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Palliative Sedation

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https://www.readbyqxmd.com/read/29776669/-the-role-of-end-of-life-palliative-sedation-medical-and-ethical-aspects-review
#1
REVIEW
Miriam S Menezes, Maria das Graças Mota da Cruz de Assis Figueiredo
BACKGROUND AND OBJECTIVE: Palliative sedation is a medical procedure that has been used for more than 25 years to relieve refractory symptoms not responsive to any previous treatment in patients with no possibility of cure and near the end of life. Many uncertainties persist on the issue regarding definition, indications, decision making, most appropriate place to perform the procedure, most used drugs, need for monitoring, fluids and nutritional support, and possible ethical dilemmas...
May 15, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29775550/palliative-sedation-with-oral-medicines-in-an-infant-with-generalized-severe-junctional-epidermolysis-bullosa
#2
Keith P Pasichow, Meg Frizzola, Elissa G Miller
Generalized severe junctional epidermolysis bullosa is a rare mechanobullous skin disorder that is uniformly fatal. We present the case of an infant who received palliative pain management and ultimately proportionate palliative sedation. However, because of the extent of the patient's skin disease, we were unable to provide palliative medication through parenteral routes. We discuss the provision of enteral palliative sedation, including the pharmacology, and creative use of medications to achieve sufficient palliation in this difficult and unique situation...
May 18, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29773676/correction-international-variation-in-clinical-practice-guidelines-for-palliative-sedation-a-systematic-review
#3
(no author information available yet)
No abstract text is available yet for this article.
June 2018: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/29767825/-palliative-sedation-development-and-consensus-of-a-german-language-documentation-template
#4
C Klein, C Wittmann, K N Wendt, C Ostgathe, S Stiel
BACKGROUND: Palliative sedation (PS) serves as a therapeutic option in cases of otherwise intractable suffering. As the use of sedative and hypnotic medication in many diverse situations is a core competency of anesthesiology, anesthesiologists are confronted with questions of sedative therapy at the end of life in institutions for specialized palliative care, in intensive care units and intermediate care wards. In recent years a number of guidelines have been published internationally but so far no official guidelines exist in Germany...
May 16, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29747564/reduse-reducing-antipsychotic-and-benzodiazepine-prescribing-in-residential-aged-care-facilities
#5
Juanita L Westbury, Peter Gee, Tristan Ling, Donnamay T Brown, Katherine H Franks, Ivan Bindoff, Aidan Bindoff, Gregory M Peterson
OBJECTIVE: To assess the impact of a multi-strategic, interdisciplinary intervention on antipsychotic and benzodiazepine prescribing in residential aged care facilities (RACFs). Design, setting: Prospective, longitudinal intervention in Australian RACFs, April 2014 - March 2016. PARTICIPANTS: 150 RACFs (with 12 157 residents) comprised the main participant group; two further groups were consultant pharmacists (staff education) and community pharmacies (prescribing data)...
May 14, 2018: Medical Journal of Australia
https://www.readbyqxmd.com/read/29743764/definition-of-terms-used-in-limitation-of-treatment-and-providing-palliative-care-at-the-end-of-life-the-indian-council-of-medical-research-commission-report
#6
Naveen Salins, Roop Gursahani, Roli Mathur, Shivakumar Iyer, Stanley Macaden, Nagesh Simha, Raj Kumar Mani, M R Rajagopal
Background: Indian hospitals, in general, lack policies on the limitation of inappropriate life-sustaining interventions at the end of life. To facilitate discussion, preparation of guidelines and framing of laws, terminologies relating to the treatment limitation, and providing palliative care at the end-of-life care (EOLC) need to be defined and brought up to date. Methodology: This consensus document on terminologies and definitions of terminologies was prepared under the aegis of the Indian Council of Medical Research...
April 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29742044/end-of-life-decision-making-in-palliative-care-and-recommendations-of-the-council-of-europe-qualitative-secondary-analysis-of-interviews-and-observation-field-notes
#7
Sandra Martins Pereira, Emília Fradique, Pablo Hernández-Marrero
BACKGROUND: End-of-life decisions (ELDs) are embedded in clinical, sociocultural, political, economic, and ethical concerns. In 2014, the Council of Europe (CoE) through its Committee on Bioethics launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations," aiming at improving decision-making processes and empowering professionals in making ELDs. OBJECTIVE: To analyze if end-of-life decision making in palliative care (PC) is consistent with this Guide and to identify if disputed/controversial issues are part of current ELDs...
