Abstract
Letters to the Editor
In the future, anamorelin may be a promising option for treating cancer cachexia; however, cardiac issues, such as QT interval prolongation, may occur. Herein, we report a case of QT prolongation caused by anamorelin. (page 460)
Brief Reports
Multicenter retrospective study to assess naldemedine's efficacy and safety in cancer patients on opioids with poor performance status. (page 548)
Fast Facts and Concepts
Assessment Tools for Dyspnea and Respiratory Distress at the End of Life #453 (page 582)
Hazardous Drug Safe Handling for Patients Receiving Cancer Treatment #454 (page 584)
Personal Reflection
The truth is, without creativity, medicine often results in failure. Lacking the curiosity to elicit and form the whole picture of what is happening, instead of relying on what is already known, may result in the missing of critical pieces of information necessary to help a patient. (page 587)
Case Discussions in Palliative Medicine
Case of a three-year-old with cardiofaciocutaneous syndrome, hydrocephalus status post-ventroperitoneal shunt, tracheostomy, and chronic ventilation for chronic lung disease demonstrates successful use of intranasal dexmedetomidine for management of refractory irritability with no noted adverse effects. (page 596)
Book and Media Reviews
(page 599)
Outpatient Palliative Care Education Needs Assessment
Although there is one specialty of palliative medicine, its practice in the ambulatory outpatient setting is distinctly different from the hospital inpatient setting where many specialist training programs are based. In this online survey, 164 clinicians (75% physicians) responded. Respondents had a median of 10 years experience, and 6 years in the ambulatory outpatient setting. Two areas of particular importance emerged: navigating insurance/prior authorizations and comanagement of pain and opioid used disorder. (page 464)
Quality of Life and Cardiac Resynchronization Therapy
Palliative medicine continues to make inroads in specialist cardiology settings, particularly for elderly patients with heart failure and reduced ejection fraction. In this prospective study of 101 patients who received cardiac resynchronization therapy, the average age was 81 years (27% women). There was no significant difference in measured quality of life outcomes between those with a pacemaker versus those with a defibrillator. (page 481)
Embedded Specialist Palliative Care for Cystic Fibrosis
Will specialists in palliative care have effects on cystic fibrosis patients similar to the effects in cancer and heart failure? In this single-site randomized study for purposes of establishing feasibility and acceptability, 50 patients were enrolled with a mean age of 38 years. Of 23 participants randomized to intervention arm, all completed all study visits; none withdrew and 94% said intervention was not burdensome, and 98% would recommend the intervention to others with cystic fibrosis. More than 90% of visits addressed the topics prescribed by the intervention manual. (page 489)
Subcutaneous Administration of Medications and Fluids by Family Members at Home
Despite reports of the success of family members administering medications and fluids subcutaneously at home without skilled professionals, this approach has not become mainstream in health care despite the push to dehospitalize patients and the shortages of skilled professionals able to make home visits. In this retrospective chart review of 272 consecutive patients, the median age was 74 years and 60% were female. Two hundred eighteen patients received a mean of four medications subcutaneously through 903 catheters. There was no difference in local infections whether placed by family or a skilled nurse. (page 497)
Scripted Social Work Intervention in the Emergency Department
In many hospitals, the majority of sick patients are seen first in the emergency department. No clear model of palliative care intervention in the emergency department has emerged. In this prospective unblinded randomized clinical trial pilot, a scripted palliative care communication intervention was conducted by emergency department social workers for 65 patients. Of the 43 patients randomized to intervention, patients appreciated the social workers bringing up goals for the future, asking about their fears and worries, and liked the construct of the conversation. (page 517)