Journal of palliative medicine
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Objective: We present a case of a patient with an intrathecal pump who experienced an unrecognized partial pocket fill, leading to an atypical opioid withdrawal characterized by akathisia. Case Report: A 57-year-old female with multiple myeloma presented to an emergency department with new-onset akathisia requiring admission. Eight weeks prior, her intrathecal pump was refilled with morphine, bupivacaine, and ziconotide. ⋯ Furthermore, she reported sedation following her last pump refill, all consistent with an unrecognized partial pocket fill followed by an unusual opioid withdrawal presentation. Conclusions: This case represents an example of both an unrecognized partial pocket fill and an atypical presentation of opioid withdrawal manifesting as akathisia. Furthermore, this patient's case may be considered a medical error given the serious morbidity that can be associated with inadvertent pocket fills.
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Background: Despite the increasing focus on goal-concordant care in the emergency department (ED), there is limited data about patients who receive a new hospice referral and the care paths of patients on hospice who present there. Objective: Describe the characteristics and clinical course of ED patients who receive a new hospice referral and those already receiving hospice care. Methods: Retrospective chart review of all adult patients presenting to the ED from January 2021 to July 2023. ⋯ No patients had repeat health care encounters at our hospital. 42% (31/74) of patients enrolled in hospice required admission. Conclusion: New hospice referrals in the ED are possible but rare. Further research should investigate possible missed opportunities to provide goal-concordant care.
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Background: Dementia clinical trials often fail to include diverse and historically minoritized groups. Objective: We sought to adapt the Alzheimer's Disease and Related Dementias-Palliative Care (ADRD-PC) clinical trial to improve enrollment and address the cultural needs of people with late-stage ADRD who identify as Hispanic or Latino and their family caregivers. Design: Bilingual, bicultural research team members adapted study materials and processes using the Cultural Adaptation Process Model. ⋯ Adaptations to the ADRD-PC study materials included specific consideration of preferred language, word choices (i.e., "palliative care" and "caregiver"), and recruitment considerations related to potential barriers to palliative care or research in general. Conclusions: Cultural adaptation of the ADRD-PC dementia palliative care clinical trial protocol depended on participatory methods and collaboration between Hispanic/Latino caregiver advisors and researchers, including bilingual, bicultural team members. Comparable methods may inform future culturally inclusive approaches to clinical research and thus improve representation of minoritized groups in dementia care research.
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Background: Medical aid in dying is legal in 10 states plus Washington DC, covering 22% of the U. S. population. Much has been written about the ethics of aid in dying, but little about evidence-based care, especially the medications used. ⋯ Two of the sedative/cardiotoxin combinations yielded median times to death of 0.8 hours. But from 2018 to 2023, as the medication combinations shifted, the mean time to death declined while the median remained relatively steady-confirming that these combinations reduced the incidence of longer deaths (especially extreme outliers). Conclusion: This first-time analysis of aid-in-dying medication protocols showed that while a sedative alone had the best median time to death, the most recent sedative/cardiotoxin protocol had an acceptable median time to death of 0.8 hours, but with fewer prolonged-death outliers.