May 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29736869/muslim-physicians-and-palliative-care-attitudes-towards-the-use-of-palliative-sedation
#8
George Muishout, Hanneke W M van Laarhoven, Gerard Wiegers, Ulrike Popp-Baier
BACKGROUND: Muslim norms concerning palliative sedation can differ from secular and non-Muslim perceptions. Muslim physicians working in a Western environment are expected to administer palliative sedation when medically indicated. Therefore, they can experience tension between religious and medical norms. OBJECTIVE: To gain insight into the professional experiences of Muslim physicians with palliative sedation in terms of religious and professional norms. DESIGN: Interpretative phenomenological study using semi-structured interviews to take a closer look at the experiences of Muslim physicians with palliative sedation...
May 8, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29689298/-suffering-in-palliative-sedation-conceptual-analysis-and-implications-for-decision-making-in-clinical-practice
#9
Claudia Bozzaro, Jan Schildmann
Palliative sedation is an increasingly used and, simultaneously, challenging practice at the end of life. Many controversies associated with this therapy are rooted in implicit differences regarding the understanding of "suffering" as prerequisite for palliative sedation. The aim of this paper is to inform the current debates by a conceptual analysis of two different philosophical accounts of suffering, (1) the subjective and holistic concept and (2) the objective and gradual concept and by a clinical-ethical analysis of the implications of each account for decisions about palliative sedation...
April 21, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29669562/comfort-in-palliative-sedation-compas-a-transdisciplinary-mixed-method-study-protocol-for-linking-objective-assessments-to-subjective-experiences
#10
Stefaan Six, Steven Laureys, Jan Poelaert, Johan Bilsen, Peter Theuns, Reginald Deschepper
BACKGROUND: In case of untreatable suffering at the end of life, palliative sedation may be chosen to assure comfort by reducing the patient's level of consciousness. An important question here is whether such sedated patients are completely free of pain. Because these patients cannot communicate anymore, caregivers have to rely on observation to assess the patient's comfort. Recently however, more sophisticated techniques from the neurosciences have shown that sometimes consciousness and pain are undetectable with these traditional behavioral methods...
April 18, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29666901/subcutaneously-administered-dexmedetomidine-is-efficiently-absorbed-and-is-associated-with-attenuated-cardiovascular-effects-in-healthy-volunteers
#11
P Uusalo, D Al-Ramahi, I Tilli, R A Aantaa, M Scheinin, T I Saari
PURPOSE: Palliative care patients often need sedation to alleviate intractable anxiety, stress, and pain. Dexmedetomidine is used for sedation of intensive care patients, but there is no prior information on its subcutaneous (SC) administration, a route that would be favored in palliative care. We compared the pharmacokinetics and cardiovascular, sympatholytic, and sedative effects of SC and intravenously (IV) administered dexmedetomidine in healthy volunteers. METHODS: An open two-period, cross-over design with balanced randomization was used...
April 17, 2018: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29649848/-palliative-sedation-despite-guidelines-a-difficult-process-of-decisions
#12
Martin Kamprad, Ute Helm
A distinction needs to be made between intermediate and continuous sedation as well as between minimal, moderate and deep sedation. To gain ethical acceptance it is crucial that for palliative sedation (PS) minimally required doses are administered to decrease suffering. Intermittent PS is used for decreasing physical symptoms, whereas deep continuous PS is used to minimize intolerable suffering or psychological symptoms. Precise medical indication and education of patient and relatives are pre-requirements to any PS...
April 2018: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29600413/palliative-sedation-in-advanced-cancer-patients-hospitalized-in-a-specialized-palliative-care-unit
#13
Santiago Parra Palacio, Clara Elisa Giraldo Hoyos, Camilo Arias Rodríguez, Daniel Mejía Arrieta, John Jairo Vargas Gómez, Alicia Krikorian
PURPOSE: To describe the practice of palliative sedation (PS) in patients with advanced cancer in a specialized palliative care (PC) unit in Colombia. METHODS: Descriptive prospective study including all adults with cancer hospitalized under PS in a cancer institute between January and July 2015 in Colombia. Variables examined were diagnosis, physical functioning, symptoms at the start of sedation, medications and dosages used, and type, level, and time of sedation...
March 29, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29579492/palliative-sedation-and-moral-distress-a-qualitative-study-of-nurses
#14
M E Lokker, S J Swart, J A C Rietjens, L van Zuylen, R S G M Perez, A van der Heide
BACKGROUND: Clinical nursing practice may involve moral distress, which has been reported to occur frequently when nurses care for dying patients. Palliative sedation is a practice that is used to alleviate unbearable and refractory suffering in the last phase of life and has been linked to distress in nurses. AIM: The aim of this study was to explore nurses' reports on the practice of palliative sedation focusing on their experiences with pressure, dilemmas and morally distressing situations...
