Abstract
Letter to the Editor
Study to determine patients' satisfaction with intranasal fentanyl and the pain reduction achieved. (page 631)
Brief Report
Description of use of palliative care services in an urban tertiary care center emergency department. (page 633)
Fast Facts and Concepts
#216 Asking about Cultural Beliefs in Palliative Care (page 714)
#253 Palliative Care Consultation in the ICU (page 715)
Personal Reflection
When advanced directives are not clear or relatives are confused about patients' wishes, it is appropriate to review a patient's life history for relevant ‘advanced actions.’ (page 717)
Case Discussions in Palliative Medicine
Case of a 5-year-old girl diagnosed with meningitis caused by malignant T-cell lymphoma with severe neuropathic pain not relieved by increasing doses of a fentanyl infusion. Intravenous administration of ketamine and lidocaine in combination with fentanyl provided excellent analgesia without significant side effects. (page 719)
Book and Media Reviews
(page 723)
Recent Literature
(page 724)
Getting Better at Prognostication
David Casarett, Joan Teno, and colleagues analyzed the records of more than 21,000 hospice patients around the country and found a simple prognostic index based on available clinical information could more accurately predict one-week mortality than hospice nurses could. (page 703)
Use of Palliative Sedation in Germany
The authors evaluated data on nearly 2,000 patients and found palliative sedation rates of 11%-13% in palliative care units and 22%-25% in hospices. Reasons for palliative sedation included dyspnea, pain, anxiety, and psychosocial distress, and many patients received intermittent sedation. (page 672)
Survival and Bed Access for Noncancer Inpatients
Do noncancer patients “oversurvive” and reduce palliative care unit (PCU) bed availability, per anecdotal reports? No, according to Canadian researchers, who conducted a retrospective review of all admissions to four PCUs in Toronto over a year. Noncancer patients had a shorter length of stay and a similar likelihood of being discharged alive than cancer patients. Noncancer patients were older and had shorter prognoses and poorer functional status on admission compared to cancer patients. (page 661)
Mapping Children's Palliative Care around the World
This study reports the results of survey responses from 251 health professionals mostly in Africa, North America, and Europe providing pediatric palliative care. This descriptive uncontrolled study begins to create a global snapshot of palliative care for children, and assesses the need for resources and education for caregivers. (page 646)
New Guidelines for Bereavement Support
The authors developed consensus guidelines for psychosocial and bereavement support for families of palliative care patients, which have been endorsed by key Australian and international organizations. (page 696)
Problem-Solving Therapy for Hospice Caregivers
This study compared the effectiveness of a problem-solving therapy (PST) intervention delivered in person versus videophone for hospice caregivers. Videophone delivery was not inferior to face to face, and may provide a solution to geographic barriers and limited resources. (page 653)
Measuring Quality in Nursing Homes
This paper reports on efforts to conceptualize high-quality end-of-life care in nursing homes and to offer a refined approach to measurement, including system-level factors as well as patient and family outcomes. (page 690)
End-of-Life Stories from People with Chronic Disabilities
Researchers interviewed women with physical disabilities about issues of death and dying. They found five themes: death as a signpost, impact of others' deaths, deaths that affected personal insights and choice, end-of-life possibilities, and a personal brush with death. (page 667)
Steroid-Induced Diabetes
This prevalence study found that steroid-induced diabetes mellitus (SDM) in palliative care patients is more common than previously recognized, and the risk of SDM increases with higher doses. (page 681)