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Journal of Palliative Medicine

Marcus J P Geist, Hubert J Bardenheuer, Jürgen Burhenne, Gerd Mikus
BACKGROUND: Drug interactions are a common cause for escalation of debilitating symptoms in palliative care patients. CYP3A is the most relevant CYP enzyme in humans involved in metabolism of about half of all available pharmaceuticals. OBJECTIVE: To increase knowledge about the CYP3A enzyme and the impact of drug interactions on its activity to improve dosing in palliative care patients. DESIGN: The prospective clinical trial uses a secure method of analyzing CYP3A activity in humans: Administration of a marker substance followed by the determination of its blood concentrations as well as the concentrations of its metabolite at certain points of time and corresponding metabolic clearance calculations...
January 12, 2018: Journal of Palliative Medicine
Jacob J Strand, Lindsay L Warner, Mihir M Kamdar, Alice W Flaherty, Vicki A Jackson
Central pain syndromes are a complex, diverse group of clinical conditions that are poorly understood. We present a patient with progressive, debilitating central pain and co-existing mood disorders that was refractory to multimodal pharmacologic and nonpharmacologic therapies, but that ultimately responded to electroconvulsive therapy (ECT). The patient described it at various times as her skin being "lit on fire," "stabbed," "squeezed like a boa constrictor," or itching unbearably. She underwent a course of three sequential ECT treatments during her hospitalization and it dramatically decreased her pain...
January 12, 2018: Journal of Palliative Medicine
Natsuko Ishida, Shuya Hongo, Ayaka Kumano, Hiroyuki Hatta, Nobuyuki Zakoji, Makiko Hirutani, Yoshiaki Yamamoto, Hirohumi Aono, Moe Tuigi, Ryohei Suzuki, Hiroshi Hanamitsu, Eisaku Wakasugi, Masaaki Takahashi, Akimasa Yamatani
BACKGROUND: Pain is a widely neglected symptom in patients with amyotrophic lateral sclerosis (ALS), even though it may be common and have a significant impact on the quality of life. OBJECTIVE: The aim of this study was to determine the frequency and characteristics of pain and its treatment in ALS patients. DESIGN: A multicenter cross-sectional study. SETTING/SUBJECTS: Eighty patients with ALS from eight hospitals...
January 10, 2018: Journal of Palliative Medicine
Brittany A Davidson, Haley A Moss, Arif H Kamal
The vast majority of women diagnosed with ovarian cancer present with advanced-stage disease with a five-year survival rate less than 50%. Studies have shown that in the past, gynecologic oncologists were not routinely collaborating with palliative care physicians resulting in goals of care planning often not occurring until the last 30 days before death. In recent years, professional societies have been increasingly more vocal about the importance of incorporating palliative care early in a patient's disease course...
January 10, 2018: Journal of Palliative Medicine
Lucas Pieper, Boris Zernikow, Ross Drake, Michael Frosch, Michael Printz, Julia Wager
BACKGROUND: Dyspnea is one of the most frequent symptoms in children with complex chronic conditions (CCC) requiring palliative care. Although it is a subject of high importance, there has been little research on dyspnea in critically ill children. OBJECTIVE: The purpose of this systematic review was to investigate the prevalence and causes of dyspnea in children with CCC and to identify the current state of research on the measurements, treatments, and the evaluation of therapeutic interventions...
January 9, 2018: Journal of Palliative Medicine
Samuel J Perna, James M Rhinewalt, Erin R Currie
BACKGROUND: Status epilepticus seizures are distressing events for hospice and palliative care patients. Currently, rectal diazepam is the only abortive therapy approved by the U.S. Food and Drug Administration for seizures occurring out of hospital. However, transmucosal (buccal and intranasal) midazolam hydrochloride is a less expensive, equally effective, and a more socially acceptable alternative. OBJECTIVE: To explore the use of transmucosal midazolam in out-of-hospital hospice patients in the State of Alabama...
