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Palliative Sedation

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https://www.readbyqxmd.com/read/29150095/-towards-a-better-use-of-midazolam-in-end-of-life-a-survey-in-a-department-of-medical-oncology
#1
Aurélie Beneton, Alexis Vallard, Christelle Brosse, Géraldine Poenou, Cécile Pacaut, Nicolas Magné, Stéphanie Morisson
INTRODUCTION: At the end of life of cancer patients, sedation is sometimes needed, in order to palliate unbearable symptoms that other treatments fail to relieve. Midazolam is currently recommended for sedation and its prescription is guided by national guidelines. The aim of the present study was to evaluate the practices of midazolam prescription in a department of medical oncology and to compare the results with French national recommendations in order to improve the midazolam use in case of sedation...
November 14, 2017: Bulletin du Cancer
https://www.readbyqxmd.com/read/29118101/japanese-physicians-experiences-of-terminally-ill-patients-voluntarily-stopping-eating-and-drinking-a-national-survey
#2
Takuya Shinjo, Tatsuya Morita, Daisuke Kiuchi, Masayuki Ikenaga, Hirofumi Abo, Sayaka Maeda, Satoru Tsuneto, Yoshiyuki Kizawa
OBJECTIVES: Voluntarily stopping eating and drinking (VSED) could be regarded as a patients' own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED. METHODS: 219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016...
November 8, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/29105683/-palliative-care-in-the-intensive-cardiac-care-unit-a-new-competence-for-the-cardiac-intensivist
#3
Massimo Romanò, Roberta Bertona, Federica Zorzoli, Rosvaldo Villani
Admissions to the intensive care unit at the end of life of patients with chronic non-malignant diseases are increasing. This involves the need for the development of palliative care culture and competence, also in the field of intensive cardiology. Palliative care should be implemented in the treatment of all patients with critical stages of disease, irrespective of prognosis, in order to improve the quality of care at the end of life.This review analyzes in detail the main clinical, ethical and communicational issues to move toward the introduction of basics of palliative care in cardiac intensive care units...
October 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29102388/-end-of-life-debate-citizen-s-point-of-view-about-deep-and-continuous-sedation
#4
J Toporski, T Jonveaux-Rivasseau, C Lamouille-Chevalier
INTRODUCTION: Sedation in palliative care meets a precise definition and corresponds to a medical practice. We assessed the comprehension of this practice by the French population. METHOD: In 2015, citizen expressed their views on the Claeys-Leonetti bill by means of a consultative forum made available on the Internet site of the National Assembly. The content of the messages filed, regarding the right to deep and continuous sedation until death was analyzed using the ALCESTE textual data analysis software, supplemented by a thematic analysis in order to identify the perception that Internet users had of this practice...
November 1, 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/29066037/end-of-life-care-preferences-in-patients-with-severe-and-persistent-mental-illness-and-chronic-medical-conditions-a-comparative-cross-sectional-study
#5
Dominique Elie, Amanda Marino, Susana G Torres-Platas, Saeid Noohi, Trent Semeniuk, Marilyn Segal, Karl J Looper, Soham Rej
OBJECTIVES: Physicians rarely engage severe and persistent mental illness (SPMI) patients in end-of-life care discussion despite an increased risk of debilitating medical illnesses and mortality. Access to quality palliative care and medical assistance in dying (MAID) has become a priority in Canada and many jurisdictions. In this study, we compared SPMI and chronic medically ill (CMI) patients' end-of-life care preferences and comfort level with end-of-life care discussion, and identified potential predictors of interest in MAID...
September 25, 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/29063727/nurse-driven-analgesia-and-sedation-in-pediatric-patients-with-univentricular-hearts-requiring-extracorporeal-life-support-after-first-stage-palliation-surgery-a-pilot-study
#6
Jörg Michel, Michael Hofbeck, Ines Gerbig, Vanya Icheva, Ellen Heimberg, Walter Jost, Christian Schlensak, Matthias Kumpf, Gunnar Blumenstock, Felix Neunhoeffer
BACKGROUND: Few data are available regarding requirements of sedation and analgesia in children during extracorporeal life support. AIMS: The aim of this study was to evaluate if children with functionally univentricular hearts on extracorporeal life support after first-stage palliation surgery have higher requirement of analgesics and sedatives compared with children without extracorporeal life support using a goal-directed nurse-driven analgesia and sedation protocol...
December 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29056564/a-nationwide-survey-about-palliative-sedation-involving-japanese-palliative-care-specialists-intentions-and-key-factors-used-to-determine-sedation-as-proportionally-appropriate
#7
Jun Hamano, Tatsuya Morita, Masayuki Ikenaga, Hirofumi Abo, Yoshiyuki Kizawa, Satoru Tunetou
CONTEXT: Although there has long been debate about physicians' intentions and what physicians consider to be proportionally appropriate when performing palliative sedation, few large studies have been performed. OBJECTIVES: To identify physicians' intentions when starting continuous deep sedation and to clarify what factors determine whether physicians regard sedation as proportionally appropriate in relation to expected survival, the patients' wishes, and refractoriness...
