Journal of palliative medicine
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Background: The 2019 coronavirus (COVID-19) pandemic placed unprecedented strains on the U. S. health care system, putting health care workers (HCWs) at increased risk for experiencing moral injury (MI). Moral resilience (MR), the ability to preserve or restore integrity, has been proposed as a resource to mitigate the detrimental effects of MI among HCWs. ⋯ Further research is needed to understand how to cultivate MR, reduce ECI, and understand other systems level factors to prevent MI symptoms in U. S. HCWs.
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Observational Study
Developing Successful Palliative Care Teams in Rural Communities: A Facilitated Process.
Background: Developing palliative care (PC) programs in rural settings is challenging due to limitations on training, staff, resources, and reimbursement. Employing established frameworks and processes can assist rural communities in developing quality PC programs. Objective: We sought to employ a facilitated community-centric planning process to guide several rural community teams across three states in the United States to support PC program development. ⋯ However, due to staff capacity limitations imposed by COVID-19, only eight communities completed a follow-up assessment in late 2020. These teams showed some improvement in knowledge of multiple PC domains as a result of the process and provided qualitative feedback indicating that the process was helpful in building capacity to offer needed services and developing the skills and workflows necessary to support delivery of PC. Conclusion: This unique development process can help rural communities organize, develop, and sustain PC programs and overcome common barriers to providing PC.
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Observational Study
Pilot Study of Lemborexant for Insomnia in Cancer Patients with Delirium.
Delirium occurs very frequently in cancer patients. Insomnia is a symptom of delirium. Lemborexant is a drug that regulates sleep-wake rhythms without causing extrapyramidal symptoms. ⋯ Lemborexant might have similar efficacy for insomnia with and without delirium when compared with previous studies. The efficacy rate of lemborexant was 70% for patients with insomnia and hyperactive delirium. This study might lead to dose reductions of antipsychotic medications and fewer extrapyramidal symptoms in cancer patients with delirium.
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Central apnea is a major cause of death in neonates with trisomy 18 (T18) and is likely due to immaturity of the respiratory drive, similar to the pathological mechanism in apnea of prematurity. Although caffeine has long been used for apnea of prematurity, its use has not yet been reported for infants with T18. Here we describe an infant with T18 receiving comfort-focused care and palliative transport home. ⋯ However, immediately before transport, she developed severe central apnea, raising concern that she may not survive the transfer. Caffeine was trialed in the hopes of reducing central apnea events. Its use was successful and facilitated safe transport, allowing the patient to uneventfully transition home, where she spent several meaningful weeks with her family before her death.