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Pallmedpro @pallmedpro.bsky.social · 16/09/2026

Here’s wishing everybody who is sitting the SCE in Palliative Medicine today all the very best. We really hope that all your hard work pays off. For those of you looking to sit the exam during another diet, visit our website for details on how to join our mailing list via pallmedpro.com

pallmedpro.com

Palliative Medicine Education and SCE Revision Resources

Pallmedpro is an educational partnership helping doctors pass their specialty certificate examinations in Palliative Medicine.

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Pallmedpro @pallmedpro.bsky.social · 22/07/2026

Doctors in palliative care often have to make safeguarding referrals: The Care Act (2014) gives us 6 principles that should shape every decision: 1️⃣ Empowerment 2️⃣ Prevention 3️⃣ Proportionality 4️⃣ Protection 5️⃣ Partnership 6️⃣ Accountability #CareAct #Safeguarding #SocialCare #Leadership

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Pallmedpro @pallmedpro.bsky.social · 15/07/2026

No swallow, no ranitidine, no IV access, no problem. This large retrospective case series looks at the tolerability and use of subcutaneous esomeprazole in patients who require acid suppression for various indications at the end of life, but who cannot swallow: www.tandfonline.com/eprint/DRMMZ...

tandfonline.com

Administering Esomeprazole as a Continuous Subcutaneous Infusion in the Palliative Demographic: A Retrospective Review

To evaluate the safety, feasibility, and effectiveness of esomeprazole via continuous subcutaneous infusion, in palliative care patients unable to tolerate oral acid suppression therapy. A retrospe...

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Pallmedpro @pallmedpro.bsky.social · 13/07/2026

Symptom Top Five… In people with stage 5 CKD managed without dialysis, symptom burden was high: fatigue affected 76%, itching 74%, drowsiness 65%, breathlessness 61% and oedema 58%. Murtagh et al., J Palliat Med (2007): doi.org/10.1089/jpm....

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Pallmedpro @pallmedpro.bsky.social · 03/07/2026

The WHO pain ladder is 40 years old, yet it’s still being taught in the UK as if it’s current guidance. The WHO published new guidance back in 2018, officially consigning their 1986 work to the history books… www.who.int/publications...

who.int

WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents

WHO has developed Guidelines for the pharmacologic and radiotherapeutic management of cancer pain in adults and adolescents to provide evidence-based guidance to initiating and managing cancer pain. T...

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Pallmedpro @pallmedpro.bsky.social · 03/07/2026

Our video library, featuring recordings from this year’s course, and other great talks not to be missed, is now open to our 2026 delegates. Check it out at pallmed.pro/videos

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Pallmedpro @pallmedpro.bsky.social · 28/06/2026

Last chance to book onto our course this Wednesday. Lots of great topics and speakers from exploring how to use AI in your revision to neuropharmacology, guidelines and more. Why not check out the programme? pallmed.pro/book

pallmed.pro

Palliative Medicine SCE Revision Course

Booking page for Pallmedpro's Palliative Medicine SCE Revision Course

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Pallmedpro @pallmedpro.bsky.social · 10/05/2026

High anticholinergic burden is linked to delirium, impaired attention, falls, urinary retention, and long‑term cognitive decline, yet we often underestimate it. The ACB Calculator provides a simple, evidence‑based scoring system to support safer prescribing. www.acbcalc.com

acbcalc.com

ACB Calculator

A tool for finding the ACB Score of commonly prescribed medicines, and for calculating the Anticholinergic Burden for your patient

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Pallmedpro @pallmedpro.bsky.social · 09/05/2026

Our Palliative Medicine Zoom course on 1-2 July is now open for bookings. If you’re a doctor working in palliative care in the UK or abroad, why not come along? pallmed.pro/book

pallmed.pro

Palliative Medicine SCE Revision Course

Booking page for Pallmedpro's Palliative Medicine SCE Revision Course

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Pallmedpro @pallmedpro.bsky.social · 01/05/2026

Coffee on the seafront whilst we make some preparations to open this year’s palliative medicine course to everyone next Friday. Not a bad office for the morning.

