Abstract
Letters to the Editor
Although midazolam is commonly prescribed in palliative care, the evidence that supports its use is minimal. Current guidelines recommend the use of the agent as an anxiolytic agent even when patients are not in their terminal phase. (page 96)
Brief Reports
Study investigates the impact of changes in consciousness status after admission on survival in advanced cancer patients, demonstrating that consciousness change one week after admission to a palliative care unit is an important predictor of survival in advanced cancer patients. (page 170)
Fast Facts and Concepts
#287: Drug-Induced Acute Urinary Retention (page 187)
Personal Reflection
I realized that before leaving and in my documentation I did not stress how serious I thought the situation was to my colleagues, as I had with the family. I had not focused on the fact she may only have days to weeks to survive if her swallowing did not improve, and this is something I now regret, as this may have expedited the process of discharge to a hospice. (page 195)
Recent Literature
(page 200)
Home-Based Palliative Care for Children
In the first North American study of its kind, the authors assessed outcomes among children with cancer who received concurrent oncology and palliative care at home compared to those who received oncology care alone. While both groups had similar levels of symptom distress, children receiving palliative care had improved quality of life and were more likely to die at home. (page 143)
Palliative Care in Heart Failure
In this randomized, prospective trial, patients hospitalized with acute heart failure who received a palliative care consult had short-term improvement in symptom burden, quality of life, and depression compared to patients receiving usual care. (page 134)
Treatment Delays in Cord Compression
In an analysis of patients with metastatic spinal cord compression, researchers identified factors that contribute to treatment delays, including a patient's ability to walk and to receive care during weekend days. (page 107)
Use of Comorbidities To Predict Prognosis
The authors describe a new tool that uses comorbid diagnoses in nursing home residents to predict six-month mortality more accurately than prognostication based on functional status. (page 100)
Snapshot of Pediatric Hospice Patients
David Casarett and colleagues looked at nine hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness (CHOICE) network and found that pediatric patients differ from adult patients in their broader range of diagnoses and use of hospice services. (page 120)
Methadone with Haloperidol for Pain
In a study of 43 hospitalized palliative care patients with pain, researchers found the use of very-low-dose methadone with haloperidol resulted in improved pain control after conversion from typical opiates. (page 114)
Caregiver Bereavement after Nursing Home Placement
In this prospective study of 217 caregivers of patients recently placed in a nursing home, caregivers who felt more prepared for a loved one's death experienced lower levels of complicated grief. Data analysis revealed that spouses were less prepared compared to adult child caregivers, and that caregivers of patients with advance care plans felt more prepared for end of life. (page 127)