The American journal of hospice & palliative care
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Cough is one of the most common symptoms prompting patients to be seen by health care providers in the United States. Persistent cough can disrupt daily activities such as conversation, eating, breathing, and sleeping, and it can become extremely debilitating both physically and mentally. ⋯ Nebulized lidocaine also appears to be well tolerated by patients with minimal side effects including dysphonia, oropharyngeal numbness, and bitter taste. Studies conducted thus far have been small, so larger randomized control trials comparing nebulized lidocaine to placebo need to be conducted in the future.
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Am J Hosp Palliat Care · Sep 2013
ReviewA systematic review of the prevalence of signs of impending death and symptoms in the last 2 weeks of life.
To optimally manage patient care, knowledge of the prevalence of signs of impending death and common symptoms in the last days is needed. Two reviewers independently conducted searches of PubMed, CINAHL, PsychINFO and the Web of Knowledge from January, 1996 to May, 2012. No limits to publication language or patient diagnosis were imposed. ⋯ Twelve articles, representing 2416 patients, in multiple settings were analyzed. Of the 43 unique symptoms, those with the highest prevalence were: dyspnea (56.7%), pain (52.4%), respiratory secretions/death rattle (51.4%), and confusion (50.1%). Overall prevalence may be useful in anticipating symptoms in the final days and in preparing families for signs of impending death.
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Am J Hosp Palliat Care · Sep 2013
ReviewAcute lung injury and acute respiratory distress syndrome requiring tracheal intubation and mechanical ventilation in the intensive care unit: impact on managing uncertainty for patient-centered communication.
A case of acute lung injury (ALI) progressing to acute respiratory distress syndrome (ARDS) requiring tracheal intubation and mechanical ventilation (ETMV) is presented. The palliative medicine service was asked to address concerns expressed by the patient's spouse reflecting uncertainty regarding outcome expectations. Acknowledging and confronting the uncertainties of a critical illness is an essential component of patient-centered communication. ⋯ A case of of ALI/ARDS requiring ETMV in the ICU is used to illustrate the situation of an incapacitated critically ill patient where the outcome is uncertain. Patient-centered communication should acknowledge and address this uncertainty. Managing uncertainty consists of effectively expressing a carefully formulated prognostic assessment and using sound communication principles to alleviate the distress associated with the uncertain outcome probabilities.
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Am J Hosp Palliat Care · Sep 2013
Medical manuscripts impact of hospice enrollment on cost and length of stay of a terminal admission.
To determine whether hospice enrollment at the time of a terminal admission alters the length of stay (LOS) or costs compared with patients not enrolled in hospice. ⋯ Enrollment in hospice during a terminal admission decreased cost and LOS. Hospice may be a way to provide more cost-effective, appropriate care to dying patients.
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Am J Hosp Palliat Care · Sep 2013
Comparative StudyA comparison of cancer and noncancer patients who receive palliative care consultation services.
This study aimed to compare multiaspect characteristics in cancer and noncancer patients who received palliative care. Totally, 226 patients with cancer and 115 noncancer patients received palliative care consultation service in Taiwan from September 2007 through December 2009 were retrospectively analyzed. ⋯ Cancer and noncancer patients presented as polysymptomatics in both physical and psychosocial symptoms at the end of life. Such physical and psychosocial characteristics should be taken into account in providing appropriate end-of-life care in the same way as it is for the patients with cancer.