Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2014
Review Case ReportsPatients who lack capacity and lack surrogates: can they enroll in hospice?
Patients who lack capacity and lack surrogates are among the most vulnerable patients we care for in palliative care. In the case we present here, we have considered how to make end-of-life decisions for a patient who lacks both capacity and surrogates, who has a terminal illness, and who is not a candidate for disease-modifying treatments. We first define and characterize this population of patients through a review of the literature and then explore some decision-making quandaries that are encountered at the end of life. Finally, we make recommendations on how best to proceed with decision making for this vulnerable population.
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J Pain Symptom Manage · Oct 2014
Observational StudySubcutaneous administration of drugs in palliative care: results of a systematic observational study.
Especially in palliative care, safe and manageable administration of medication is essential. Subcutaneous drug administration is a possible alternative, when oral intake is hampered. However, evidence for this method is rare. ⋯ The results of this study acknowledge the clinical practice of subcutaneous administration of medication as a very flexible, broadly feasible, rather safe, and nonburdensome method. Nevertheless, this practice is not free from complications, needs appropriate nursing care, and requires standardized policies and procedures.
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J Pain Symptom Manage · Oct 2014
The effectiveness of the Geritalk communication skills course: a real-time assessment of skill acquisition and deliberate practice.
Communication skills are critical in Geriatrics and Palliative Medicine because these patients confront complex clinical scenarios. We evaluated the effectiveness of the Geritalk communication skills course by comparing pre- and post-course real-time assessment of the participants leading family meetings. We also evaluated the participants' sustained skills practice. ⋯ This intensive training and family meeting assessment offers evidence-based communication skills training.
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J Pain Symptom Manage · Oct 2014
Autonomic dysfunction in cancer cachexia coincides with large fiber polyneuropathy.
Cancer cachexia occurs in most patients suffering from solid malignancies. Recent works suggest paraneoplastic mechanisms. Empirical studies also found autonomic dysfunction in cancer patients, but comprehensive evaluation of the peripheral nervous system is lacking. ⋯ Large fiber polyneuropathy coincides with autonomic dysfunction in cachectic cancer patients. Our findings suggest a relevant role of sympathetic impairment in cancer cachexia.
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Accurate documentation of inpatient code status discussions (CSDs) is important because of frequent patient care handoffs. ⋯ Documentation quality of inpatient CSDs was poor. Our findings highlight the need to improve the quality of resident and attending CSD documentation.