Journal of palliative medicine
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To describe the postresuscitative hospital course of emergency department patients who initially survive nontraumatic out-of-hospital cardiac arrests (OOHCA) but die in the hospital. ⋯ In this urban setting, approximately three of four OOHCA patients who are initially resuscitated do not survive to hospital discharge. This short in-hospital course post-CPR is often marked by pain and ends with the withdrawal of life support. This information may be an important component of advance planning discussions and may assist patients as they weigh the pros and cons associated with resuscitation preferences.
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We undertook a systematic review of published evidence of the effectiveness of propofol for terminal sedation. INCLUSIONS: Prospective or retrospective trials (controlled or uncontrolled) or case series of propofol for sedation in advanced incurable disease in either generalist setting or specialist palliative care units. ⋯ Four articles--all case series or case reports--reporting generally favorable reports of the use of propofol as sedation for intractable symptoms in the last days of life especially when one or more other drugs have failed. Since these four articles are essentially hypothesis-generating, the article also discusses the possibility of the design of a clinical trial to compare propofol with other drugs used in this situation.
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Clinical Trial
The effect of oral methadone on the QTc interval in advanced cancer patients: a prospective pilot study.
Recent reports suggest that high doses of methadone may prolong QTc interval and occasionally cause torsades de pointes; however, few of these studies involved the palliative care population. ⋯ Baseline QTc prolongation was common, whereas significant QTc interval 500 ms or more after methadone initiation rarely occurred, with no evidence of clinically significant arrhythmias. This study supports the safety of methadone use for pain control in patients with advanced cancer in the palliative care setting.
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Acute palliative care units (APCUs) are new programs aimed at integrating palliative and oncology care. Few outcome studies from APCUs are available. ⋯ Our APCU serves patients with advanced cancer with diverse clinical characteristics and survival, and discharged home a significant proportion with survival greater than 6 months. RESULTS from this simultaneous care program suggest a pattern of care different from that of traditional hospice and palliative care services.
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The aim of this study is to clarify the actual experiences and preferences of the bereaved family for the care of their deceased family member. ⋯ As the preferences for the care of deceased bodies are changing, end-of-life care needs to be improved with respect to culture, religious views, and the wishes of the patient and their family.