Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2024
Hypothalamic Hyperphagia in the Hospice Patient: Case Report and Discussion.
We present a case of insatiable appetite and harmful overeating in a hospice patient that showcases the burden of hypothalamic hyperphagia, a rare complication of brain cancer. While confounders exist such as progression of disease and prior tapering of dexamethasone, in this case the initiation of metformin was associated with substantial appetite reduction and resolution of our patient's debilitating food-seeking behaviors. We will explore metformin as a potential cost-effective option for palliation in a hospice setting and explore some of the physiologic mechanisms involved.
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J Pain Symptom Manage · Nov 2024
ReviewLimitations with California Medicaid Data for Palliative and End of Life Care Quality Measures.
In 2014 the California legislature passed Senate Bill 1004 (SB 1004) that was designed to expand access to specialty palliative care for individuals served by California's Medicaid (known as Medi-Cal) Managed Care Plans (MCPs). The California Department of Health Care Services (DHCS) operationalized the legislation by developing minimum requirements for palliative care programs that all MCPs must meet or exceed.7 Quality and utilization data specific to California's Medicaid population are needed for stakeholders to identify care deficiencies and disparities, describe the end of life experience and utilization patterns of MCP members, compare these patterns to Medicare beneficiaries or other populations, and set appropriate targets to help monitor progress. ⋯ Beyond the practical challenges of allowing time for data access and approvals, both projects revealed several limitations to using administrative data to assess quality of palliative and end of life care for a Medicaid population. We describe these challenges that undermined our confidence in analysis results and propose solutions to measuring the quality of palliative and end of life care for Medicaid patients and suggested next steps.
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J Pain Symptom Manage · Nov 2024
Review Case ReportsMedical management of refractory haematuria in palliative patients.
The management of haematuria, in patients with a palliative diagnosis, refractory to standard measures presents a significant challenge for multidisciplinary teams. Our experiences with two cases led us to review the literature and highlighted the limited evidence base. ⋯ We aim to help support clinicians manage other palliative patients with this challenging symptom in future. Relevant references for this review were identified through searches of PubMed using the terms "haematuria," "hematuria," "palliative," "antifibrinolytic," "tranexamic acid," "etamsylate" "glucocorticoid," "oestrogen," "estrogen," "estradiol," "somatostatin," "thalidomide," hyperbaric oxygen" and "intravesical hyaluronic acid." Other references were suggested by the authors.
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J Pain Symptom Manage · Nov 2024
ReviewPSYCHOLOGICAL INTERVENTIONS FOR MESOTELIOMA PATIENTS AND THEIR CAREGIVERS: A SYSTEMATIC LITERATURE REVIEW.
Malignant Mesothelioma (MM) has a striking impact on the somatopsychic balance of patients and their families, including physical, psychological, and interpersonal problems. The aim of this systematic literature review was to investigate what psychological interventions are offered to patients with MM and their caregivers worldwide. ⋯ Our study has shown that there are still few psychological interventions available for MM patients and their caregivers. The somatopsychic consequences of MM in patients and caregivers should encourage institutions and healthcare professionals to develop assessment and intervention models that address the different dimensions of their suffering and promote their residual vitality.