The American journal of hospice & palliative care
-
Am J Hosp Palliat Care · Jun 2010
Antimicrobial use among patients receiving palliative care consultation.
We sought to characterize antimicrobial use among patients receiving palliative care consultation. ⋯ Our results suggest significant use of empiric, broad-spectrum antimicrobial therapy among hospitalized patients near the end of life. We advocate for careful assessment of potential benefits and treatment burdens of antimicrobial therapy, especially when palliation is the goal.
-
Individuals with cancer have multiple symptoms, which frequently co-occur. A nonrandom distribution of symptoms suggests a common mechanism. Symptom clusters (SCs) were considered part of various syndromes in the early years of medicine. ⋯ Symptom clusters may help in cancer diagnosis, symptom management, and prognostication. However, the cluster method, reliability, and validity need to be established before assessment or treatment guidelines are established. Symptom clusters require further research before becoming part of routine medical symptom assessment and management.
-
Am J Hosp Palliat Care · May 2010
Predictors of symptom severity and response in patients with metastatic cancer.
We examined determinants of symptom severity and response to treatment among 150 patients with cancer participating in a phase II trial of a palliative care team intervention. Patients completed a modified Edmonton Symptom Assessment Scale (ESAS) at baseline and 1 week. ⋯ Multivariate analysis of covariance (ANCOVA) showed that symptom improvement was independently predicted by worse baseline EDS score and female gender. Performance status, gender, and baseline symptom severity should be accounted for in trials of palliative care interventions; inclusion criteria based on symptom severity should also be considered.
-
Am J Hosp Palliat Care · May 2010
Case ReportsA palliative care approach in treating patients with sickle cell disease using exchange transfusion.
The authors present a case report of an adult patient with sickle cell disease (SCD), who required frequent hospitalizations for sickle cell vaso-occlusive painful crisis as well as management of complications that resulted from treatment. The patient demonstrated clinical improvement after initiating palliative exchange transfusions of packed red blood cells (PRBCs) once every 4 weeks. They also promptly addressed their physical and psychosocial issues of care. ⋯ The review of medical literature did not reveal any clear-cut guidelines for palliative chronic exchange transfusion for painful vaso-occlusive crisis in adult patients. This case review highlights the usefulness of this palliative model of care. The burden and benefits of chronic exchange transfusion always need to be weighed carefully.
-
Am J Hosp Palliat Care · May 2010
Intermittent cancer pain: clinical importance and an updated cancer pain classification.
We report the characteristics of intermittent cancer pain. In addition, we propose a new clinically based classification. ⋯ (1) Intermittent pain is a major problem in patients with cancer, (2) NBP is a common but under-recognized form of cancer pain, (3) NBP is less defined and controlled than BP, (4) incident NBP accounts for 40% of all incident cancer pain, and (5) variable IP definitions and classifications make comparisons between studies difficult.