Journal of palliative medicine
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Review Case Reports
The cautious use of cyclizine in a patient with myasthenia gravis.
This brief report describes the cautious but successful use of cyclizine, an anticholinergic agent, for the relief of intractable nausea in a patient with myasthenia gravis, followed by a review of the available literature.
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Fentanyl is a lipophilic, short-acting, synthetic opioid with a piperidine chemical structure. Fentanyl is an effective analgesic for cancer pain, and newer formulations such as the transmucosal and buccal forms have shown efficacy for the management of cancer-related breakthrough pain. This article reviews the pharmacodynamics, pharmacology, and clinical efficacy for this new option in treating moderate to severe pain.
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A Consensus Conference sponsored by the Archstone Foundation of Long Beach, California, was held February 17-18, 2009, in Pasadena, California. The Conference was based on the belief that spiritual care is a fundamental component of quality palliative care. This document and the conference recommendations it includes builds upon prior literature, the National Consensus Project Guidelines, and the National Quality Forum Preferred Practices and Conference proceedings.
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Palliative sedation is commonly used to treat refractory symptoms. A systematic review of guideline for palliative sedation suggested that mild sedation is preferred and the minimum amount of medication should be used. There is little objective evidence that sedation relieves symptoms because assessment of response is limited by the therapy. ⋯ Awareness can occur in up to 17% of those undergoing conscious sedation. Seventeen percent of individuals who undergo palliative sedation fail to have symptoms relieved by sedation. Routine use of sedation scales should be used during palliative sedation to minimize treatment failure.
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The objective of this study was to establish screening criteria for constipation in palliative care and, subsequently, to determine data for diagnostic suspicion of constipation in a palliative care population. Also we investigate the incidence of fecal impaction in the same sample of palliative care patients. ⋯ The screening for constipation in palliative care should be performed exploring subjective symptoms and other objective signs. A diagnosis of suspected constipation was found in almost half of the palliative care patients studied. A VNS of constipation did not produce good predictive values for the detection of constipation in our sample.