Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2023
Implementing a Serious Illness Risk Prediction Model: Impact on Goals of Care Documentation.
Goals of care conversations can promote high value care for patients with serious illness, yet documented discussions infrequently occur in hospital settings. ⋯ Implementation of a goals of care initiative using a mortality prediction model significantly increased goals of care documentation especially among high-risk patients. Further study to assess strategies to increase goals of care documentation for intermediate risk patients is needed especially by nonspecialty palliative care.
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J Pain Symptom Manage · Dec 2023
Psychosocial well-being of siblings of pediatric patients in palliative home care.
Despite the proposed high burden of siblings of children and adolescents with life-limiting conditions receiving pediatric palliative care (PPC) at home, little is known about their psychosocial well-being. ⋯ Siblings of children receiving PPC in a home care setting are at risk for a relevant impairment of their health-related quality of life. Future studies should address the potential for possible interventions specific for this population-at-risk.
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J Pain Symptom Manage · Dec 2023
Radiation therapy in the last month of life. Association with Aggressive Care at the End of Life.
Half of the patients with cancer who undergo radiation therapy do so with palliative intent. ⋯ Radiation therapy in the last month of life occurs in younger patients with rapidly progressive cancer, who are subject to more aggressive cancer care, and have late palliative care consults.
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J Pain Symptom Manage · Dec 2023
Dexmedetomidine at home for intractable dystonia and insomnia in children with special needs: a case series.
We know that syndromic conditions and severe chronic diseases can be associated with symptoms that may interfere with sleep, significantly impacting the life quality of children and caregivers. Drugs commonly used in treating insomnia, such as melatonin, benzodiazepines, niaprazine, and antihistamines, are often either ineffective or associated with adverse effects, requiring new therapeutic perspectives. Dexmedetomidine is a selective alpha-2 agonist with hypnotic and anxiolytic effects, which, by stimulating alpha-2 adrenergic receptors in the locus coeruleus, induces sleep comparable to stages 2-3 of the non-REM phase without substantially affecting the respiratory drive during sedation. Its use has already been extensively described in pediatric intensive care or procedural sedation literature. In 2018, the Italian Medicines Agency (Agenzia Italiana Del Farmaco AIFA) authorized the off-label use of dexmedetomidine outside of intensive care in Children undergoing palliative treatment to control distressing symptoms related to pathology and refractory sleep disorders, and the literature reported cases of children who received dexmedetomidine at home. ⋯ Therefore, its use at home may represent a promising therapeutic approach for intractable sleep disorders or dystonic states in pediatric palliative care children. Further studies are needed to confirm our results.