Archives of internal medicine
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Multicenter Study Comparative Study
The optimal delivery of palliative care: a national comparison of the outcomes of consultation teams vs inpatient units.
Growing attention to end-of-life care has led to intensive efforts to provide better palliative care. However, it is not known whether palliative care is best provided by consultative teams or in dedicated units. ⋯ Care received in palliative care units may offer more improvements in care than those achieved with palliative care consultations.
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Opioids are widely prescribed for chronic nonmalignant pain, often at doses exceeding those recommended in clinical practice guidelines. However, the risk-benefit ratio of high-dose opioid therapy is not well characterized. The objective of this study was to characterize the relationship between opioid dose and opioid-related mortality. ⋯ Among patients receiving opioids for nonmalignant pain, the daily dose is strongly associated with opioid-related mortality, particularly at doses exceeding thresholds recommended in recent clinical guidelines.