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End-of-life 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/29108407/periprocedural-analgesic-efficacy-of-a-single-pre-emptive-administration-of-propacetamol-in-catheter-ablation-for-atrial-fibrillation-a-randomized-controlled-trial
#2
Sung Yeon Ham, Jong-Wook Song, Jae-Kwang Shim, Woo Kyung Lee, Hee-Jung Kim, Young-Lan Kwak
BACKGROUND: Anesthetic care for termination of atrial fibrillation with catheter ablation poses significant challenges due to significant pain lengthy procedure. A delicate polypharmacy combining anaesthetic agents to minimize respiratory depression and hemodynamic changes and to provide satisfactory sedation and analgesia is needed. METHODS: Ninety-eight patients were randomized into two groups receiving either two gram of propacetamol or normal saline intravenously for 20 min before anesthesia...
November 6, 2017: Minerva Anestesiologica
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/29056584/the-french-exception-the-right-to-continuous-deep-sedation-at-the-end-of-life
#6
Ruth Horn
In 2016, a law came into force in France granting terminally ill patients the right to continuous deep sedation (CDS) until death. This right was proposed as an alternative to euthanasia and presented as the 'French response' to problems at the end of life. The law draws a distinction between CDS and euthanasia and other forms of sympton control at the end of life. France is the first country in the world to legislate on CDS . This short report describes the particular context and underlying social values that led to this piece of legislation, and explores its meaning in the wider French context...
October 22, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29029757/palliative-care-and-end-of-life-care-for-polypathological-patients
#7
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/29027853/intraoperative-test-stimulation-versus-stereotactic-accuracy-as-a-surgical-end-point-a-comparison-of-essential-tremor-outcomes-after-ventral-intermediate-nucleus-deep-brain-stimulation
#8
Tsinsue Chen, Zaman Mirzadeh, Kristina M Chapple, Margaret Lambert, Virgilio G H Evidente, Guillermo Moguel-Cobos, Srivadee Oravivattanakul, Padma Mahant, Francisco A Ponce
OBJECTIVE Ventral intermediate nucleus deep brain stimulation (DBS) for essential tremor is traditionally performed with intraoperative test stimulation and conscious sedation, without general anesthesia (GA). Recently, the authors reported retrospective data on 17 patients undergoing DBS after induction of GA with standardized anatomical coordinates on T1-weighted MRI sequences used for indirect targeting. Here, they compare prospectively collected data from essential tremor patients undergoing DBS both with GA and without GA (non-GA)...
October 13, 2017: Journal of Neurosurgery
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/28941298/symptom-management-and-psychological-support-for-families-are-the-cornerstones-of-end-of-life-care-for-children-with-spinal-muscular-atrophy-type-1
#10
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/28931433/role-of-gabaa-receptors-in-alcohol-use-disorders-suggested-by-chronic-intermittent-ethanol-cie-rodent-model
#11
REVIEW
Richard W Olsen, Jing Liang
GABAergic inhibitory transmission is involved in the acute and chronic effects of ethanol on the brain and behavior. One-dose ethanol exposure induces transient plastic changes in GABAA receptor subunit levels, composition, and regional and subcellular localization. Rapid down-regulation of early responder δ subunit-containing GABAA receptor subtypes mediating ethanol-sensitive tonic inhibitory currents in critical neuronal circuits corresponds to rapid tolerance to ethanol's behavioral responses. Slightly slower, α1 subunit-containing GABAA receptor subtypes mediating ethanol-insensitive synaptic inhibition are down-regulated, corresponding to tolerance to additional ethanol behaviors plus cross-tolerance to other GABAergic drugs including benzodiazepines, anesthetics, and neurosteroids, especially sedative-hypnotic effects...
September 20, 2017: Molecular Brain
https://www.readbyqxmd.com/read/28854065/efficacy-of-thalidomide-in-preventing-delayed-nausea-and-vomiting-induced-by-highly-emetogenic-chemotherapy-a-randomized-multicenter-double-blind-placebo-controlled-phase-iii-trial-clog1302-study
#12
RANDOMIZED CONTROLLED TRIAL
Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Tao Sun, Jingyan Wang, Zhitu Zhu, Xiuna Zhang, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Yuyang Dong, Fugang Wen, Yuzhi An, Caijun Yuan, Tiejun Chen, Lizhong Zhou, Ying Chen, Jian Zhang, Zhenghua Wang, Jinglei Qu, Feng Jin, Jingdong Zhang, Xiuhua Jin, Xiaodong Xie, Jun Wang, Li Man, Lingyu Fu, Yunpeng Liu
Purpose We examined the efficacy and safety of thalidomide (THD) for the prevention of delayed nausea and vomiting in patients who received highly emetogenic chemotherapy (HEC). Patients and Methods In a randomized, double-blind, active-controlled, phase III trial, chemotherapy-naive patients with cancer who were scheduled to receive HEC that contained cisplatin or cyclophosphamide-doxorubicin/epirubincin ≥ 50 mg/m(2) regimens were randomly assigned to a THD group (100 mg twice daily on days 1 to 5) or placebo group, both with palonosetron (0...