January 5, 2018: Journal of Palliative Medicine
Mara R Hobler, Ruth A Engelberg, J Randall Curtis, Kathleen J Ramos, Miriam I Zander, Shacole S Howard, Christopher H Goss, Moira L Aitken
BACKGROUND: Persons with cystic fibrosis (CF) experience high morbidity and mortality, yet little is known about their palliative care needs and how clinicians may address these needs. OBJECTIVES: (1) To identify palliative care and advance care planning needs of patients with CF and their families; and (2) to identify clinicians' potential roles in meeting these needs. METHODS: A mixed-methods study of adult patients (age ≥18 years) with moderate-to-severe CF [forced expiratory volume in the first second (FEV1) <65% predicted] were recruited from a CF Center...
January 3, 2018: Journal of Palliative Medicine
Jennifer Hopping-Winn, Juliette Mullin, Laurel March, Michelle Caughey, Melissa Stern, Jill Jarvie
Since 2013, Kaiser Permanente Northern California has engaged in a systematic effort to elicit, document, and honor the care preferences of patients as they near the end of life. This is done through its Advanced Steps program, in which selected patients discuss their preferences for future medical care with their healthcare agent during a structured conversation with a trained advance care planning facilitator. The facilitator then translates the patient's wishes into an actionable medical order set using a Physician's Order for Life-Sustaining Treatment (POLST) form...
January 3, 2018: Journal of Palliative Medicine
Keiko Kurita, M Cary Reid, Eugenia L Siegler, Eli L Diamond, Holly G Prigerson
BACKGROUND: Cognitive function of patients with advanced cancer is frequently compromised. OBJECTIVE: To determine the extent that patients' cognitive screening scores was associated with their end-of-life (EoL) treatment preferences, advance care planning (ACP), and care. DESIGN: Patients were interviewed at baseline and administered a cognitive screen. Caregivers completed a postmortem assessment. SETTING/SUBJECTS: Patients with distant metastases and disease progression after first-line chemotherapy and their caregivers (n = 609) were recruited from outpatient clinics and completed baseline and postmortem assessments...
January 3, 2018: Journal of Palliative Medicine
Annemarie Bösch, Julia Wager, Boris Zernikow, Ralf Thalemann, Heidi Frenzel, Heiko Krude, Tobias Reindl
BACKGROUND: The increasing number of children with life-threatening and life-limiting conditions requires an individualized approach and additional supportive care in hospitals. However, these patients' characteristics and their prevalence in a pediatric tertiary hospital setting have not been systematically analyzed. OBJECTIVE: This study aimed to determine the proportion of hospitalized children who are receiving care for life-threatening diseases with feasible curative treatments and for life-limiting diseases (LLDs) with inevitable premature death as opposed to care for acute or chronic diseases; additionally, it sought to compare patient characteristics, clinical features, and symptoms within these subgroups...
January 3, 2018: Journal of Palliative Medicine
Lauren J Hunt, See J Lee, Krista L Harrison, Alexander K Smith
OBJECTIVE: To provide a guide to researchers selecting a dataset pertinent to the study of palliative care for people with dementia and to aid readers who seek to critically evaluate a secondary analysis study in this domain. BACKGROUND: The impact of dementia at end-of-life is large and growing. Secondary dataset analysis can play a critical role in advancing research on palliative care for people with dementia. METHODS: We conducted a broad search of a variety of resources to: 1...
December 21, 2017: Journal of Palliative Medicine
Melissa H Tukey, Katherine Faricy-Anderson, Emily Corneau, Rouba Youssef, Vincent Mor
BACKGROUND: Evidence suggests that the aggressiveness of care in cancer patients at the end of life is increasing. We sought to evaluate the use of invasive procedures at the end of life in patients with advanced non-small-cell lung cancer (NSCLC). OBJECTIVE: To evaluate the utilization of invasive procedures at the end of life in Veterans with advanced NSCLC. DESIGN: Retrospective cohort study of Veterans with newly diagnosed stage IV NSCLC who died between 2006 and 2012...
