Annals of palliative medicine
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Home discharge after hospital admission to an inpatient palliative care unit (PCU) is a major challenge. Dysfunction of the autonomic nervous system is commonly observed in patients with advanced cancer in this setting. The aim of this prospective observational study was to determine whether the measurement of heart rate variability (HRV) by assessing parameters of the autonomic nervous system on a 24-h-ECG at the time of admission to the PCU was correlated with the likelihood of discharge. ⋯ KPS and PPS were significant predictors of the likelihood of discharge while HRV did not predict discharge.
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Chronic obstructive pulmonary disease (COPD) is associated with a progressive course with a variable illness trajectory causing death either from respiratory failure or complications from its comorbities. Palliative care benefits patients throughout all stages of COPD, with a goal to manage patients' symptom burden which can reduce physical, psychological, and social complications. Dyspnea is the most common and distressing symptom patients with end stage COPD experience, which responds only partially to therapy and eventually becomes refractory to routine care. ⋯ Caregivers and informed patients can utilize palliative care resources to provide effective relief from refractory dyspnea and help patients maintain a dignified quality-of-life until the end of life. This review is focused on identifying current deficiencies in palliative care provided to patients with advanced COPD with attempts to overcome these. We hope to increase awareness of palliative care in advanced COPD to healthcare providers caring for this population of patients.
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This review focuses on newer medications for the treatment of pain as well as on new guidelines and indications for the use of established medications. With regard to classical analgesics, the use of non-opioids and opioids is reviewed. Here are relevant new data on the use of the old substance acetaminophen as well as on non-selective non-steroidal anti-inflammatory drugs (NSAIDs) and the newer COX-2 selective agents, which continue to be misunderstood. ⋯ Calcitonin has also found some new indications in difficult to treat pain conditions, while the discussion on the role of cannabinoids in pain management continues, partially driven by political issues. For localized neuropathic pain, there is increasing interest in topical preparations such as lidocaine and capsaicin patches, in particular in view of their minimal systemic adverse effects. Overall, recent advances in the pharmacological management of pain are not so much the result of new 'miracle' drugs, but new preparations and new ways to use old drugs in a variety of settings, often as components of a multimodal approach to pain relief.