The journal of supportive oncology
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Referral criteria were developed to rationalize transfer-of-care requests and referrals to a hospital-based palliative care program (PCP) in Saudi Arabia. This study aimed to explore the impact of an approved referral criteria policy on the pattern of referrals to a PCP. Two periods, 19 months each, were identified: one before the implementation of the referral criteria (precriteria), and the other started 6 months later (post-criteria). ⋯ The median survival of referred patients decreased from 2.27 months during the precriteria period to 1.73 months during the postcriteria period (P = 0.0051). The findings suggest that the implementation of the referral criteria policy was associated with a more rational pattern of transfer-of-care referrals to the PCP. However, more educational efforts and organizational actions are needed to prevent delayed referrals of cancer patients to palliative care teams.
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Our objective was to assess the prevalence of use of different classes of antidepressants, prescribing patterns, and determinants of exposure to specific types of antidepressants and resource utilization at a comprehensive cancer center from 2001 to 2006. Data were collected from the institution's outpatient pharmacy database and cross-referenced with the institution's electronic medical record system. ⋯ In terms of resource utilization, men had significantly more hospital admissions (P < 0.0001) and emergency room visits (P = 0.004) than women, whereas non-Caucasian ethnic groups had more emergency room visits (P < 0.0001) and clinic visits (P = 0.001) than Caucasians. Further investigation of men and non-Caucasians in the screening, evaluation, and treatment of depression is necessary to confirm disparities and evaluate their possible causes.
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Benign, self-limited hiccups are more of a nuisance, but persistent and intractable hiccups lasting more than 48 hours and 1 month, respectively, are a source of significant morbidity in the patient with advanced malignancy. The hiccup reflex is complex, but stimulation of vagal afferents followed by activation of efferent phrenic and intercostal nerve pathways results in contraction of the diaphragm and intercostal muscles, respectively. The etiology of hiccups in the cancer and palliative care population may include chemotherapy, electrolyte derangements, esophagitis, and neoplastic involvement of the central nervous system (CNS), thorax, and abdominal cavity. ⋯ Most patients with ongoing hiccups require pharmacotherapy, with chlorpromazine being the only US Food and Drug Administration-approved agent. However, numerous other medications have been reported to be efficacious for treating intractable hiccups. Gabapentin has recently been shown to terminate hiccups effecitvely in cancer patients and may emerge as a therapy of choice in the palliative setting due to favorable tolerability, pain-modulating effects, minimal adverse events, and lack of drug interactions.