Journal of palliative medicine
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Background: People prefer to die at home, if given a choice. However, data show that less than half of hospice patients get to do so, as many lack the social resources needed for end-of-life (EOL) care to be supported at home. The Social Model Hospice Home (SMHh) is an emerging model of care and offers an option for individuals whose EOL care cannot be fully supported by their available social network. ⋯ These themes reveal the beginning of an explanatory theory of why the SMHh concept can support the delivery of effective, high-quality EOL care. Conclusions: The result of this study substantiates SMHh as a viable alternative to traditional in-home or institution-based EOL care. As the SMHh movement develops, more research is needed to explore and understand how this emerging model of care can be implemented on a larger scale.
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Background: Since the onset of the COVID-19 pandemic, all facets of palliative care provision for patients with serious illness have faced unparalleled challenges. Methods: We describe our palliative care program's response to the increased clinical volume associated with the pandemic by adapting workflows for inpatient and outpatient palliative care teams caring for oncology and nononcology populations. ⋯ Discussion: This article highlights transformations in palliative care delivery implemented in response to the pandemic and reflects on how these transformations have shaped our current care delivery models. We further delineate our intentional reliance on key population health principles to drive ongoing innovation in palliative care provision across our clinical teams.
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Case Reports
Novel Use of Intranasal Dexmedetomidine for Refractory Irritability in Pediatric Home Care.
Background: Dexmedetomidine is a selective alpha-2 agonist with sedative, analgesic, and anxiolytic properties used intravenously for procedural sedation and in the intensive care unit. The reported use of intranasal (IN) dexmedetomidine for symptom management in pediatric palliative care is limited. Case History: A boy with cardiofaciocutaneous syndrome and refractory irritability was supported by pediatric palliative care throughout numerous hospitalizations for goals of care discussions and pain and symptom management. ⋯ After the addition of scheduled IN dexmedetomidine for management of irritability, the boy demonstrated marked improvement in comfort and sleep. Conclusion: This case report shows the successful use of IN dexmedetomidine for management of refractory irritability with no noted adverse effects. Future studies and use of this medication will need to consider potential indications, optimal dosing, and long-term effects in the pediatric palliative care setting.
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People of the Pentecostal faith are a grouping of Protestant Christians. Pentecostals are a growing group not only in the United States, but also worldwide. ⋯ This article offers 10 recommendations for clinicians to better understand and support Pentecostal patients and families. These overarching concepts of Pentecostal faith and practices are presented as a point of initiation for further exploration of the support that may be needed, and not as a comprehensive guide.
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Background: Cardiac resynchronization therapy (CRT) improves quality of life (QOL) in heart failure (HF) patients with reduced ejection fraction. Clinicians may have difficulty choosing between CRT with a pacemaker (CRT-P) or a defibrillator (CRT-D) for older patients. CRT-P devices are smaller, have more battery longevity, are less prone to erosions or recalls, and do not deliver shocks. ⋯ Larger cohort studies with longer follow-up are needed to accurately assess potential QOL differences between CRT-D and CRT-P recipients to guide clinical decision making and ensure the right balance of risk versus benefit in these patients. Appropriate goals-of-care discussions are the corner stone of clinical decision making regarding defibrillator therapy. As such, even as the data stand at present, there is a need for more deliberate referral of older patients with HF to Palliative Care Specialists, or to Cardiologists trained in Palliative Care Medicine. clinicaltrials.gov listing: NCT03031847.