The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Aug 2011
Review Comparative StudyOpioid and adjuvant analgesics: compared and contrasted.
An adjuvant (or co-analgesic) is a drug that in its pharmacological characteristic is not necessarily primarily identified as an analgesic in nature but that has been found in clinical practice to have either an independent analgesic effect or additive analgesic properties when used with opioids. The therapeutic role of adjuvant analgesics (AAs) is to increase the therapeutic index of opioids by a dose-sparing effect, add a unique analgesic action in opioid-resistant pain, or reduce opioid side effects. A notable difference between opioids and AAs is that unlike opioids some AAs are associated with permanent organ toxicity, for example, nonsteroidal anti-inflammatory drugs (NSAIDs) and renal failure. ⋯ No apparent tolerance to analgesia develops with AAs. Abrupt discontinuation of an opioid after chronic repeated use for more than a few days will cause a withdrawal syndrome of variable severity. Adjuvant analgesics are an essential tool in cancer pain.
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Am J Hosp Palliat Care · Aug 2011
ReviewCannabis in palliative medicine: improving care and reducing opioid-related morbidity.
Unlike hospice, long-term drug safety is an important issue in palliative medicine. Opioids may produce significant morbidity. Cannabis is a safer alternative with broad applicability for palliative care. ⋯ As palliative medicine grows, so does the need to reclassify cannabis. This article provides an evidence-based overview and comparison of cannabis and opioids. Using this foundation, an argument is made for reclassifying cannabis in the context of improving palliative care and reducing opioid-related morbidity.
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Am J Hosp Palliat Care · Aug 2011
Comparative StudyUtility of the APACHE IV, PPI, and combined APACHE IV with PPI for predicting overall and disease-specific ICU and ACU mortality.
The Acute Physiology and Chronic Health Evaluation (APACHE) IV and Palliative Performance Index (PPI) are scales commonly used to assess prognosis in intensive care units (ICUs) and acute care units (ACUs). ⋯ The benefits of combining scales were best exemplified in participants with dementia. Inconsistencies in the predictive value of specific participant populations are likely due to difference in the illness trajectories of disease processes.
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Am J Hosp Palliat Care · Aug 2011
Adverse experiences with implantable defibrillators in Oregon hospices.
Implantable cardioverter-defibrillators (ICDs) improve survival in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation. Unless deactivated, ICDs may deliver unwanted shocks to terminally ill patients near the time of death. This study sought to determine the frequency and nature of adverse experiences with ICDs in hospice programs and what preventative measures the programs had taken. ⋯ As patients near the end of their lives, receiving defibrillating shocks may no longer be consistent with their goals of care. Based on the high frequencies of potentially preventable adverse outcomes documented by this study, we propose that hospices routinely screen patients for ICDs and proactively adopt policies to manage them, rather than in response to an adverse event.
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Our objective was to validate 6 literature-derived goals of care by analyzing open-ended and closed-ended responses about goals of care from a previous study of hospitalized patients. Eight clinicians categorized patients' open-ended articulations of their goals of care using a literature-derived framework and then compared those categorizations to patients' own closed-ended selections of their most important goal of care. Clinicians successfully categorized patients' open-ended responses using the literature-derived framework 83.5% of the time, and their categorizations matched patients' closed-ended most important goal of care 87.8% of the time. Goals that did not fit within the literature-derived framework all pertained to the goal of understanding a patient's diagnosis or prognosis; this seventh potential goal can be added to the literature-derived framework of 6 goals of care.