Abstract
Letters to the Editor
What is the best way to assess a patient's driving ability? There are no published recommendations to help hospice and palliative medicine professionals address the problem of driving safety. (page 804)
Brief Reports
Article describing the patients seen and the issues addressed in an outpatient palliative care program for patients with chronic heart failure. (page 815)
Fast Facts and Concepts
#240 Levorphanol (page 875)
#241 Improving Communication When Hearing Loss Is Present (page 876)
Personal Reflection
At that moment, I felt enormously proud of our team for providing a great deal of care for a family all in one meeting, but also I felt proud of Maria's family for accepting palliative care as real care, and not “doing nothing.” (p 879)
Case Discussions in Palliative Medicine
Case example illustrates a process for formulating and expressing a prognostic assessment for an ICU patient requiring renal replacement therapy for acute renal failure. (page 883)
Book and Media Reviews
(page 890)
Palliative Procedures in Malignant Bowel Obstruction
This retrospective review of 141 patients with stage IV colorectal cancer found surgical (OR) and endoscopic (GI) procedures successful in palliating symptoms of malignant bowel obstruction. Researchers identified patient factors and CT scan findings to determine which patients benefited from GI or OR options. In carefully selected patients, symptom relief was excellent, 90% went home and 84% were able to eat after the intervention. (page 822)
Subcutaneous Implantable Pleural Catheters for Malignant Effusions
In this single-center, prospective study, the authors describe their use of 168 subcutaneous implantable pleural port (SIPP) catheters in 137 patients since 2005. Almost 98% of patients reported complete or partial relief of dyspnea. After SIPP placement, 20.8% of patients died within a month and 32% survived more than 6 months. The authors report 3 infections (1 empyema, 2 episodes of cellulitis) and 3 mechanical complications. They conclude that SIPP is a safe and effective option for outpatient management of recurrent malignant pleural effusion. (page 829)
Use of High-Flow Nasal Oxygen in Cancer Patients
Medical oxygen remains controversial in treating patients with dyspnea. Researchers at Memorial Sloan Kettering Cancer Center performed a database search to determine the prevalence and clinical use of humidified high-flow nasal oxygen (HHFNOx) at their hospital since 2008. They randomly selected 183 cancer patients who used HHFNOx, which can deliver up to 50–60 L/min. Most patients received this therapy for hypoxia (72%), and they improved (41%), remained stable (41%), or declined (15%). Most people tolerated the device well. (page 835)
Physician Perspectives on Efficacy and Side Effects of Steroids
Japanese researchers surveyed 124 palliative care physicians and found the use of steroids extremely common (99% of respondents). The physicians estimated the effective rates of steroids in anorexia (57%), fatigue (50%), and dyspnea (52%), based on their experience. However, 23% of respondents reported potentially fatal complications, including GI bleeding, hyperglycemia, and P. jiroveci pneumonia. (page 840)
Online Palliative Care Support
In this pilot study, researchers evaluated use by patients and families of a public interactive website of the Johns Hopkins Pancreatic Cancer Research Center. Patients sought advice from a palliative care nurse practitioner through the website. Researchers found the site had 707 visits by 395 participants during the 8-week study period. Forty-eight visitors posted 55 questions, mostly related to physical issues in pancreatic cancer and its treatment. Twenty survey respondents found the website helpful and easy to use. (page 846)