December 21, 2017: Journal of Palliative Medicine
Cara L Wallace, Gail Adorno, Daniel B Stewart
BACKGROUND: Due to large number of deaths occurring in nursing home (NH) settings, along with reports of pain and suffering, there is great need for improvements in the provision of end-of-life (EOL) care in NHs. OBJECTIVE: The aim of this study was to develop a comprehensive understanding of the experience of dying in NHs through the perspective of residents, family, and facility staff. DESIGN: This study uses a qualitative interpretive meta-synthesis to provide a holistic view of EOL care in NHs across multiple qualitative studies...
December 6, 2017: Journal of Palliative Medicine
William F Bond, Minchul Kim, Chris M Franciskovich, Jason E Weinberg, Jessica D Svendsen, Linda S Fehr, Amy Funk, Robert Sawicki, Carl V Asche
BACKGROUND: Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. OBJECTIVE: To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. DESIGN: This was a case-control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs...
December 5, 2017: Journal of Palliative Medicine
Sinead Cobbe, Kathy Nugent, Shirley Real
BACKGROUND: Complex decongestive therapy (CDT) is a regimen of physical treatment for lymphedema. Its effectiveness is unknown in advanced cancer patients. This study evaluates effectiveness of CDT in this population. METHOD: This is a prospective observational cohort study for 18 months of advanced cancer patients with lymphedema, who received three or more CDT interventions. Measurements were taken before the first (T1), third (T3), and sixth (T6) treatments as follows: limb volume using circumferential measurements, quality of life (QOL) using qualitative questions, skin quality using a locally developed scale measuring color, thickness, and texture...
December 5, 2017: Journal of Palliative Medicine
Toni L Glover, Paula Turpening, Cynthia Garvan, Sheri Kittelson
No abstract text is available yet for this article.
December 5, 2017: Journal of Palliative Medicine
Mellar P Davis, Bertrand Behm
No abstract text is available yet for this article.
December 5, 2017: Journal of Palliative Medicine
Joan M Teno, Russ Montgomery, Tom Valuck, Janet Corrigan, Diane E Meier, Amy Kelley, J Randall Curtis, Ruth Engelberg
Innovation is needed to improve care of the seriously ill, and there are important opportunities as we transition from a volume- to value-based payment system. Not all seriously ill are dying; some recover, while others are persistently functionally impaired. While we innovate in service delivery and payment models for the seriously ill, it is important that we concurrently develop accountability that ensures a focus on high-quality care rather than narrowly focusing on cost containment. The Gordon and Betty Moore Foundation convened a meeting of 45 experts to arrive at guiding principles for measurement, create a starter measurement set, specify a proposed definition of the denominator and its refinement, and identify research priorities for future implementation of the accountability system...
December 1, 2017: Journal of Palliative Medicine
Sanders Chang, Peter May, Nathan E Goldstein, Juan Wisnivesky, Kenneth Rosenzweig, R Sean Morrison, Kavita V Dharmarajan
INTRODUCTION: Palliative radiation therapy (PRT) is a commonly utilized intervention for symptom palliation among patients with metastatic cancer, yet it is under-recognized as a distinct area of subspecialty within radiation oncology. OBJECTIVE: We developed a multidisciplinary service model within radiation oncology called the Palliative Radiation Oncology Consult (PROC) service to improve the quality of cancer care for advanced cancer patients. We assessed the service's impact on patient-related and healthcare utilization outcomes...
November 30, 2017: Journal of Palliative Medicine
Kieran Quinn, Stephen Workman
Allowing physicians to write a do not resuscitate (DNR) or do not administer cardiopulmonary resuscitation order after properly informing patients and their families that death would be irreversible offers a more rational and compassionate approach than traditional shared decision making in establishing a DNR status for some hospitalized patients.
November 30, 2017: Journal of Palliative Medicine
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