Journal of palliative medicine
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Multicenter Study
Pharmacovigilance in hospice/palliative care: net effect of haloperidol for delirium.
Prescribing practice in hospice/palliative care is largely extrapolated from other areas of clinical practice, with few studies of net medication effects (benefits and harms) in hospice/palliative care to guide prescribing decisions. Hospice/palliative care patients differ in multiple ways from better studied participant groups, hence the applicability of studies in other participant groups is uncertain. Haloperidol, a butyrophenone derivative and dopamine antagonist, is commonly prescribed for nausea, vomiting, and delirium in hospice/palliative care. Its frequent use in delirium occurs despite little evidence of the effect of antipsychotics on the untreated course of delirium. The aim of this study was to examine the immediate and short-term clinical benefits and harms of haloperidol for delirium in hospice/palliative care patients. ⋯ Overall, 1 in 3 participants gained net clinical benefit at 10 days.
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Multicenter Study
Polypharmacy and drug omissions across hospices in Northern Ireland.
Polypharmacy and drug omissions (DO) (i.e., drugs prescribed but not administered) may impact on quality of life of hospice inpatients. ⋯ Polypharmacy is prevalent among hospice inpatients. Drugs omitted amounted to 8.8%, with the frequency of DO increasing in those who were dying. Documentation justifying DO was lacking. Daily focused drug chart review, pharmacy support, and electronic prescribing may all help to reduce and rationalize medication burden and aid prompt and effective management of DO.
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Patients with end-stage renal disease (ESRD) on hemodialysis (HD) suffer from a high symptom burden. However, there is significant heterogeneity within the HD population; certain subgroups, such as the elderly, may experience disproportionate symptom burden. ⋯ Among HD patients, transplant eligibility is associated with symptom burden. Our pilot data suggest that consideration be given to employing transplant status as a method of identifying HD patients at risk for greater symptom burden and targeting them for palliative interventions.
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The widespread impact of cancer worldwide and noncurative treatment methods despite all developments drive patients towards investigating and using nonconventional treatment methods. Herbs, which have an important role in complementary and alternative medicine practices, may cause unfavorable results when used especially with chemotherapeutics in cancer patients due to the substances they contain and due to the properties of some, which still cannot be clarified. Further overshadowing the success of the treatments, patients do not talk about these issues with their doctors and physicians are unable to comprehend these properties of herbs. In this compilation we aimed to clarify the concepts of complementary and alternative medicine, to gather the properties of important and frequently used herbs, and to increase the awareness of physicians on this subject.
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Case Reports
Methylnaltrexone use in a seventeen-month-old female with progressive cancer and rectal prolapse.
Opioid-induced constipation is commonly seen in pediatrics, especially at the end of life. As patients clinically decline, constipation often leads to increased pain and distress, while its enteral treatment becomes more challenging. ⋯ Opioid-induced constipation, abdominal distention, and rectal prolapse caused our patient's most distressing symptoms, even in the context of advanced cancer. A single dose of subcutaneous methylnaltrexone (0.12 mg/kg) resolved her constipation and rectal prolapse within one hour. Although evidence is limited, the drug has successfully been used in pediatric patients with no reported side effects to date. We recommend its use earlier in the course of severe opioid-induced constipation in children unable to tolerate an oral laxation regimen. Prospective research is needed to establish the parameters for use of this effective agent in children who cannot tolerate other regimens.