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Management vomited on end of life care

G Michael Allan, Jamil Ramji, Danielle Perry, Joey Ton, Nathan P Beahm, Nicole Crisp, Beverly Dockrill, Ruth E Dubin, Ted Findlay, Jessica Kirkwood, Michael Fleming, Ken Makus, Xiaofu Zhu, Christina Korownyk, Michael R Kolber, James McCormack, Sharon Nickel, Guillermina Noël, Adrienne J Lindblad
OBJECTIVE: To develop a clinical practice guideline for a simplified approach to medical cannabinoid use in primary care; the focus was on primary care application, with a strong emphasis on best available evidence and a promotion of shared, informed decision making. METHODS: The Evidence Review Group performed a detailed systematic review of 4 clinical areas with the best evidence around cannabinoids: pain, nausea and vomiting, spasticity, and adverse events. Nine health professionals (2 generalist family physicians, 2 pain management-focused family physicians, 1 inner-city family physician, 1 neurologist, 1 oncologist, 1 nurse practitioner, and 1 pharmacist) and a patient representative comprised the Prescribing Guideline Committee (PGC), along with 2 nonvoting members (pharmacist project managers)...
February 2018: Canadian Family Physician Médecin de Famille Canadien
Angela Star, Jason W Boland
Symptom management is an important part of both palliative care and end-of-life care. This article will examine the recent research evidence about drugs commonly used for symptom management in adult patients receiving palliative care. In particular, the management of symptoms where recent palliative care-based evidence has changed recommended practice will be reviewed. This includes: breathlessness, delirium, nausea and vomiting in bowel obstruction, opioid-induced constipation and upper respiratory tract secretions...
February 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
Anna Winthereik, Mette Neergaard, Peter Vedsted, Anders Jensen
OBJECTIVE: General practitioners (GPs) are pivotal in end-of-life (EOL) care. This study aimed to assess GP-reported provision of EOL care and to assess associations with GP characteristics. DESIGN: Population-based questionnaire study. SETTING: Central Denmark Region with approximately 1.3 million inhabitants. SUBJECTS: All 843 active GPs in the Central Denmark Region were sent a questionnaire by mail. MAIN OUTCOME MEASURES: Responses to 18 items concerning four aspects: provision of EOL care to patients with different diagnosis, confidence with being a key worker, organisation of EOL care and EOL skills (medical and psychosocial)...
December 2016: Scandinavian Journal of Primary Health Care
Naveen Salins, Lipika Patra, M R Usha Rani, S O Lohitashva, Raghavendra Rao, Raghavendra Ramanjulu, Nandini Vallath
INTRODUCTION: Palliative care is usually delivered late in the course of illness trajectory. This precludes patients on active disease modifying treatment from receiving the benefit of palliative care intervention. A survey was conducted to know the opinion of oncologists, oncology nurses, and patients about the role of early specialist palliative care in cancer. METHODS: A nonrandomized descriptive cross-sectional study was conducted at a tertiary cancer care center in India...
July 2016: Indian Journal of Palliative Care
Kathleen E Bickel, Kristen McNiff, Mary K Buss, Arif Kamal, Dale Lupu, Amy P Abernethy, Michael S Broder, Charles L Shapiro, Anupama Kurup Acheson, Jennifer Malin, Tracey Evans, Monika K Krzyzanowska
PURPOSE: Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. METHODS: An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden...
September 2016: Journal of Oncology Practice
Raymond J Chan, Joan Webster, Alison Bowers
BACKGROUND: This is an updated version of a Cochrane review published in Issue 11, 2013 in the Cochrane Library. In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans that detail essential steps in caring for patients with specific clinical problems. In particular, care pathways for the dying have been developed as a model to improve care of patients who are in the last days of life. The care pathways were designed with an aim of ensuring that the most appropriate management occurs at the most appropriate time, and that it is provided by the most appropriate health professional...
February 12, 2016: Cochrane Database of Systematic Reviews
John P McNulty, George Muller
A compounded preparation is needed when no commercially manufactured medication is available to adequately address a patient's medical needs. Among the greatest therapeutic challenges faced by both patients and caregivers is the treatment required by individuals who have a terminal condition. It is difficult to find evidence-based studies on the management of end-of-life situations because each patient's medical case is unique. In addition, maintaining a controlled environment for such patients is difficult...
