Journal of palliative medicine
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Ketamine is a lipophilic, general anesthetic. When given at subanesthetic doses, it also has been found to be an effective analgesic, with efficacy in cancer-associated neuropathic pain, ischemic pain, and regional pain syndromes. ⋯ Ketamine is metabolized via cytochrome P450 3A4, although no significant interactions have been reported. Ketamine is considered one of the World Health Organization (WHO) essential drugs for the management of refractory pain.
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Case Reports
Mood and pain responses to repeat dose intramuscular ketamine in a depressed patient with advanced cancer.
Depression is highly prevalent in patients with advanced cancer, commonly affecting quality of life. Considering the response delay with conventional antidepressants and the short life expectancy for these patients, treatments for Major Depressive Disorder (MDD) with faster onset of action are desirable. ⋯ Pain was also improved, although for a shorter duration. These findings support the use of IM ketamine as a possible antidepressant option for this population.
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To investigate the strength of association between trainees' self-assessments of the quality of their end-of-life communication skills and the assessments of their patients, patients' families, and clinician-evaluators. ⋯ Trainee self-evaluations do not predict assessments by their patients, patients' families, or their clinician-evaluators regarding the quality of end-of-life communication. Although these results should be confirmed using the same measures across all raters, in the meantime efforts to improve communication about end-of-life care should consider outcomes other than physician self-assessment to determine intervention success.
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Case Reports
"Her husband doesn't speak much English": conducting a family meeting with an interpreter.
A growing percentage of critically ill patients and their families in the United States speak limited English. We present the case of a palliative care consult conducted across language barriers to frame a discussion about the use of interpreters for family meetings, including the evidence for using a professional interpreter, the burden experienced by interpreters involved in end-of-life discussions, potential challenges encountered when conducting a family meeting with an interpreter, and recommended best practices for interpreter use in these settings.