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Pallmedpro @pallmedpro.bsky.social · 21/01/2026

Results are out on your MRCP(UK) accounts for December’s SCE in Palliative Medicine…How did you all get on? We’ll shortly be emailing our 2025 delegates to see how we can ensure our 2026 delegates get the results they deserve. We’re thinking of you all today.

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Pallmedpro @pallmedpro.bsky.social · 10/12/2025

To all those exhausted palliative medicine doctors who sat their SCE today…well done for making it this far. We wish you all the very best and will be in touch in the New Year to find out how you got on. For now, have a wonderful and well-deserved Christmas.

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Pallmedpro @pallmedpro.bsky.social · 30/11/2025

Who’s at the Guildford Advanced Course tomorrow? This is a great place to brush up on complex symptom-control and evidence-based practice for those working in palliative medicine. It’s also great revision! #palliativemedicine #evidencebasedmedicine

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Pallmedpro @pallmedpro.bsky.social · 01/10/2025

Have you read Soliman et al.'s 2025 systematic review and meta-analysis in the management of neuropathic pain? How might it change your practice? www.thelancet.com/action/showP...

thelancet.com

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Pallmedpro @pallmedpro.bsky.social · 01/10/2025

Good morning from the gallery! Looking forward to going live at 9 after our intro VT 🎬

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Pallmedpro @pallmedpro.bsky.social · 24/09/2025

Our Resources Portal is now open to delegates on our 2025 course, who should now all have logins. We’ll be adding to it as the course gets underway, including enabling our practice question bank. Visit pallmed.pro/resources, or book your course place via pallmed.pro/book if you haven’t already!

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Pallmedpro @pallmedpro.bsky.social · 09/09/2025

Have you learned your controlled drug schedules? Knowing the relevant schedules and the legal restrictions placed upon common palliative care medicines can be helpful, along with how you may need to advise patients looking to take these medicines abroad. GOV.UK has more: www.gov.uk/guidance/con...

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Pallmedpro @pallmedpro.bsky.social · 03/09/2025

Breathlessness steals more than air — it steals agency. Currow & Johnson (2020) argue opioids, used well, can give it back. Start low, titrate slow, monitor closely. This is symptom control with purpose, not palliation by default.

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Pallmedpro @pallmedpro.bsky.social · 03/09/2025

Still hesitating over morphine for breathlessness? The evidence is stronger than many think. Currow & Johnson’s review dismantles myths, clarifies dosing, and reframes risk. Worth a re‑read before your next MDT. spcare.bmj.com/content/10/3...

spcare.bmj.com

Opioids for breathlessness: a narrative review

Chronic breathlessness is a disabling and distressing condition for which there is a growing evidence base for a range of interventions. Non-pharmacological interventions are the mainstay of managemen...

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Pallmedpro @pallmedpro.bsky.social · 03/09/2025

Opioids for chronic breathlessness ≠ “last resort”. Currow & Johnson (2020) remind us: low‑dose morphine can improve function & QoL when optimised, monitored, and individualised. Not about sedation — about living better, breathing easier.

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Pallmedpro @pallmedpro.bsky.social · 31/08/2025

Our revision flashcards are in the process of being updated for 2025-2026, with some great new content added. You'll be able to pre-order the 8th Edition from 15th September, for release on 1st October. Course delegates can claim a FREE update in October. pallmed.pro/flashcards

pallmed.pro

Palliative Medicine SCE Flashcards

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Pallmedpro @pallmedpro.bsky.social · 28/08/2025

🤔 MCA 2005 and Scotland’s AWI diverge on capacity assessment, scope of proxy authority, and how we justify decisions. Know the ground rules before you cross them. A clear overview from the Mental Welfare Commission: www.mwcscot.org.uk/adults-incap...

mwcscot.org.uk

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Pallmedpro @pallmedpro.bsky.social · 28/08/2025

⚖️ Same patient scenario, different nation, different paperwork. MCA 2005 gives LPAs broad health/welfare powers if capacity is lost. Scotland’s AWI splits decision‑making: welfare powers via guardianship/intervention orders, and healthcare decisions through statutory authority for clinicians.

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Pallmedpro @pallmedpro.bsky.social · 28/08/2025

🧠 Under the MCA 2005 (England & Wales), we decide for an adult lacking capacity by asking what’s in their ‘best interests’. In Scotland’s Adults with Incapacity Act, that phrase never appears. The focus shifts to benefit and least restrictive option, with statutory principles front and centre.

