The American journal of hospice & palliative care
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Neuropathic pain is a common problem in clinical practice, affecting patients physically, emotionally, financially, and socially. Current treatment includes antidepressants, antiepileptics, and opioid analgesics. Bupropion is a specific inhibitor of neuronal noradrenaline reuptake and a weak inhibitor of dopamine reuptake, which shows some promise in the treatment of neuropathic pain.
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Am J Hosp Palliat Care · Aug 2010
Case ReportsIntracerebroventricular morphine for refractory cancer pain: transitioning to the home setting.
Refractory cancer pain may be effectively controlled by titrating intracerebroventricular (ICV) preservative-free opioid. In this case report, a continuous infusion of ICV morphine permitted our patient with lung cancer and painful spinal metastases to be discharged to home hospice with family. ⋯ Sterile, injectable, preservative-free morphine is directly infused into CSF through a subcutaneous Ommaya reservoir placed under the scalp by a neurosurgeon, with an attached catheter passed through a burr hole in the skull with its tip in a cerebral ventricle. Although investigators have described home care of patients receiving intraspinal analgesics, no report describes the process of transitioning the patient receiving continuous ICV morphine infusion to the home setting.
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This report describes the death place of patients with advanced cancer referred to an Egyptian palliative care program over 1 year. Of 79 patients included, 73% died at home and 27% in hospital or ambulance. ⋯ The palliative care survival of those who died at home was significantly longer than those who died in hospital or ambulance (63 vs 39 days, P = .04). These results demonstrate the need for the integration of effective home care model in evolving Egyptian palliative care programs and suggest that physician home visits and earlier referral to palliative care help patients die at home.
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Am J Hosp Palliat Care · Jun 2010
Comparative StudyAPACHE IV versus PPI for predicting community hospital ICU mortality.
Both the Acute Physiology and Chronic Health Evaluation (APACHE) IV and Palliative Performance Index (PPI) are scales used to estimate intensive care unit (ICU) prognosis and mortality. ⋯ This prospective cohort study in the ICU of a community hospital demonstrated that both the APACHE IV and PPI were significant tools for predicting ICU mortality. When contrasting the 2 scales, the APACHE IV could more accurately rule in mortality when mortality occurred and rule out mortality when survival occurred.