Prescribing of Continuous Parenteral Infusions for Symptom Relief in Dying Patients: Reassuring but Needs Further Investigation

2019 ◽  
Author(s):  
Eilidh Burns
Keyword(s):  
Symptom Relief ◽  
Dying Patients ◽  
Parenteral Infusions

scholarly journals CARer-ADministration of as-needed subcutaneous medication for breakthrough symptoms in homebased dying patients (CARiAD): study protocol for a UK-based open randomised pilot trial

2018 ◽  
Author(s):  
Marlise Poolman ◽  
Jessica Roberts ◽  
Anthony Byrne ◽  
Paul Perkins ◽  
Zoe Hoare ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Controlled Trial ◽  
Symptom Relief ◽  
Symptom Control ◽  
Pilot Trial ◽  
Life Care ◽  
Dying Patients ◽  
Wish To Die ◽  
The Uk ◽  
At Home

Abstract Background: Whilst the majority of seriously ill people wish to die at home, only half achieve this. The likelihood of someone dying at home often depends on the availability of able and willing lay carers to support them. Dying people are usually unable to take oral medication. When top-up symptom relief medication is required, a clinician travels to the home to administer injectable medication, with attendant delays. The administration of subcutaneous injections by lay carers, though not widespread practice in the UK, has proven key in achieving home deaths in other countries. Our aim is to determine if carer-administration of as-needed subcutaneous medication for four frequent breakthrough symptoms (pain, nausea, restlessness and noisy breathing) in home-based dying patients is feasible and acceptable in the UK. Methods: The paper describes a randomised pilot trial across three UK sites, with an embedded qualitative study. Dyads of adult patients/carers are eligible, where patients are in the last weeks of life, wish to die at home, and lay carers who are willing to be trained to give subcutaneous medication. Dyads who do not meet strict risk assessment criteria (including known history of substance abuse or carer ability to be trained to competency) will not be approached. Carers in the intervention arm will receive a manualised training package delivered by their local nursing team. Dyads in the control arm will receive usual care. The main outcomes of interest are feasibility, acceptability, recruitment rates, attrition and selection of the most appropriate outcome measures. Interviews with carers and healthcare professionals will explore attitudes to, experiences of and preferences for giving subcutaneous medication and experience of trial processes. The study has obtained full ethical approval. Discussion: This study will rehearse the procedures and logistics which will be undertaken in a future definitive randomised controlled trial, and will inform the design of such a study. Findings will illuminate methodological and ethical issues pertaining to researching last days of life care. The study is funded by the National Institute for Health Research (Health Technology Assessment [HTA] project 15/10/37). Trial registration: ISRCTN, ISRCTN 11211024. Assigned 27 September 2016, http://www.isrctn.com/ISRCTN11211024. Keywords: End-of-life care, Care of the dying, Palliative care, Symptom control, Carer administration, Randomised pilot trial

scholarly journals CARer-ADministration of as-needed subcutaneous medication for breakthrough symptoms in homebased dying patients (CARiAD): study protocol for a UK-based open randomised pilot trial

2019 ◽  
Author(s):  
Marlise Poolman ◽  
Jessica Roberts ◽  
Anthony Byrne ◽  
Paul Perkins ◽  
Zoe Hoare ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Controlled Trial ◽  
Symptom Relief ◽  
Symptom Control ◽  
Pilot Trial ◽  
Life Care ◽  
Dying Patients ◽  
Wish To Die ◽  
The Uk ◽  
At Home

Abstract Background: Whilst the majority of seriously ill people wish to die at home, only half achieve this. The likelihood of someone dying at home often depends on the availability of able and willing lay carers to support them. Dying people are usually unable to take oral medication. When top-up symptom relief medication is required, a clinician travels to the home to administer injectable medication, with attendant delays. The administration of subcutaneous injections by lay carers, though not widespread practice in the UK, has proven key in achieving home deaths in other countries. Our aim is to determine if carer-administration of as-needed subcutaneous medication for four frequent breakthrough symptoms (pain, nausea, restlessness and noisy breathing) in home-based dying patients is feasible and acceptable in the UK. Methods: The paper describes a randomised pilot trial across three UK sites, with an embedded qualitative study. Dyads of adult patients/carers are eligible, where patients are in the last weeks of life, wish to die at home, and lay carers who are willing to be trained to give subcutaneous medication. Dyads who do not meet strict risk assessment criteria (including known history of substance abuse or carer ability to be trained to competency) will not be approached. Carers in the intervention arm will receive a manualised training package delivered by their local nursing team. Dyads in the control arm will receive usual care. The main outcomes of interest are feasibility, acceptability, recruitment rates, attrition and selection of the most appropriate outcome measures. Interviews with carers and healthcare professionals will explore attitudes to, experiences of and preferences for giving subcutaneous medication and experience of trial processes. The study has obtained full ethical approval. Discussion: This study will rehearse the procedures and logistics which will be undertaken in a future definitive randomised controlled trial, and will inform the design of such a study. Findings will illuminate methodological and ethical issues pertaining to researching last days of life care. The study is funded by the National Institute for Health Research (Health Technology Assessment [HTA] project 15/10/37). Trial registration: ISRCTN, ISRCTN 11211024. Assigned 27 September 2016, http://www.isrctn.com/ISRCTN11211024. Keywords: End-of-life care, Care of the dying, Palliative care, Symptom control, Carer administration, Randomised pilot trial