May 2014: International Journal of Pharmaceutical Compounding
Stefanie Anna Schatz-Krienzer, Friedemann Nauck
On the basis of a case study, the complex problems of an invasive therapy (gastroscopy with stentig) in an end of life situation will be demonstrated and discussed. The main problems of the 67-year-old patient with a gastric cardia carcinoma were the symptoms of nausea and vomiting, which were managed well with conservative treatment. The wish from the patient to eat was a highly ethical demand on the team of the palliative care unit. This paper shows the area of tension between the highly developed interventional endoscopic capabilities on the one hand and the reasonable treatment in end of life situations on the other...
August 2014: Wiener Medizinische Wochenschrift
Laura Tolen, Jill A McMath, Calvin Alt, Douglas J Weschules, Calvin H Knowlton, Mary Lynn McPherson
The purpose of this study was to compare the relative severity of nausea and vomiting scores before and after initiation of treatnment regimens in end-of-life cancer patients, and secondarily to evaluate the efficacy of a combination antiemetic preparation (ABHR; lorazepam [Ativan], diphenhydramine [Benadryl], haloperidol [Haldol], and metoclopramide [Reglan] in this patient population. A retrospective analysis of antiemetic use was performed through a systematic chart review of patients with an end-of-life diagnosis of lung, pancreatic, or colorectal cancer whose medications were provided through Hospice Pharmacia...
March 2006: International Journal of Pharmaceutical Compounding
Claudia Gamondi, Nadia Galli, Carlo Schönholzer, Claudio Marone, Hugo Zwahlen, Luca Gabutti, Giorgia Bianchi, Claudia Ferrier, Claudio Cereghetti, Olivier Giannini
QUESTION UNDER STUDY: Data on pain management in haemodialysis patients with end-stage renal disease are scanty. Our study aimed to collect information on the frequency and severity of pain and symptom distress among long-term dialysis patients in southern Switzerland. METHODS: Patients with chronic kidney disease stage 5, on dialysis, treated in five nephrology units in southern Switzerland, who had given informed consent and were able to complete the survey, were interviewed to assess pain and correlated symptoms using a Visual Analogue Scale (VAS), the Brief Pain Inventory and the Edmonton Symptom Assessment System...
2013: Swiss Medical Weekly
Stefano Nava, Miguel Ferrer, Antonio Esquinas, Raffaele Scala, Paolo Groff, Roberto Cosentini, Davide Guido, Ching-Hsiung Lin, Anna Maria Cuomo, Mario Grassi
BACKGROUND: Despite best-possible medical management, many patients with end-stage cancer experience breathlessness, especially towards the end of their lives. We assessed the acceptability and effectiveness of non-invasive mechanical ventilation (NIV) versus oxygen therapy in decreasing dyspnoea and the amount of opiates needed. METHODS: In this randomised feasibility study, we recruited patients from seven centres in Italy, Spain, and Taiwan, who had solid tumours and acute respiratory failure and had a life expectancy of less than 6 months...
March 2013: Lancet Oncology
Carole Farrell, Sarah G Brearley, Mark Pilling, Alex Molassiotis
PURPOSE: Nausea is a troublesome and distressing symptom for patients receiving chemotherapy. While vomiting is well controlled with current antiemetics, nausea is a more difficult symptom to manage. The aim of this study was to assess the impact of nausea on nutritional status, quality of life and psychological distress. METHODS: This was a prospective observational study over two cycles of chemotherapy. Patients completed the Multinational Association of Supportive Care in Cancer Antiemesis Tool, a measure of nutritional status (Patient-Generated Subjective Global Assessment), the Functional Assessment of Cancer Therapy-General (FACT-G) quality of life scale and the Hospital Anxiety and Depression Scale at the end of each chemotherapy cycle (around day 10 post-chemotherapy)...
January 2013: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Charles Ho, Lynn Straatman
Recent studies and consensus statements have expressed the need to involve palliative care services in the care of children with progressive neuromuscular diseases (PMD), yet there have been no reviews of the utilization of palliative care services by children who died on a palliative care program. We conducted a retrospective chart review of all children who had a PMD who died on a single-center palliative care program. Twenty cases were identified. Services utilized by these patients included respite care, transition services, pain and symptom management, and end-of-life care...
