Abstract
Letters to the Editor
A multicenter study comparing in-center hemodialysis requiring transport matched to patients on assisted peritoneal dialysis (asPD) found that better renal treatment satisfaction scores were found among the asPD group.
(page 1758)
Brief Reports
Study to determine impact of the advanced illness management program on end-of-life utilization and quality of care.
(page 1835)
Fast Facts and Concepts
End-of-Life Considerations for the Pentecostal Patient #449
(page 1877)
Personal Reflection
Staff and trainees too can practice this attention, spending a few minutes in a patient's room, to pray or meditate. Make the preferential option, perhaps, to spend time with someone whose social world outside the hospital makes you uncomfortable. Above all, behold them; let their stillness quiet—or even bewilder—you.
(page 1880)
Case Discussions in Palliative Medicine
Case of a 10-year-old child with acute lymphoblastic leukemia who developed syndrome of inappropriate antidiuretic hormone (SIADH) after duloxetine was given for chemotherapy-induced neuropathic pain and comorbid anxiety. The SIADH resolved after duloxetine was stopped. This case highlights a rare side effect of duloxetine and caution should be taken when prescribing duloxetine to children.
(page 1884)
Book and Media Reviews
(page 1892)
Home-Based Palliative Care
Implementation research is the most important area to move our field forward in reaching the patients who need palliative care. When things do not turn out as expected is where some of the most important information emerges. This article compares and contrasts two trials of home-based palliative care with different outcomes. The analysis illustrates the challenges of implementation research that are different from those of classical clinical trial design.
(page 1767)
Palliative Care for Heart Failure
Despite being one of the most prevalent causes of death world wide, heart failure is underserved by palliative care despite clinical practice guidelines that recommend it. In this retrospective cohort study of 113,555 patients with heart failure in the centrally managed and funded department of veterans affairs health system in the United States, only 20% received palliative care.
(page 1774)
Pharmacoeconomics of Respiratory Medications Near Death
End-stage respiratory disease such as chronic obstructive pulmonary disease is a leading cause of death worldwide. A challenge is to manage medications in a way that controls symptoms while managing cost. In this retrospective pharmacoeconomic analysis of a national sample of 37,935 patients served by a single pharmacy in the United States, there was significant monetary waste from unused inhalers during a clinical period where the patient would not benefit because of clinical decline. A combination of nebulized and oral medication would control symptoms without unnecessary expense.
(page 1782)
Effect of Payment Model on Pain in Persons Dying of Dementia
Dementia is a leading cause of death in elderly patients living in a nursing home. In this retrospective study of 115,757 patients in the United States where Medicare is the national payer, 18% had pain in the last 5 days of life. Despite the fact that patients were enrolled in a variety of innovative payment models under Medicare, there was no difference.
(page 1795)
Intensive Care Unit Nurse Role in Initiating End-of-Life Care Decision Making
The distinguishing characteristic of the intensive care unit in the hospital is the quality and intensity of nursing care. In this cross-sectional descriptive study in tertiary hospitals in China, nurses reported only moderate initiative in addressing end-of-life care decision making. Facilitators and barriers to end-of-life decision making were significantly correlated with the degree of nurse initiative. The results point to strategies to improve nurse initiative.
(page 1802)
Pharmacist-Initiated Deprescribing as Part of Hospital Palliative Care Consultation
It has been widely noted that, over the course of a serious illness, medications accumulate in the medication list like barnacles on the bottom of a boat. Yet, deprescribing medications when they are no longer useful is an important element of good care for best patient outcomes and cost containment. In this pilot study of 45 hospital in-patients receiving palliative care consultations in the United States, 82% of their recommendations were implemented by the managing service. Medication classes recommended for discontinuation included vitamins/supplements (20%), antidiabetics (3%), antiplatelet (10%), anticoagulants (10%), cholesterol medications (10%), and others.
(page 1818)