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@DukePallCare SUCCESS! Journal Club Time Machine: Speed Dating with the Classics. Format - everyone in attendance (MS2-Attending) teaches a classic article for 4 minutes, it is put in context by someone old for 1-2 min, and we move on. Here's the list! A #HPC thread:
No 1 - SUPPORT Trial: https://pubmed.ncbi.nlm.nih.gov/7474243/ . 5 AMCs. Docs don't know pt's CPR preference, many DNRs within 2d of death, lots of ICU time and pain. RN led intervention gives docs data. Centers around communication. NO CHANGE IN KEY METRICS.
No 2 - Prognostication: https://pubmed.ncbi.nlm.nih.gov/10678857/ . Docs of pts referred to #hospice asked for assessment of prognosis. Only 20% accurate (+/- 33%) with most over-optimistic. Average miss factor of 5.3! Longer pt/doc relationship = worse prognostication accuracy ( #LoveThemTooMuch)
No 3 - Death Trajectories: https://pubmed.ncbi.nlm.nih.gov/12110073/ . @AGSJournal Death Trajectories based on deaths in a sample of Medicare patients. The origin of the classic teaching tool to discuss the challenges of accurate #prognostication and the mysteries of #frailty.
No 4 - What Matters at #EOL: https://pubmed.ncbi.nlm.nih.gov/11074777/ . @steinhaus1 @jatulsky. Survey of pts, #bereaved fam, docs, and care team re: what matters at #EOL. Table 5 is key - All agree 'Freedom from pain" #1. 'At peace with God'/'Mentally aware' higher for pt/fam than care team.
No 5 - "Are you at Peace": https://pubmed.ncbi.nlm.nih.gov/16401817/ . Another #Duke paper. One-item #spiritual probe. Being "At Peace" correlated with emotional/spiritual wellbeing, esp around faith&purpose. Peace generally can be religious or not, depending on pt's faith tradition.
No 6 - Family Perspectives on #EOL care at last place of care: https://pubmed.ncbi.nlm.nih.gov/14709580/ . @JoanMTeno 2000 67% of pts died in institutions. Unmet needs re sx, MD/DO #communication, emotional support, tx with respect. Dying at home with #hospice care had better EOL experience.
No 7 - PC Consults Cut Costs: https://pubmed.ncbi.nlm.nih.gov/21383364/ . @DianeEMeier @MSHSGeriPalCare Medicaid data from 4 NY hospitals. Pts with #PC consults incurred almost $7K less in hospital charges than matched UC group. Less $ on ICU/lab/imaging. Actually, #GoalConcordantCare cuts costs!
No 8 - Change in EOL Care for Medicare Decedents 2000- 2015: https://pubmed.ncbi.nlm.nih.gov/29946682/ . Fewer in-hospital deaths (33%->20%), increase in home/ALF death (31->40%), more ICU use last 30d of life (29%), EOL healthcare transitions unchanged in 15 years (11%). #WorkToBeDone
No 9 - Pediatric PC Patients: https://pubmed.ncbi.nlm.nih.gov/21555495/ . Description of pts seen by 6 hospital-based #PedPC teams. Genetic/congenital (41%), neuromusc (39%), cancer (20%), resp (13%); most w/ some med tech (49% had g-tubes). Only 30% died in year after c/s. #UpstreamFromInception
No 10 - Early PC in #NSCLC: https://pubmed.ncbi.nlm.nih.gov/20818875/ . #Temel and @DahlinPallCare @VjacksonJackson and @MGHPalCareGeri. Read the whole thing. #PC group had better #QOL, less depression, less aggressive EOL care and lived LONGER by 2.7mo. #IfPCWasChemoWeWouldBeApprovedAndPricey
Thanks to those who walked down memory lane with me! Speed Dating is a fun kickoff to academic #JournalClub and helps to tell the story of how #HPC got where we are, carried on the shoulders of giants (who are mostly still working among us!), over the last few decades.
Thanks to @JessicaMaMD for her leadership in the Journal Club space, after getting rave reviews from last year’s fellows. Making journal club fun is HARD but she’s done it! 
