Journal of palliative medicine
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Barriers to providing quality end-of-life (EOL) care in the intensive care unit (ICU) are common, but little is known about how these barriers vary by level of training or discipline. ⋯ We found that perceived barriers to EOL care differed significantly by level of training, discipline and institution, suggesting the interventions to improve EOL care may need to be locally targeted and specific to level of training and discipline.
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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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A large gap exists between the practice of emergency medicine and palliative care. Although hospice and palliative medicine has recently been recognized as a subspecialty of emergency medicine, few palliative care teams routinely interact with emergency providers, and primary palliative care skills among emergency providers are lacking. ⋯ At an urban academic medical center with a well-developed palliative care service, the majority of palliative care consultations were for patients who arrive via the ED. Despite this, only a small minority of consultations originated from emergency providers and consultation was on average initiated days into a patient's hospital stay.
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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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Proxy reporting is frequently used to assess symptom distress of patients with advanced chronic organ failure. The aim of the present cross-sectional study was to examine agreement in severity of symptom distress, presence of symptom-related interventions, and satisfaction with medical treatment among patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and chronic renal failure (CRF) and their family caregivers. ⋯ Studies using proxy reporting reflect the views of proxies and do not accurately represent the patients' experience. For clinical care, it's important to pay attention to the perception from the patient as well as the perception from the family caregiver of symptom distress, presence of symptom-related interventions, and satisfaction with treatment.