Journal of palliative medicine
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Background: To understand real-world dispensing and utilization patterns of medical cannabis (MC) and its financial impact on patients, we analyzed the database of a cannabis company licensed in New York state. Objectives: To evaluate the tetrahydrocannabinol (THC)/cannabidiol (CBD) dose ratios, association of various medical conditions to THC/CBD dose, and the cost of products in registered patients receiving MC from four licensed state dispensaries. Design: Retrospective analysis conducted on anonymized data between January 1, 2016 and December 31, 2020 listing 422,201 dispensed products from 32,845 individuals aged 18 years and older. ⋯ Individuals with a history of substance use disorder utilizing MC as an alternative substance displayed the highest average THC/dose [mean (95% CI): 14.25 (13.36-15.14)]. Conclusion: MC was utilized for various medical conditions with variability in THC:CBD ratio seen depending on the condition. Cost variation was also observed based on the individual's medical condition.
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Background: The benefits of palliative care programs are well documented. However, the effectiveness of specialist palliative care services is not well established. The previous lack of consensus on criteria for defining and characterizing models of care has restrained direct comparison between these models and limited the evidence base to inform policy makers. ⋯ Findings from qualitative studies revealed that care coordination, provision of practical help, after-hours support, and medical crisis management were some of the factors contributing to patients' and caregivers' positive experience. Conclusion: Strong evidence exists for community specialist palliative care to improve quality of life and reducing secondary service utilization. Future research should focus on equity outcomes and the interface between generalist and specialist care.
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Case Reports
Fluoroquinolone-Induced Seizure in a Patient Receiving End-of-Life Care: A Case Report.
When caring for patients nearing the end of live (EOL), healthcare providers must carefully assess the potential benefits and drawbacks of common medical interventions, such as starting antibiotic treatment. Antibiotic use during this stage can be a challenging and multifaceted situation, encompassing important clinical, social, and ethical considerations. While physicians may be motivated to prescribe antibiotics to terminally ill patients in hopes of prolonging survival and alleviating symptoms, it's crucial to recognize that these drugs can have significant implications for individuals at the EOL. ⋯ Geriatric patients, who often have underlying risk factors, are particularly susceptible to fluoroquinolone-induced seizures. However, there have also been reports of otherwise healthy individuals experiencing seizures as a result of fluoroquinolone use. This report sheds light on the complexities associated with initiating antibiotic therapy in patients nearing the EOL.
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Purpose: To assess the feelings and knowledge of health care professionals (HCPs) about gasping in dying patients in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs). Methods: A 9-item questionnaire addressed to 488 HCPs (physicians, nurses, and nursing assistants) of 2 NICUs and 2 PICUs. ⋯ Of the respondents, 43% felt that gasping was painful to the patient and most felt that witnessing gasps was distressing for the parents, and 77% reported being distressed by witnessing gasps. Conclusions: Efforts are needed to educate HCPs about the physiology of gasping, to help them to cope with gasping, and to give better support to parents.