April 2018: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/29560568/continuous-deep-sedation-until-death-a-swiss-death-certificate-study
#15
Sarah Ziegler, Margareta Schmid, Matthias Bopp, Georg Bosshard, Milo Alan Puhan
BACKGROUND: In the last decade, the number of patients continuously deeply sedated until death increased up to fourfold. The reasons for this increase remain unclear. OBJECTIVE: To identify socio-demographic and clinical characteristics of sedated patients, and concurrent possibly life-shortening medical end-of-life decisions. DESIGN: Cross-sectional death certificate study in German-speaking Switzerland in 2001 and 2013. PARTICIPANTS: Non-sudden and expected deaths (2001: N = 2281, 2013: N = 2256) based on a random sample of death certificates and followed by an anonymous survey on end-of-life practices among attending physicians...
March 20, 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29557260/-palliative-sedation-a-retrospective-cohort-study-on-the-use-and-labelling-of-continuously-administered-sedatives-on-a-palliative-care-unit
#16
Eva Schildmann, Sebastian Pörnbacher, Helen Kalies, Claudia Bausewein
BACKGROUND: Sedatives are frequently used towards the end of life. However, there is scarce information when their use is labelled as 'palliative sedation'. AIM: To assess the use and labelling of 'continuous administration of sedatives within the last 7 days of life', based on objective operational criteria, on a palliative care unit. DESIGN: Retrospective cohort study, using medical records. Explorative statistical analysis (SPSS 23). SETTING/PARTICIPANTS: Patients who died on a palliative care unit from August 2014 to July 2015...
March 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29548893/palliative-sedation-in-terminal-cancer-patients-admitted-to-hospice-or-home-care-programs-does-the-setting-matter-results-from-a-national-multicenter-observational-study
#17
Augusto Caraceni, Raffaella Speranza, Elio Spoldi, Cristina Sonia Ambroset, Stefano Canestrari, Mauro Marinari, Anna Maria Marzi, Luciano Orsi, Laura Piva, Mirta Rocchi, Danila Valenti, Gianluigi Zeppetella, Furio Zucco, Alessandra Raimondi, Leonor Vasconcelos Matos, Cinzia Brunelli
CONTEXT: Few studies regarding palliative sedation (PS) have been carried out in home care (HC) setting. A comparison of PS rate and practices between hospice (HS) and HC is also lacking. OBJECTIVES: Comparing HC and HS settings for PS rate, patient clinical characteristics before and during PS, decision-making process, and clinical aspects of PS. METHODS: About 38 HC/HS services in Italy participated in a multicenter observational longitudinal study...
March 13, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29548891/pressure-injury-progression-and-factors-associated-with-different-end-points-in-a-home-palliative-care-setting-a-retrospective-chart-review-study
#18
Marco Artico, Daniela D'Angelo, Michela Piredda, Tommasangelo Petitti, Luciano Lamarca, Maria Grazia De Marinis, Angelo Dante, Maura Lusignani, Maria Matarese
CONTEXT: Patients with advanced illnesses show the highest prevalence for pressure injuries. In the palliative care setting, the ultimate goal is injury healing, but equally important is wound maintenance, wound palliation (wound-related pain and symptom management), and primary and secondary wound prevention. OBJECTIVES: To describe the course of healing for pressure injuries in a home palliative care setting according to different end-points, and to explore patient and caregiver characteristics and specific care activities associated with their achievement...
March 13, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29546602/the-many-faces-of-apomorphine-lessons-from-the-past-and-challenges-for-the-future
#19
REVIEW
Manon Auffret, Sophie Drapier, Marc Vérin
Apomorphine is now recognized as the oldest antiparkinsonian drug on the market. Though still underused, it is increasingly prescribed in Europe for patients with advanced Parkinson's disease (PD) with motor fluctuations. However, its history is far from being limited to movement disorders. This paper traces the history of apomorphine, from its earliest empirical use, to its synthesis, pharmacological development, and numerous indications in human and veterinary medicine, in light of its most recent uses and newest challenges...
March 15, 2018: Drugs in R&D
https://www.readbyqxmd.com/read/29534713/palliative-sedation-in-germany-factors-and-treatment-practices-associated-with-different-sedation-rate-estimates-in-palliative-and-hospice-care-services
#20
Stephanie Stiel, Mareike Nurnus, Christoph Ostgathe, Carsten Klein
BACKGROUND: Clinical practice of Palliative Sedation (PS) varies between institutions worldwide and sometimes includes problematic practices. Little available research points at different definitions and frameworks which may contribute to uncertainty of healthcare professionals in the application of PS. This analysis investigates what demographic factors and characteristics of treatment practices differ between institutions with high versus low sedation rates estimates in Palliative and Hospice Care in Germany...
March 13, 2018: BMC Palliative Care
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