Palliative Uses of Methylphenidate in Patients With Cancer: A Review

2002 ◽  
Vol 20 (1) ◽  
pp. 335-339 ◽  
Author(s):  
Mark Rozans ◽  
Albert Dreisbach ◽  
Juan J.L. Lertora ◽  
Marc J. Kahn
Keyword(s):  
Palliative Care ◽  
English Language ◽  
Literature Search ◽  
Medical Literature ◽  
Symptom Relief ◽  
Analgesic Effects ◽  
Patients With Cancer ◽  
Hyperactivity Disorder ◽  
Dying Patients ◽  
Precise Role

PURPOSE: Cancer is, unfortunately, often a terminal disease. The goal of therapy for many patients with cancer is palliation of symptoms common at the end of life, including pain, depression, and cognitive dysfunction. Methylphenidate is a psychostimulant most commonly used in the treatment of attention deficit hyperactivity disorder. In this report, we review the use of methylphenidate in the palliative care of patients with cancer. METHODS: This review was written on the basis of a computerized literature search of Medline. We considered all English language publications from 1966 to present using the following key words: methylphenidate, palliative care, and cancer. Forty-nine articles were identified as being relevant for this review. RESULTS: On the basis of this review, we came to the conclusion that methylphenidate is used to ameliorate opioid-induced somnolence, to augment the analgesic effects of opioids, to treat depression, and to improve cognitive function in patients with cancer. CONCLUSION: The medical literature supports the palliative use of methylphenidate in the care of patients with cancer. Further placebo-controlled trials are needed to elucidate the precise role that methylphenidate will have in providing symptom relief to dying patients.

Research on Starvation in the Warsaw Ghetto – Ethical Problems

2010 ◽  
pp. 439-450
Author(s):  
Marta Janczewska
Keyword(s):  
Research Team ◽  
Ethical Dilemmas ◽  
Medical Profession ◽  
Research Work ◽  
Special Kind ◽  
Scientific Discipline ◽  
Medical Treatments ◽  
Warsaw Ghetto ◽  
Dying Patients ◽  
To Receive

Research team of physicians and lab technicians under Izrael Milejkowski’s direction undertook the effort to carry out a series of clinical and biochemical experiments on patients dying of starvation in the Warsaw ghetto so as to receive the fullest possible picture of hunger disease. The research was carried out according to all the rigors of strict scientific discipline, and the authors during their work on academic articles, published it after the war entitled: „Starvation disease: hunger research carried out in the Warsaw ghetto in 1942,” according to their own words, they “supplemented the gap in accordance with the progress of knowledge.” The article is devoted to the reflections over ethical dilemmas of the research team, who were forced in their work to perform numerous medical treatments of experimental nature on extremely exhausted patients. The ill, according to Dr Fajgenblat’s words,“demonstrated negativism toward the research and treatment, which extremely hindered the work, and sometimes even frustrated it.” The article attempts to look at the monumental research work of the Warsaw ghetto doctors as a special kind of response of the medical profession to the feeling of helplessness to the dying patients. The article analyzes the situation of Warsaw ghetto doctors, who undertook the research without support of any outer authority, which could settle their possible ethical dilemmas (Polish deontological codes, European discussions on the conditions of the admissibility of medical research on patients, etc.).

Should Percutaneous Coronary intervention be the Standard Treatment Strategy for Significant Coronary Artery Disease in all Octogenarians?.