November 1, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28832240/-was-it-worth-it-intrathecal-analgesia-for-cancer-pain-a-qualitative-study-exploring-the-views-of-family-carers
#13
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/28810438/patients-with-limited-communication-in-end-of-life-situations-initial-psychometric-properties-of-a-discomfort-observation-scale
#14
Ana Lucila Soto-Rubio, José Manuel Tomás Miguel, Marián Pérez-Marín, Pilar Barreto Martín
This work presents an observational scale which takes into account different observable indicators of discomfort of patients in end-of-life situations with difficulties in communicating due to cognitive impairment, fatigue or sedation and provides details of its validation. In all, 71 adults participated. Model fit was adequate ( χ(2)(27) = 43.28, p = .024, comparative fit index = .975, root mean square error of approximation = .092 and confidence interval 90% (.033-.140)). Alpha coefficient was ...
March 1, 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28803083/the-impact-of-combined-use-of-opioids-antipsychotics-and-anxiolytics-on-survival-in-the-hospice-setting
#15
Marin Golčić, Renata Dobrila-Dintinjana, Goran Golčić, Aleksandar Čubranić
CONTEXT: Opioids and sedatives are the cornerstone of symptom management in the end-of-life patients, but undertreatment is a common problem. Although several studies explored the individual effect of opioids, anxiolytics and antipsychotics on survival, not much is known regarding their combined use. As these drugs share similar and potentially fatal side effects, primarily respiratory depression which occurs more often during night-hours, it is crucial to explore whether their interaction poses a danger for fragile hospice patients...
August 9, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28735270/subcutaneous-levetiracetam-for-the-management-of-seizures-at-the-end-of-life
#16
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
https://www.readbyqxmd.com/read/28716475/fouling-assemblage-of-benthic-plastic-debris-collected-from-mersin-bay-ne-levantine-coast-of-turkey
#17
Sedat Gündoğdu, Cem Çevik, Serkan Karaca
The Mediterranean is an ecosystem that faces more and more microplastic pollution every day. This causes the whole of the Mediterranean to face the negative effects of plastic pollution. This study examines the state of plastic debris and fouling organisms found on it in one of the areas most affected by plastic pollution, Mersin Bay. As a result, a total of 3.88kg plastic (mean=0,97kg; n=120; 2670item/km(2); 86,3kg/km(2)) was collected and based on the ATR-FTIR analysis, it was determined that this total contained 9 types of plastics...
July 14, 2017: Marine Pollution Bulletin
https://www.readbyqxmd.com/read/28715310/discovering-ways-to-mend-growing-bodies-the-bioengineering-of-devices-for-the-youngest-patients-brings-unique-challenges-and-rewards
#18
David L Chandler
Some babies are born with a rare condition known as esophageal atresia, in which part of the connection between the throat and stomach is missing or nonfunctional. While this was once untreatable and fatal, in recent years surgeons have developed a method using traction to stretch the tissues out on each end until, over time, they are long enough to be sewn together and so substitute for the missing portion of the esophagus. The procedure has allowed many infant patients to go home with a full, normal life ahead of them...
July 2017: IEEE Pulse
https://www.readbyqxmd.com/read/28662627/continuous-palliative-sedation-for-existential-distress-a-survey-of-canadian-palliative-care-physicians-views
#19
Anna Voeuk, Cheryl Nekolaichuk, Robin Fainsinger, Ann Huot
BACKGROUND: Palliative sedation can be used for refractory symptoms during end-of-life care. However, continuous palliative sedation (CPS) for existential distress remains controversial due to difficulty determining when this distress is refractory. OBJECTIVES: The aim was to determine the opinions and practices of Canadian palliative care physicians regarding CPS for existential distress. METHODS: A survey focusing on experience and views regarding CPS for existential distress was sent to 322 members of the Canadian Society of Palliative Care Physicians...
January 2017: Journal of Palliative Care
https://www.readbyqxmd.com/read/28602377/end-of-life-care-in-the-treatment-of-heart-failure-in-older-adults
#20
REVIEW
John Arthur McClung
Heart failure presents unique challenges to the clinician who desires to provide excellent and humane care near the end of life. Accurate prediction of mortality in the individual patient is complicated by a chronic disease that is punctuated by recurrent acute episodes and sudden death. Health care providers continue to have difficulty communicating effectively with terminally ill patients and their caregivers regarding end-of-life care preferences, all of which needs to occur earlier rather than later. This article also discusses various means of providing palliative care, and specific issues regarding device therapy, cardiopulmonary resuscitation, and palliative sedation with concurrent discussion of the ethical ramifications and pitfalls of each...
July 2017: Heart Failure Clinics
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