October 19, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29029757/palliative-care-and-end-of-life-care-for-polypathological-patients
#8
E Martinez-Litago, M C Martínez-Velasco, M P Muniesa-Zaragozano
Patients with advanced chronic diseases receive fragmented care, which entails high resource consumption and a poor quality of life. Uncertainty in the prognosis and scarce investigation into the importance of symptomatic control in this patient group hinders a proper therapeutic approach. Palliative care teams optimise the use of resources through comprehensive patient care, the optimization of the patient's environment, communication, the preparation of early care plans and the creation of coordinated healthcare circuits, which improve the quality of the patient's care in advanced stages of the disease...
October 10, 2017: Revista Clínica Española
https://www.readbyqxmd.com/read/28975307/effect-of-lorazepam-with-haloperidol-vs-haloperidol-alone-on-agitated-delirium-in-patients-with-advanced-cancer-receiving-palliative-care-a-randomized-clinical-trial
#9
RANDOMIZED CONTROLLED TRIAL
David Hui, Susan Frisbee-Hume, Annie Wilson, Seyedeh S Dibaj, Thuc Nguyen, Maxine De La Cruz, Paul Walker, Donna S Zhukovsky, Marvin Delgado-Guay, Marieberta Vidal, Daniel Epner, Akhila Reddy, Kimerson Tanco, Janet Williams, Stacy Hall, Diane Liu, Kenneth Hess, Sapna Amin, William Breitbart, Eduardo Bruera
Importance: The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. Objective: To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. Design, Setting, and Participants: Single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016...
September 19, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28960387/population-pharmacodynamic-modelling-of-midazolam-induced-sedation-in-terminally-ill-adult-patients
#10
Linda G Franken, Brenda C M de Winter, Anniek D Masman, Monique van Dijk, Frans P M Baar, Dick Tibboel, Birgit C P Koch, Teun van Gelder, Ron A A Mathot
AIMS: Midazolam is the drug of choice for palliative sedation and is titrated to achieve the desired level of sedation. A previous pharmacokinetic (PK) study showed that variability between patients could be partly explained by renal function and inflammatory status. The goal of this study was to combine this PK information with pharmacodynamic (PD) data, to evaluate the variability in response to midazolam and to find clinically relevant covariates that may predict PD response. METHOD: A population PD analysis using nonlinear mixed effect models was performed with data from 43 terminally ill patients...
September 27, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28941298/symptom-management-and-psychological-support-for-families-are-the-cornerstones-of-end-of-life-care-for-children-with-spinal-muscular-atrophy-type-1
#11
Chiara Di Pede, Caterina Agosto, Valentina De Tommasi, Alessandra De Gregorio, Franca Benini
AIM: This study described end-of-life care for children affected by spinal muscular atrophy type 1 (SMA1), which is characterised by progressive muscle weakness and develops in the first six months of life. METHODS: We retrospectively analysed 17 children (13 boys) who attended the University of Padua's paediatric palliative care centre in Italy from March 2000 to March 2015. All the children received supportive care without proactive respiratory intervention to prolong survival...
September 23, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28898796/transjugular-biopsy-case-report-of-inferior-vena-cava-hepatocellular-carcinoma-with-intracardiac-extension
#12
Laurence Weinberg, Diana Abu-Ssaydeh, Chris Macgregor, Jason Wang, Clarence Wong, Manfred Spanger, Vijayragavan Muralidharan
BACKGROUND: Diagnosis of hepatocellular carcinoma (HCC) can be established with near certainty by correlating radiological imaging with clinical presentation. However, in the absence of diagnostic certainty, biopsy of liver tissue is mandatory for optimal management. We present our management of a patient with advanced liver disease who presented with an IVC mass extending into the right atrium, with co-existing liver lesions not meeting criteria for an imaging diagnosis of HCC. CASE PRESENTATION: A 62-year-old male with Child-Pugh C liver cirrhosis presented with decompensated liver failure...
2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28889811/cardiovascular-ct-for-evaluation-of-single-ventricle-heart-disease-risks-and-accuracy-compared-with-interventional-findings
#13
B Kelly Han, Marnie Huntley, David Overman, Dawn Witt, David Dassenko, Ross F Garberich, John R Lesser
OBJECTIVE: We sought to evaluate the risk and image quality from cardiovascular CT in patients across all stages of single-ventricle palliation, and to define accuracy by comparing findings with intervention and surgery. METHODS: Consecutive CT scans performed in patients with single-ventricle heart disease were retrospectively reviewed at a single institution. Diagnosis, sedation needs, estimated radiation dose, and adverse events were recorded. Anatomical findings, image quality (1-4, 1=optimal), and discrepancy compared with interventional findings were determined...