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Reposted by Pallmedpro

Pharmacopalliation @pharmacopalliation.bsky.social · 27/08/2025

💊💊ALFENTANIL💊💊 Alfentanil’s pKa ~6.5, much lower than fentanyl (~8.4) or morphine (~8.0) At physiologic pH (7.4), ~90% of alfentanil exists in the unionised, lipid-soluble form → crosses the blood–brain barrier very rapidly This explains why alfentanil has the fastest onset of action of any opioid

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Pallmedpro @pallmedpro.bsky.social · 20/08/2025

Did you know, that the half life of phenobarbitone is an average of 4 days?! The way we use it in palliative care needs to be proportionate, specialist-led, and congruent with known pharmacokinetics. @bmj.com Supportive and Palliative Care has more: spcare.bmj.com/content/earl... #palliativecare

spcare.bmj.com

Novel staggered loading of phenobarbitone for refractory seizures and agitation at the end of life

Background Seizures and agitation are distressing symptoms commonly encountered at the end of life and may require treatment with phenobarbitone when standard therapies fail. Current phenobarbitone do...

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Pallmedpro @pallmedpro.bsky.social · 17/08/2025

Fallon et al.’s 2018 randomised trial found oral ketamine no different to placebo in cancer-related neuropathic pain, but wondered if there could still be a role for it in cases where central sensitisation was observed (a population not specifically selected for) pmc.ncbi.nlm.nih.gov/articles/PMC...

pmc.ncbi.nlm.nih.gov

Oral Ketamine vs Placebo in Patients With Cancer-Related Neuropathic Pain: A Randomized Clinical Trial

This multicenter randomized clinical trial compares oral ketamine with placebo for treating neuropathic pain in patients with cancer.

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Pallmedpro @pallmedpro.bsky.social · 17/08/2025

Although an older study, this placebo-controlled double-blind RCT found no net benefit using SC ketamine in general cancer pain. 6 years later, Fallon et al. Looked more specifically at neuropathic cancer pain. pubmed.ncbi.nlm.nih.gov/22965960/

pubmed.ncbi.nlm.nih.gov

Randomized, double-blind, placebo-controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain - PubMed

Ketamine does not have net clinical benefit when used as an adjunct to opioids and standard coanalgesics in cancer pain.

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Pallmedpro @pallmedpro.bsky.social · 14/08/2025

The Dual Process Model of Grief: Laughed during grief then felt guilty? Don’t. The Dual Process Model says we shift between loss-oriented coping (feeling, remembering) and restoration-oriented coping (adapting, rebuilding). This back-and-forth prevents burnout. Joy and sorrow can walk together

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Pallmedpro @pallmedpro.bsky.social · 14/08/2025

Worden’s Tasks of Mourning: Grief isn’t just a wave to ride — it’s work. Worden’s 4 tasks: accept the loss, process the pain, adjust to life without them, and keep a lasting connection while moving forward. It’s not “getting over” someone — it’s living with love and loss in the same heart.

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Pallmedpro @pallmedpro.bsky.social · 14/08/2025

Grief, according to Kübler-Ross: Heard grief has “5 stages” you must follow? Denial → anger → bargaining → depression → acceptance was never a rigid sequence. Kübler-Ross saw it in those facing terminal illness. You might skip, loop, or feel several at once. It’s a guide, not a timetable.

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Pallmedpro @pallmedpro.bsky.social · 11/08/2025

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Pallmedpro @pallmedpro.bsky.social · 10/08/2025

Naloxegol’s long tail prevents it from reaching the CNS where it would otherwise reverse the analgesic effects of opioids. It works peripherally in the gut.

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Pallmedpro @pallmedpro.bsky.social · 10/08/2025

(4/4) Fix Opioid-Induced Constipation by tackling the cause: laxatives to soften stool and get things moving, with a low threshold for adding NICE-approved PAMORAs (like naloxegol) that block opioids in the gut but leave pain relief intact.

