Abstract
Letter to the Editor
A retrospective descriptive study to determine the effect of palliative care services (PCS) on total expenditures and total length of stays.
Brief Report
The postresuscitative hospital course of emergency department patients who initially survive nontraumatic out-of-hospital cardiac arrests but die in the hospital.
Fast Facts and Concepts
#151 Hypercalcemia of malignancy
#181 Oral oxymorphone
Personal Reflection
As it turns out, I was waiting for reassurance from my patient who had passed away. I was waiting for him to wink at me from elsewhere, as if to say “Yes, my life was worth my death … I am OK.”
Case Discussions in Palliative Medicine
Report in which coblation of an acetabular metastasis prior to cement filling has been performed.
Book and Media Reviews
Dead Body Care
Nine percent of Japanese families experience problems with the deceased body after leaving the hospital, including a change in the facial appearance (8.5%), stains on the body (8%), and an odor emanating from the body (4%). Over half the families preferred not to have traditional Japanese care of the body. Rather, they most preferred to have make-up applied lightly and moderately. Maintaining the appearance of the body was related to the overall evaluation of the quality of end–of-life care. (page 27)
Methadone and QTc
A recent review in the Annals of Internal Medicine advocated wholesale electrocardiogram screening for patients treated with methadone. In a population of patients receiving palliative care at baseline prior to initiation of methadone, 28% patients had QTc prolongation. Clinically significant increase in QTc after initiation of methadone occurred in only one patient at week 2, and none at weeks 4 and 8. There was no clinical evidence of torsades de pointes, ventricular fibrillation or sudden death. (page 33)
Benefit versus Burden
The WALT survey was used in a predominantly Latino population receiving care at a large urban safety net hospital. Eligible patients were cared for by one of four clinics: HIV; geriatrics; oncology; or cardiology. Hypothetical scenarios reflecting outcomes of resuscitation were presented and patients were given information on the burden and outcome of treatment They were then given the option of accepting or declining treatment. Patients were willing to accept a high level of cognitive (vegetative state) and functional (bed-bound) impairment even when the chance of recovery was exceedingly low. (page 39)
Acute Palliative Care Unit Discharge Outcomes
All patients discharged from an acute palliative care unit (APCU) serving patients with cancer over a 5-year period were evaluated retrospectively: median age, 59 years (range, 18–101); median unit stay, 7 days; and median survival 21 days. Approximately one third died during admission. Transfers from oncology units were associated with death in the APCU, while younger age and direct admissions to the unit were associated with home discharge. (page 49)
Malignant Pleural Effusion
Which is better: talc pleurodesis or Pleurx® catheter placement? Treatment with talc was less costly than Pleurx® (talc, $8,170.80; Pleurx®, $9,011.60) with similar effectiveness (talc, 0.281 QALYs; Pleurx®, 0.276 QALYs). Pleurx became more cost effective (<$100K/QALY) when life expectancy was 6 weeks or less. (page 59)
Jewish Ethics and Pain Treatment
Observant Jews are challenged to integrate ancient tradition with modern sensibilities. There is no central body that determines policy and a wide spectrum of opinions are usually found. However, regarding pain treatment, there appears to be a wide consensus mandating its aggressive use even at the risk of significant side effects as long as the motivation is relief of suffering. (page 67)