Articles: palliative-care.
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J Pain Palliat Care Pharmacother · Jun 2021
Case ReportsSpiritual Healing in a Hospice Veteran Led to a Successful Opioid Taper: A Case Report.
Addressing "total pain" is a concept commonly practiced in palliative care. Spiritual healing in a Navy Veteran led to a significant improvement in pain allowing a voluntary taper of opioid medication. ⋯ A reduction in opioid morphine equivalent daily doses (MEDD) were 87.5% without any symptoms from the clinical opioid withdrawal scale (COWS). The Veteran died peacefully during an opioid taper in hospice care.
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Background: Emergency department (ED) visits are common for older patients with chronic, life-limiting illnesses and may offer a valuable opportunity for clinicians to initiate proactive goals of care conversations (GoCC) to ensure end-of-life care that aligns with the patients' values, goals, and preferences. Objectives: The purpose of this study is to assess whether GoCC are occurring with patients in Department of Veteran Affairs (VA) EDs, to characterize these patients' goals of care and life-sustaining treatment (LST) decisions, and to examine the extent to which palliative or hospice consultations occur following the ED visit. Design: We conducted a cross-sectional retrospective study using health record data. ⋯ The percentage of patients wanting other LSTs (e.g., mechanical ventilation) was higher among the lowest risk patients; and the percentage of patients requesting limits to LSTs was highest among higher risk patients. Eighteen percent of patients had a palliative or hospice care consult within three months of their ED visit. Conclusions: In this study, we verified that GoCC are being initiated in the ED with Veterans at differing stages in their illness trajectory and that higher proportions of higher risk patients preferred to limit LSTs.
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Palliative medicine · Jun 2021
Randomized Controlled TrialHealthcare professionals' views of the use of oral morphine and transmucosal diamorphine in the management of paediatric breakthrough pain and the feasibility of a randomised controlled trial: A focus group study (DIPPER).
Oral morphine is frequently used for breakthrough pain but the oral route is not always available and absorption is slow. Transmucosal diamorphine is administered by buccal, sublingual or intranasal routes, and rapidly absorbed. ⋯ There were perceived advantages to transmucosal diamorphine, but there is a need for access to a safe preparation. A clinical trial would be feasible provided barriers were overcome.
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Objective: To examine the relationship between admission Karnofsky Performance Status (KPS) and discharge disposition. Background: Little is known about the relationship between functional status before hospitalization and discharge disposition. Methods: In a retrospective cohort study of patients seen by Mount Sinai Hospital Medicine Primary Palliative Care Program (HPPC), we used demographic and clinical data to compare discharge disposition by patients' functional status before admission into the hospital. ⋯ Key Message: This retrospective cohort study examined the relationship between KPS before hospital admission and discharge disposition in hospitalized seriously ill patients admitted to the hospital medicine service who received a HPPC consultation. The results suggest that those with a higher admission KPS (more functional) are more likely to be discharged home, whereas those with a lower KPS (less functional) are more likely to be discharged to a facility or hospice. KPS before hospital admission could guide palliative care resource allocation and discharge needs.
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J Pain Symptom Manage · Jun 2021
The level of distress from fatigue reported in the final two months of life by a palliative care population; An Australian national prospective, consecutive case series.
Fatigue is the most commonly reported symptom in life-limiting illnesses, although not much is known about the distress it causes patients as they approach death. ⋯ Distress from fatigue is high in this cohort of patients. Interventions to reduce this distress need to be a research priority.