January 2013: Journal of Child Neurology
Hidemichi Watari, Masayoshi Hosaka, Yukio Wakui, Eiji Nomura, Hitoshi Hareyama, Fumie Tanuma, Rifumi Hattori, Masaki Azuma, Hidenori Kato, Naoki Takeda, Satoshi Ariga, Noriaki Sakuragi
OBJECTIVE: Malignant bowel obstruction (MBO), of which symptoms lead to a poor quality of life, is a common and distressing clinical complication in advanced gynecologic cancer. The aim of this study was to prospectively assess the clinical efficacy of octreotide to control vomiting in patients with advanced gynecologic cancer with inoperable gastrointestinal obstruction. METHODS: Patients with advanced gynecologic cancer, who presented at least one episode of vomiting per day due to MBO, were enrolled in this prospective study from 2006 to 2009...
May 2012: International Journal of Gynecological Cancer
Steven M Radwany, Vivian E von Gruenigen
Palliative care improves the quality of life of patients and their families through the prevention and treatment of distressing symptoms while addressing the psychological, social, and spiritual aspects of patient care. Emerging paradigms of delivery promote early involvement in the disease trajectory and specialty approaches to care. Interdisciplinary assessment and shared decision making are important components. Throughout the disease course, aggressive symptom management can improve patients' quality of life and their ability to tolerate and continue treatment...
March 2012: Clinical Obstetrics and Gynecology
Carolyn Casey, Lee-may Chen, Michael W Rabow
Patients with gynecologic cancer experience significant symptom burden throughout their disease course and treatment, which negatively impacts their quality of life. The most common symptoms in gynecologic cancer include pain, fatigue, depression and anxiety. Palliative care, including symptom management, focuses on the prevention and relief of suffering and improvement in quality of life, irrespective of prognosis. In a comprehensive cancer care model, palliative care, including symptom management, is offered concurrently with anticancer therapies throughout the disease course, not just at the end of life and not only once curative attempts have been abandoned...
July 2011: Expert Review of Anticancer Therapy
John A Snowden, Sam H Ahmedzai, John Ashcroft, Shirley D'Sa, Timothy Littlewood, Eric Low, Helen Lucraft, Rhona Maclean, Sylvia Feyler, Guy Pratt, Jennifer M Bird
Supportive care plays an increasingly important role in the modern management of multiple myeloma. While modern treatments have significantly prolonged overall and progression free survival through improved disease control, the vast majority of patients remain incurable, and live with the burden of the disease itself and the cumulative side effects of treatments. Maintenance of quality of life presents challenges at all stages of the disease from diagnosis through the multiple phases of active treatment to the end of life...
July 2011: British Journal of Haematology
Keri L Rodriguez, Joseph T Hanlon, Subashan Perera, Emily J Jaffe, Mary Ann Sevick
BACKGROUND: Approximately 25% of all US deaths occur in the long-term care setting, and this figure is projected to rise to 40% by the year 2040. Currently, there is limited information on nonpain symptoms and their appropriate treatment in this setting at the end of life. OBJECTIVE: This study evaluated the prevalence of undertreatment of nonpain symptoms and factors associated with undertreatment in older nursing home hospice/palliative care patients. METHODS: This study used a cross-sectional sample of older (>or=65 years) hospice/palliative care patients to represent all patients from the 2004 National Nursing Home Survey (NNHS) funded by the Centers for Disease Control and Prevention...
June 2010: American Journal of Geriatric Pharmacotherapy
David H Jang, Robert S Hoffman, Lewis S Nelson
OBJECTIVE: Abrus precatorius is cultivated in many subtropical areas. The seeds exist in a variety of colors such as black, orange, and most commonly, glossy red. A black band is found at the end of the seed. The plant contains multiple pods which typically contain three to five Abrus seeds. The seeds contain abrin, which inhibits ribosomal function, halting protein synthesis and leading to cellular death. A unique aspect of this case is the use of the internet to order a potentially lethal poison as well as transmission of a picture to identify the seed...
December 2010: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Helen Noble, Professor Julienne Meyer, Dr Jackie Bridge, Dr Barbara Johnson, Dr Daniel Kelly
Little is known about the prevalence and burden of symptoms in patients managed without dialysis. This study was the result of a larger study exploring the experiences of 30 such patients and their trajectories to death. Data were analysed relating to symptoms once the patients had been referred to a Renal Supportive Care Service based in the East End of London, UK. A high symptom prevalence was found with 30 different symptoms reported at first consultation. Widely reported symptoms impacting on daily living included breathlessness, oedema, pruritus, nausea and vomiting and pain...
March 2010: Journal of Renal Care
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