Journal of palliative medicine
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Multicenter Study
Pharmacovigilance in hospice/palliative care: rapid report of net clinical effect of metoclopramide.
Understanding the performance of prescribed medications in day-to-day practice is important to minimize harm, maximize clinical benefits, and, eventually, better target the people who are most likely to benefit, especially in hospice/palliative care where there may be limited time to optimize prescribing. Metoclopramide, a benzamide prokinetic antiemetic, is widely used for a number of indications including nausea, vomiting, hiccups, and reflux. It has recently had a new "black box" warning issued by the Food and Drug Administration in relation to tardive dyskinesia to limit use to 12 weeks. ⋯ Overall, one in three people gained net clinical benefit at one week. Limiting effects include side-effects that need to be sought actively in clinical care.
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The use of propofol for palliative sedation of children is not well documented. ⋯ Our experience demonstrates that propofol PST is a useful palliative option for pediatric patients experiencing intractable suffering at the end of life. We describe an algorithm that can be used to identify such children who are candidates for PST.
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Forgiveness has begun to receive empirical attention in end-of-life contexts, but primarily among patients. This study examined forgiveness issues and communication priorities among family members of hospice patients. ⋯ Although not as commonly endorsed as expressions of love and gratitude, forgiveness-related communications are seen as extremely important by many family members of hospice patients. If family members see forgiveness (granting or seeking) as important but have not completed the process, these unresolved issues are associated with depressive symptoms. This study suggests that unresolved offenses and forgiveness issues warrant assessment and clinical attention within families receiving hospice care.