2020 ◽  
Vol 16 ◽  
Author(s):  
George Kassimis ◽  
Grigoris V. Karamasis ◽  
Athanasios Katsikis ◽  
Joanna Abramik ◽  
Nestoras Kontogiannis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Symptom Relief ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Coronary artery disease (CAD) remains the leading cause of cardiovascular death in octogenarians. This group of patients represents nearly a fifth of all patients treated with percutaneous coronary intervention (PCI) in real-world practice. Octogenarians have multiple risk factors for CAD and often greater myocardial ischemia than younger counterparts, with a potential of an increased benefit from myocardial revascularization. Despite this, octogenarians are routinely under-treated and belittled in clinical trials. Age does make a difference to PCI outcomes in older people, but it is never the sole arbiter of any clinical decision, whether in relation to the heart or any other aspect of health. The decision when to perform revascularization in elderly patients and especially in octogenarians is complex and should consider the patient on an individual basis, with clarification of the goals of the therapy and the relative risks and benefits of performing the procedure. In ST-segment elevation myocardial infarction (MI), there is no upper age limit regarding urgent reperfusion and primary PCI must be the standard of care. In non-ST-segment elevation acute coronary syndromes, a strict conservative strategy must be avoided; whereas the use of a routine invasive strategy may reduce the occurrence of MI and need for revascularization at follow-up, with no established benefit in terms of mortality. In stable CAD patients, invasive therapy on top of the optimal medical therapy seems better in symptom relief and quality of life. This review summarizes the available data on percutaneous revascularization in the elderly patients and particularly in octogenarians, including practical considerations on PCI risk secondary to ageing physiology. We also analyse technical difficulties met when considering PCI in this cohort and the ongoing need for further studies to ameliorate risk stratification and eventually outcomes in these challenging patients.

How Do People Taking Psychiatric Drugs Explain Their “Chemical Imbalance?”

2012 ◽  
Vol 13 (3) ◽  
pp. 176-189 ◽  
Author(s):  
David Cohen ◽  
Shannon Hughes
Keyword(s):  
Drug Effect ◽  
Symptom Relief ◽  
Institutional Support ◽  
Mental Illnesses ◽  
Personal Meaning ◽  
Mental Health Practitioners ◽  
Psychiatric Drugs ◽  
Health Practitioners ◽  
Chemical Imbalance ◽  
Post Hoc

Many people believe that chemical imbalances cause mental illnesses, despite the absence of evidence to ascertain this. This study describes the reasoning that people use in their own case to justify this belief. Data come from recorded medication histories with 22 adults aged 23–68 years, taking different psychiatric drugs for various problems and varying durations, asked directly if they thought their problem was caused by a chemical imbalance and to explain their answer. About two-thirds expressed belief that they had a chemical imbalance; and the rest that they did not have one, did not or could not know, or that their medication had caused one. Reasoning backward from positive drug experiences (ex juvantibus or post hoc) and appeals to authority and convention characterized most answers expressing belief in an imbalance. Experiencing improvement while taking drugs and acquiescing in mental health practitioners’ views instills or reinforces people’s belief that they are or were chemically imbalanced, which suggests viewing the belief as a drug effect. The chemical imbalance notion is likely to persist, as its appeal to give personal meaning to symptom relief and its unfalsifiability ensure institutional support that neutralizes the absence of scientific support.

scholarly journals Are public health measures and individualised care compatible in the face of a pandemic? A national observational study of bereaved relatives’ experiences during the COVID-19 pandemic

2021 ◽  
pp. 026921632110198
Author(s):  
Catriona R Mayland ◽  
Rosemary Hughes ◽  
Steven Lane ◽  
Tamsin McGlinchey ◽  
Warren Donnellan ◽  
...  
Keyword(s):  
Public Health ◽  
Family Support ◽  
Online Survey ◽  
Free Text ◽  
Professional Networks ◽  
Dying Patients ◽  
The Face ◽  
Individualised Care ◽  
The Impact ◽  
Informative Communication

Background: COVID-19 public health restrictions have affected end-of-life care experiences for dying patients and their families. Aim: To explore bereaved relatives’ experiences of quality of care and family support provided during the last days of life; to identify the impact of factors associated with perceived support. Design: A national, observational, open online survey was developed and disseminated via social media, public fora and professional networks (June–September 2020). Validated instruments and purposively designed questions assessed experiences. Analysis used descriptive statistics, logistic regression and thematic analysis of free-text responses. Participants: Individuals (⩾18 years) who had experienced the death of a relative/friend (all care settings) within the United Kingdome during the COVID-19 pandemic. Results: Respondents ( n = 278, mean 53.4 years) tended to be female ( n = 216, 78%); over half were ‘son/daughter’ (174, 62.6%) to the deceased. Deceased individuals (mean 81.6 years) most frequently died in their ‘usual place of care’ ( n = 192, 69.3%). Analysis established five conceptual themes affecting individualised care: (1) public health restrictions compounding the distress of ‘not knowing’; (2) disparate views about support from doctors and nurses; (3) challenges in communication and level of preparedness for the death; (4) delivery of compassionate care; (5) emotional needs and potential impact on grief. Male respondents (OR 2.9, p = 0.03) and those able to visit (OR 2.2, p = 0.04) were independently associated with good perceptions of family support. Conclusion: Despite public health restrictions, individualised care can be enabled by proactive, informative communication; recognising dying in a timely manner and facilitating the ability to be present before death.

Sign in / Sign up

Export Citation Format

Share Document