September 11, 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/28880142/-an-elderly-couple-dies-of-natural-causes-on-the-same-day
#14
S Zwart, E H E Vermeijlen
BACKGROUND: A 77-year-old woman died of metastatic colorectal cancer. On that same day, her 82-year-old husband, who had stayed in bed next to her during the last days of her life, also died. CASE DESCRIPTION: We describe their two separate trajectories to death: anticipated dying and unexpected death with diagnostic uncertainty. We analysed the general practitioner's role in this scenario. Existential suffering was partly the reason for commencing palliative sedation for the husband after his wife had died...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28864877/clinical-assessment-and-management-of-delirium-in-the-palliative-care-setting
#15
Shirley Harvey Bush, Sallyanne Tierney, Peter Gerard Lawlor
Delirium is a neurocognitive syndrome arising from acute global brain dysfunction, and is prevalent in up to 42% of patients admitted to palliative care inpatient units. The symptoms of delirium and its associated communicative impediment invariably generate high levels of patient and family distress. Furthermore, delirium is associated with significant patient morbidity and increased mortality in many patient populations, especially palliative care where refractory delirium is common in the dying phase. As the clinical diagnosis of delirium is frequently missed by the healthcare team, the case for regular screening is arguably very compelling...
October 2017: Drugs
https://www.readbyqxmd.com/read/28832240/-was-it-worth-it-intrathecal-analgesia-for-cancer-pain-a-qualitative-study-exploring-the-views-of-family-carers
#16
Nishi Patel, Melanie Huddart, Helen Makins, Theresa Mitchell, Jane L Gibbins, Juan Graterol, Deborah Stevens, Paul Perkins
BACKGROUND: Intrathecal drug delivery is known to reduce pain in patients where conventional systemic analgesia has been ineffective or intolerable. However, there is little information regarding the effects of intrathecal drug delivery on quality of life and function in those with advanced, incurable cancer. AIM: Retrospective exploration of the views of bereaved carers regarding the physical and psychosocial effects of external tunnelled intrathecal drug delivery in patients with advanced incurable cancer...
August 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28807643/-use-of-subcutaneous-route-for-comfort-care%C3%A2-in-neonatal-palliative-population-systematic-review-and-survey-of-practices-in-france
#17
N Pouvreau, J Tandonnet, O Tandonnet, L Renesme
INTRODUCTION: Subcutaneous hydration (hypodermoclysis) and drug administration is a widely used method of analgesic therapy in adult palliative care medicine. Very little is known about its use in neonatal medicine. Evidence-based guidelines do not exist due to a lack of data. In this study, the advantages of subcutaneous analgesic therapy in terms of comfort in neonatal palliative care situations were investigated. METHODS: This report details the results of a systematic review associated with a survey in neonatal intensive care units (NICUs) and pediatric palliative care departments (PPCTs) in France...
September 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28792784/improved-pain-control-in-terminally-ill-cancer-patients-by-introducing-low-dose-oral-methadone-in-addition-to-ongoing-opioid-treatment
#18
Per Fürst, Staffan Lundström, Pål Klepstad, Sara Runesdotter, Peter Strang
BACKGROUND: Cancer pain is often not well controlled and there is a need for improved treatment strategies. Methadone exhibits unique properties among opioids and recent reports show promising results from adding a low dose of methadone to regular opioid therapy. OBJECTIVE: To examine the effects of oral low-dose methadone added to regular scheduled opioids in terminally ill patients with complex cancer-related pain. DESIGN: This was a retrospective chart review...
August 9, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28771478/patients-in-palliative-care-development-of-a-predictive-model-for-anxiety-using-routine-data
#19
Sonja Hofmann, Stephanie Hess, Carsten Klein, Gabriele Lindena, Lukas Radbruch, Christoph Ostgathe
INTRODUCTION: Anxiety is one of the most common psychological symptoms in patients in a palliative care situation. This study aims to develop a predictive model for anxiety using data from the standard documentation routine. METHODS: Data sets of palliative care patients collected by the German quality management benchmarking system called Hospice and Palliative Care Evaluation (HOPE) from 2007 to 2011 were randomly divided into a training set containing two-thirds of the data and a test set with the remaining one-third...
2017: PloS One
https://www.readbyqxmd.com/read/28735270/subcutaneous-levetiracetam-for-the-management-of-seizures-at-the-end-of-life
#20
REVIEW
Anna Elizabeth Sutherland, John Curtin, Victoria Bradley, Olivia Bush, Maggie Presswood, Victoria Hedges, Katrien Naessens
OBJECTIVES: To report the results of a combined case series analysis of subcutaneous levetiracetam (Keppra) for the management of seizures in palliative care patients. METHODS: A comprehensive literature review on the use of subcutaneous levetiracetam was performed, and these data were combined with a prospective observational audit of its use in terminal care undertaken in a regional palliative care network. RESULTS: 7 papers were identified from the literature review-four case reports and three observational case series-reporting on a total of 53 cases where subcutaneous levetiracetam was administered...
July 22, 2017: BMJ Supportive & Palliative Care
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