model (Chronic Care Model or CCM). As I think it is worth it, I decided to share a transcript summary of the conversation. It will not disappoint you.

Ham: How did you come up with the idea for CCM?

Wagner: From my own clinical practice. For me it was frustrating to see how well prepared and well-meaning physicians, when they had to deal with caring for chronic patients, failed to achieve good results, while we were starting to have evidence that by doing things differently, patients could better understand what was happening to them and could improve clinical outcomes. And for this reason I thought we had to share this evidence with the doctors.

Surgical Checklist: a challenged guarantee

The efficacy of surgical checklist questioned in the Ontario study. The importance of a good implementation program. http://t.co/p85tRgnJKh

— Elvira bisbe (@EBisbe) abril 1, 2014

The tweet from Dr. Elvira Bisbe ​​warns us that New England has sprung a surprise: a study in Ontario, deployed in 101 hospitals and more than 200,000 cases revealed that the application of a surgical checklist doesn’t significantly reduce complications nor mortality.

Palliative chemotherapy: an oxymoron?

An oxymoron is a figure of speech which consists in using contradictory terms in conjunction. In this case: chemotherapy and palliative care. From US data it’s well known that between 20 and 50% of patients with advanced cancer receive chemotherapy 30 days before death. I think these figures are impressive and even more so after reading the results of the work conducted by Professor Wright of Harvard Medical School. This is an ample view of over 386 patients with advanced cancer who averaged 4 months of life after entering the study. In this group it was noticed that patients who were treated with chemotherapy in the last months of life were more likely to receive towards the end of their life inappropriate clinical performances such as cardiac resuscitation or mechanical ventilation or to end their days in the intensive care units.

The American Society for Clinical Oncology (ASCO) believe that the disappearance of palliative chemotherapy would be a true "Triple Aim": better life quality for patients, fewer unwanted effects and lower costs, although the great difficulty with this issue, according to ASCO, lies in deciding when it’s time to stop treatment.

More participation, better policies?

Elena Torrente @etorrente


“For us [the Athenians legislators], the debate is not a stepping stone towards action, but the first step essential to taking any wise decision.” – Pericles

I read this quote in the book “És la política, idiotes!” by Professor of Political Science Quim Brugué where he firmly defends politics and the need for collective decisions in politics. Right now when political disaffection prevails, this is an interesting book to say the least that points to an issue that for me is paramount: Intelligence is always collective.

Nowadays, in the era of social networks where we can share knowledge and contribute ideas, interesting debate has never been so easy. But, how about in the area of public policy? Is collective intelligence taken into consideration when they design it? Does it make sense to do it?