Journal of palliative medicine
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In imminently dying patients, mechanical ventilation withdrawal is often a comfort measure and avoids prolonging the dying process. ⋯ Palliative withdrawal of mechanical ventilation was performed in only half of dying mechanically ventilated patients. Because clinical service rather than physiologic parameters are associated with withdrawal, targeted interventions may improve withdrawal decisions. Considering FIO2 and vasopressor requirements may facilitate counseling families about anticipated time to death.
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Multicenter Study
Polypharmacy and drug omissions across hospices in Northern Ireland.
Polypharmacy and drug omissions (DO) (i.e., drugs prescribed but not administered) may impact on quality of life of hospice inpatients. ⋯ Polypharmacy is prevalent among hospice inpatients. Drugs omitted amounted to 8.8%, with the frequency of DO increasing in those who were dying. Documentation justifying DO was lacking. Daily focused drug chart review, pharmacy support, and electronic prescribing may all help to reduce and rationalize medication burden and aid prompt and effective management of DO.
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Observational Study
Is it appropriate to withdraw antibiotics in terminal patients with cancer with infection?
Antibiotic administration is frequent in terminal patients with cancer, yet the effects on survival are still under debate. ⋯ The results suggest that with good communication between patients, families, and medical staff, withdrawal of antibiotics should be considered if signs of death appear, in order to avoid unnecessary risks. The possible benefit of prolonged survival should be in line with the goal of care, and also take into account preparing the patient for a dignified death.
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Patients are commonly referred to cancer genetics services when all affected family members are deceased. This makes genetic testing and risk assessment more difficult, reducing the benefit from screening and prophylactic treatment. ⋯ Using a simple "3, 2, 1" family rule in cancer care and particularly in palliative care could enable earlier cancer genetic risk assessment for unaffected relatives, improving the potential to benefit from targeted screening and intervention.
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Cancer pain continues to be undertreated, despite the availability of evidence-based guidelines. The Australian National Pain Strategy identified establishment of systems and guidelines to adequately manage cancer pain as a high priority. ⋯ Barriers to evidence-based practice identified by our survey might be addressed via strategies to support decision making and coordination of care (e.g., a clinical pathway). Particular attention should be paid to promoting access to nonpharmacologic interventions and patient education, and improving referral and care coordination.