Journal of palliative medicine
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Web-based applications are available for prognostication of individual patients. These prognostic models were developed for groups of patients. No one is the average patient, and using these calculators to inform individual patients could provide misleading results. ⋯ Instead of reporting average risk scores, web-based calculators may improve accuracy of predictions by reporting the unconfounded risks.
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Current methods for identifying patients at risk of dying within six months suffer from clinician biases resulting in underestimation of this risk. As a result, patients who are potentially eligible for hospice and palliative care services frequently do not benefit from these services until they are very close to the end of their lives. ⋯ This prospective approach appears to provide a method to identify patients with CHF who would potentially benefit from a clinical evaluation for referral to hospice care or for a palliative care consult due to high predicted risk of dying within 180 days after discharge from a hospital. This approach can provide a model to match at-risk patients with evidenced-based care in a more consistent manner. This method of identifying patients at risk needs further prospective evaluation to see if it has value for clinicians, increases referrals to hospice and palliative care services, and benefits patients and families.
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Palliative care clinicians are increasingly involved in the care of elderly patients suffering from chronic malignant and nonmalignant illnesses, of which neuropathic pain is a prevalent problem. As a person becomes more frail, pain medications such as opioid analgesics and adjuvant pain medications can result in unwanted effects such as sedation, confusion, and increased risk of falls. ⋯ Methadone is an opioid analgesic that is effective in the treatment of neuropathic pain, is excreted by the bowels, is highly lipophilic, and can be administered through the oral, buccal, or sublingual routes. We present three cases highlighting the use of low-dose adjuvant methadone to manage complex neuropathic pain in the frail elderly.
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Lymphedema frequently develops as a long-term effect from cancer and/or its treatment, including head and neck cancer (HNC). There is a substantial lack of understanding regarding the symptoms and experiences related to head and neck lymphedema. ⋯ Clinicians need to inquire about tissue swelling and associated symptoms early in the post-treatment period to initiate lymphedema management strategies in a timely manner and facilitate reduction of long-term symptom burden and functional deficits.
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The aim of this work was to analyze routine assessments recorded, when a patient was documented as likely to die in hours to days, to determine the prevalence, intensity, and associations of physical symptoms. ⋯ The terminal phase is perceived as a time where the majority will experience distressing symptoms, but this work suggests a contrary view. However, there did seem to be a detrimental effect depending on place of care with more significant problems recorded when people were dying at home. More work is needed to clarify this given the current push for more home deaths.