Journal of palliative medicine
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Malignant bowel obstruction (MBO) frequently defines the trajectory of end-stage ovarian cancer and results in severe physical and psychological distress in patients and their caregivers. Venting gastrostomy (VG) is an alternative to both prolonged medical therapy with nasogastric intubation and intestinal bypass/diversion for refractory MBO. Limited published data from large academic research centers support use of VG in patients with advanced ovarian cancer and MBO. ⋯ Five of six patients were managed with VG. Our experience suggests that VG may be beneficial in controlling nausea and vomiting in ovarian cancer patients with MBO and that VG placement with concurrent evacuation of large-volume ascites was associated with minimal complications. Future prospective studies to evaluate the benefits of VG are warranted.
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Entrustable professional activities (EPAs) are routine tasks considered essential to a professional practice. An EPA can serve as a performance-based outcome that a clinical supervisor would progressively entrust a learner to perform. ⋯ Near uniform agreement from a national group of palliative medicine physicians provides strong validation for the set of 12 EPAs.
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"Chemical coping" is a commonly used term in the pain and palliative care literature, but is heterogeneously defined. We conducted a Delphi survey among palliative care and pain specialists internationally to identify a consensus definition for "chemical coping with opioids" and warning signs for chemical coping. ⋯ Our expert panel reached a consensus definition for chemical coping and related warning signs, which may help clinicians and researchers to identify patients at risk of opioid misuse.