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Pallmedpro @pallmedpro.bsky.social · 10/08/2025

(3/4) So what helps Opioid-Induced Constipation? More fibre? More water? Helpful to a point – but if opioids have drained water from the stool, fibre just bulks it up. And extra drinks don’t magically get that water into the colon. This is a different pathology which needs a different approach…

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Pallmedpro @pallmedpro.bsky.social · 10/08/2025

(2/4) Opioid-induced constipation hits from 3 angles: slower gut muscles, more water pulled out of stool, and weaker “time to go” signals. Fibre and fluids often can’t fight all 3.

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Pallmedpro @pallmedpro.bsky.social · 10/08/2025

Let’s talk Opioid-Induced Constipation (1/4) On opioids and can’t go? It’s not you, it’s your gut. Opioids slow bowel movement, dry out stool, and cut gut secretions. That’s a recipe for constipation – even with a great diet.

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Pallmedpro @pallmedpro.bsky.social · 07/08/2025

Octreotide ACTIVATES rather than blocks somatostatin receptors. It DECREASES insulin secretion (can cause hyperglycaemia), is more associated with HYPOthyroidism, and is sometimes used to vasoconstrict varices. Normally labelled with Indium, it CAN be labelled with technetium. (5) is most accurate

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Pallmedpro @pallmedpro.bsky.social · 06/08/2025

Which of the following statements about octreotide is most accurate? 1️⃣ Exerts action through somatostatin receptor blockade 2️⃣️ Increases insulin secretion 3️⃣ Commonly causes hyperthyroidism 4️⃣ Increases variceal bleeding risk 5️⃣ Is labelled with technetium in nuclear medicine imaging 📊 Show results

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Pallmedpro @pallmedpro.bsky.social · 01/08/2025

Our Palliative Medicine course is open to everyone, and it’s been great to see delegates booking from across the world. If the time zones don’t fit, remember you get access to our resources, handouts, questions and more. Drop us a line or check out pallmed.pro/book for more!

pallmed.pro

Palliative Medicine SCE Revision Course

Booking page for Pallmedpro's Palliative Medicine SCE Revision Course

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Pallmedpro @pallmedpro.bsky.social · 19/07/2025

Delighted that @pharmacopalliation.bsky.social will be presenting again at this year’s course (pictured left) We’re looking forward to it!

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Pallmedpro @pallmedpro.bsky.social · 16/07/2025

BOOKING OPENS 9am GMT+1 for our 12th annual Palliative Medicine Exam Revision Course. Whether you’re a UK or international doctor sitting the Specialty Certificate Examination, or an established professional looking for CPD, check out our topic list below, or visit Pallmed.pro/book for more!

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Pallmedpro @pallmedpro.bsky.social · 21/03/2025

So many familiar faces! Jonathan’s at #PCC2025 today, so if you’ve seen our flashcards, been on one of our courses, authored in (/already read) Case Histories in Palliative Medicine, or just want to say ‘hi’, please do! oxford.ly/4hG4C9B

oxford.ly

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Pallmedpro @pallmedpro.bsky.social · 04/03/2025

Good luck to all Palliative Medicine SCE candidates. You've done all you can do now. Step away from the PCF.

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Pallmedpro @pallmedpro.bsky.social · 16/02/2025

Delegates on our December 2024 course are now entitled to 30% discount on this title. A personal discount code can be activated via your resources portal for a limited time.

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Pallmedpro @pallmedpro.bsky.social · 10/02/2025

Edited by palliative medicine physician Dr Jonathan Pickard, and consultant pharmacist Mr Jonathan Hindmarsh, 54 expert authors provide “diagnostic skills and clinical reasoning that helps temper knowledge and understanding with pragmatism and practicality in the face of life-limiting illness.”

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Pallmedpro @pallmedpro.bsky.social · 10/02/2025

It’s finally here! @oxfordunipress.bsky.social Oxford Case Histories in Palliative Medicine “guides medical professionals and trainees through 52 cases curated to illustrate the varied and often complex landscape of palliative medicine.” oxford.ly/4hG4C9B

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Pallmedpro @pallmedpro.bsky.social · 18/01/2025

A: £200 as a one-off payment.

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Pallmedpro @pallmedpro.bsky.social · 16/01/2025

Q: What is the total size of the Macmillan Grant payment?

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