Journal of palliative medicine
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Continuous morphine infusions (CMIs) treat pain and dyspnea at the end of life (EOL). CMIs may be initiated at an empiric rate and/or are rapidly escalated without proper titration. ⋯ Hospitalized patients at EOL had a much higher 24-hour IV morphine equivalents and CMI rates at time of death compared to CMI initiation. Variability was observed in the number of CMI rate adjustments and the number of bolus doses administered.
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Multicenter Study
The Language of End-of-Life Decision Making: A Simulation Study.
Framing is known to influence decision making. ⋯ In this high-fidelity simulation experiment involving a critically and terminally ill elder, the majority of physicians framed the available options in ways implying LST was the expected or preferred choice. Framing of treatment options could influence ultimate treatment decisions.
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Observational Study
A Two-Group Trial of a Terminal Ventilator Withdrawal Algorithm: Pilot Testing.
Terminal ventilator withdrawal entails cessation of mechanical ventilation to allow a natural death. There is little empirical evidence to guide the conduct of this procedure. If the process is not well conducted, patients undergoing terminal ventilator withdrawal are at high risk for experiencing significant respiratory distress. ⋯ Feasibility and proof of concept for the nurse-led algorithm were established.