Abstract
Letters to the Editor
Since the same word is used in different ways, it's easy to see why DNR is often misunderstood and misapplied. This is particularly true for modalities that are commonly used in tandem with cardiopulmonary resuscitation in the inpatient setting, such as epinephrine and endotracheal intubation. (page 747)
Brief Reports
Study to identify factors associated with 30-day readmission among older adults newly discharged to hospice. (page 841)
Fast Facts and Concepts
# 281 Care of Post-Laryngectomy Stoma (page 857)
Personal Reflection
There would be no DNR order, even though they knew they were risking Mike dying at 3 a.m., with no family even in the hospital, much less in his room. They all knew, they were beginning to mourn, and still the family was willing to give up what they knew was right for this young man who was so much like his grandfather. (page 859)
Case Discussions in Palliative Medicine
Case of endometrial adenocarcinoma with metastasis to the larynx treated with transoral endoscopic debulking surgery with postoperative regional low-dose radiotherapy, instead of traditional tracheostomy. (page 867)
Book and Media Reviews
(page 870)
Recent Literature
(page 871)
Barriers in Palliative Care Research
In a survey, leaders identified barriers to palliative care research, including lack of funding and institutional capacity; a small but growing research workforce; and public aversion to topics related to serious illness and end of life, among other issues. (page 782)
Effects of Research Participation on Families
In this descriptive study of parents of seriously ill children, not a single parent reported regretting participating in a research study. About half of parents said their participation had a positive effect, and 93% would recommend this experience to other parents. (page 788)
Do DNR Orders Impact Other Hospital Care?
The authors analyzed retrospective data from 270 oncology inpatients with do-not-resuscitate (DNR) orders, and found most patients continued to receive appropriate medical interventions. A majority of patients survived hospitalization and were alive at 30 days after documentation of DNR orders. (page 776)
Identifying Quality Measures
Authors from the Carolinas Center for Medical Excellence's PEACE project report pilot data on the usability and feasibility of potential quality measures, as well as data collection processes for hospice and palliative care programs. (page 769)
Gastrostomy Placement with Large-Volume Ascites
In this prospective study, researchers found gastrostomy/ gastrojejunostomy placement is possible in fragile, end-stage patients with voluminous ascites after drainage and subsequent formation of a gastrocutaneous fistula. (page 811)
Estimating Prognosis
The authors describe a tool to estimate prognosis in ambulatory cancer patients earlier in their disease trajectory. (page 797)
Identifying Candidates for Pleurodesis
In a retrospective study, researchers found the success rate of talc pleurodesis for patients with malignant pleural effusion was 56% for end-stage patients versus 79% for patients eligible for cancer-directed therapy. The physician's prediction of a successful talc pleurodesis was correct in 50% of cases. (page 822)
Outcomes after Pleurodesis
Researchers describe that video-assisted thoracic surgery and talc pleurodesis without intubation can achieve results in pleural effusion similar to the same operation performed under general anesthesia. They report earlier improvement of patients' quality of life as well as reduced mortality, morbidity, and medical costs. (page 761)