Journal of palliative medicine
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Randomized Controlled Trial Clinical Trial
Can we predict which patients with refractory dyspnea will respond to opioids?
Dyspnea is frequently encountered in end-stage diseases even when reversible issues are addressed. Which clinical factors best define patient subpopulations that will most predictably benefit from opioids in this clinical setting? ⋯ Phase 4 pharmaco-vigilance trials are needed in palliative care to define people who are most likely to experience a net benefit from treatment such as opioids for refractory dyspnea.
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Although intravenous midazolam and flunitrazepam are frequently administered for primary insomnia in Japan, there is no empirical study on their efficacy and safety. ⋯ Intravenous midazolam and flunitrazepam appeared to be almost equal about efficacy and safety for primary insomnia, but flunitrazepam is less expensive and shows lower risk of tolerance development. A future prospective comparison study is necessary.
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Previous studies of end-of-life experience have been conducted primarily in urban medical centers and mostly focused on preferences for rather than experience of care. ⋯ Opportunities exist in community health care settings to improve quality of life for people approaching life's end. Clinicians, patients, and patients' families can contribute by engaging in open and ongoing communication about preferences for care, symptoms and their management, activities designed to enrich patients' personal experiences, as well as having patient care coordination and continuity of care on nights and weekends.
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Delirium, a common complication of advanced cancer, may put caregivers at risk for poor mental health outcomes. We looked for a relationship between caregiver-perceived delirium in a patient with advanced cancer and rates of caregiver psychiatric disorders. ⋯ This is the first report of an association between caregiver-perceived delirium and a caregiver mental health outcome. Further studies, using improved measures of delirium, are needed.
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To examine the current practices relating to do-not-resuscitate (DNR) orders for terminal patients with cancer at teaching hospitals in Korea. ⋯ From our teaching-hospital-based analysis of terminal cancer patients in Korea, consent for a DNR order was common. However, DNR order forms were not standardized and lacked room to document patient involvement in the decision. Usually the DNR decision was made within last days of the patient's life. Our results reflect the need for the improvement of end-of-life care decisions in Korea.