Abstract
Letter to the Editor
Newly developed flax dressings (FlaxAid) were used to treat decubitus ulcers in this clinical study (page 146)
Brief Report
Survey of renal providers whose patients were participating in a clinical trial of symptom management at nine hemodialysis units in southwestern Pennsylvania (page 163)
Fast Facts and Concepts
#104 Insomnia: Nonpharmacologic Treatments (page 242)
#105 Insomnia: Drug Therapies (page 243)
Personal Reflection
During this moment, at the time that these young parents lost their five year-old son, I was overwhelmed by my own sense of helplessness, feeling that I didn't deserve to be present at such a private, sacred moment for this family. (page 248)
Case Discussions in Palliative Medicine
Though underutilized, the medical autopsy can play an important role in families' grief processes, particularly in those cases wherein uncertainties exist regarding the ultimate cause of death. (page 251)
Book and Media Reviews
(page 254)
Recent Literature
(page 255)
Rehospitalization Rates and Palliative Care
Italian researchers found significant reductions in rehospitalization rates and costs in end-stage brain tumor patients with home-based palliative care services. (page 225)
Conservative Management of ESRD
In this systematic review, the authors found management of end-stage renal disease without dialysis resulted in a median survival of at least six months. These conservatively-treated patients reported a high symptom burden, and more studies are needed to compare the symptoms of age-matched dialysis patients. The authors conclude conservative management is an important alternative to discuss when counseling patients and families about dialysis. (page 228)
Improving Access to Palliative Care
The palliative care services at Massachusetts General Hospital and Brigham and Women's Hospital tripled their consultation rates with innovative quality initiatives at each hospital. (page 192)
Withdrawal of Mechanical Ventilation in ALS
This retrospective study describes 12 patients with ALS who decided to withdraw mechanical ventilation. Patients reported a perceived “loss of meaning in life” which led to their decision, and ventilator withdrawal was performed under deep sedation as a medically, legally and ethically justified procedure. (page 205)
Caregivers' Quality of Life
In this Korean study, spouse caregivers of cancer patients completed questionnaires to assess their quality of life, including socioeconomic factors, caregiver burden, health risk factors, spirituality and family function. Caregivers who reported “a reason and purpose for living” had higher QOL scores and better adaption. (page 216)
Essential Drugs in International Palliative Care
Using the Delphi method, members of the International Association for Hospice and Palliative Care ranked their preferences for first-line opioid, antiemetic and laxative for treatment of adults with cancer pain and other life-threatening conditions. (page 186)
Palliative Prognostic Index in Cancer
Researchers in Kuwait found the Palliative Prognostic Index may be helpful to predict survival and in-hospital mortality of advanced cancer patients in an acute care setting. (page 200)
New Tool To Measure Family Distress
The authors developed a tool to assess family difficulties in caring for loved ones with end-stage cancer at home. (page 210)
Factors Associated with Poor Prognosis in Cancer
This systematic review identified prognostic factors in cancer that are associated with a median survival of < 6 months, including poor performance status, older age, weight loss, metastatic disease or disease recurrence. There was little evidence that treatment prolongs survival at this stage. (page 175)