scholarly journals Forensic Toxicological and Medico-Legal Evaluation in a Case of Incongruous Drug Administration in Terminal Cancer Patients

Toxics ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 356
Author(s):  
Pascale Basilicata ◽  
Pasquale Giugliano ◽  
Giuseppe Vacchiano ◽  
Angela Simonelli ◽  
Rossella Guadagni ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Young Male ◽  
Lung Parenchyma ◽  
Clinical Situation ◽  
Anterior Mediastinum ◽  
Terminal Cancer ◽  
Pharmacological Interaction ◽  
Increased Risk ◽  
Terminal Cancer Patients

Background: In most cases, palliative care is prescribed to adults diagnosed with cancer. The definition of the most suitable therapy for an effective sedation in terminal cancer patients still represents one of the most challenging goals in medical practice. Due to their poor health, the correct dosing of drugs used for deep palliative sedation in terminal cancer patients, often already on polypharmacological therapy, can be extremely complicated, also considering possible drug-to-drug interactions that could lead to an increased risk of overdose and/or incongruous administration with fatal outcomes. The case of a terminal cancer patient is presented, focusing on the “adequacy” of administered therapy. Materials and Methods: A young male, affected by Ewing sarcoma, attending a palliative care at his own home, died soon after midazolam administration. Toxicological and histological analyses were performed on body fluids and organ fragments. Results and Discussion: Morphological reliefs evidenced a neoplastic mass, composed of lobulated tissue with a lardy, pinkish-gray consistency, extending from the pleural surface to the lung parenchyma, also present at the sacrum region (S1–S5), at the anterior mediastinum level, occupying the entire left pleural cavity, and infiltrating the ipsilateral lung. Metastatic lesions diffused to rachis and lumbar structures. The brain presented edema and congestion. Toxicological analyses evidenced blood midazolam concentrations in the range of 0.931–1.690 µg/mL, while morphine was between 0.266 and 0.909 µg/mL. Death was attributed to cardiorespiratory depression because of a synergic action between morphine and midazolam. The pharmacological interaction between midazolam and morphine is discussed considering the clinical situation of the patient. The opportunity to proceed with midazolam administration is discussed starting from guidelines recommendation. Finally, professional liability outlines are highlighted.

scholarly journals Current Use of Sedatives for Terminal Cancer Patients near Death Receiving Home Palliative Care, and Influence on Home Care Period

2019 ◽  
Vol 14 (3) ◽  
pp. 187-192
Author(s):  
Kotaro Hashimoto ◽  
Kazuki Sato ◽  
Mitsuharu Sasaki ◽  
Hiroaki Takabayashi ◽  
Masanori Kawahara ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Cancer Patients ◽  
Terminal Cancer ◽  
Terminal Cancer Patients ◽  
Care Period

Development of a spiritual pain assessment sheet for terminal cancer patients: Targeting terminal cancer patients admitted to palliative care units in Japan

2006 ◽  
Vol 4 (2) ◽  
pp. 179-188 ◽  
Author(s):  
KEIKO TAMURA ◽  
KAORI ICHIHARA ◽  
EIKO MAETAKI ◽  
KEIKO TAKAYAMA ◽  
KUMI TANISAWA ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Three Dimensions ◽  
Terminal Cancer ◽  
Philosophical Perspective ◽  
Terminal Cancer Patients ◽  
Assessment Sheet ◽  
Palliative Care Units

Objective: This research explores the potential benefit of a spiritual pain assessment sheet to clinical practice. With spiritual pain defined as “pain caused by extinction of the being and meaning of the self,” the spiritual pain assessment sheet was developed by Hisayuki Murata from his conceptual framework reflecting the three dimensions of a human being as a being founded on temporality, a being in relationship, and a being with autonomy. The assessment sheet was developed from reviews of the literature and examinations from a philosophical perspective on the structure of spiritual pain.Methods: Patients admitted to palliative care units in Japan were interviewed using the assessment sheet. The responses were analyzed qualitatively. The usefulness of the assessment sheet and the burden placed on the patients by its use were also investigated.Results: The spiritual pain elucidated by the assessment sheet was the same as that revealed in the earlier research of Morita. The patients reported that they did not find the use of the assessment sheet a burden, and more than half reported that it was useful. The burden of the assessment sheet on the subjects was thus determined to be low. Positive feedback on the assessment sheet was also received from the nurses who conducted the patient interviews, who said the assessment sheet made it easier to talk with the patients about their spiritual pain.Significance of research: The research results indicate that the spiritual pain assessment sheet provided an appropriate assessment of spiritual pain among terminal cancer patients, showing that such a sheet could be used as an assessment tool in the future.

scholarly journals The efficacy of specialised rehabilitation using the Op-reha Guide for cancer patients in palliative care units: protocol of a multicentre, randomised controlled trial (JORTC-RHB02)

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Nanako Nishiyama ◽  
Yoshinobu Matsuda ◽  
Noriko Fujiwara ◽  
Keisuke Ariyoshi ◽  
Shunsuke Oyamada ◽  
...  
Keyword(s):  
Palliative Care ◽  
Randomised Controlled Trial ◽  
Cancer Patients ◽  
Group Performance ◽  
Controlled Trial ◽  
Care Group ◽  
Terminal Cancer ◽  
Terminal Cancer Patients ◽  
Palliative Care Units ◽  
Randomised Controlled

Abstract Background Although rehabilitation is recommended for terminal cancer patients, the specific components and methods of such programs are poorly documented. No studies to date have examined the effectiveness of rehabilitation for terminal cancer patients. This study aims to evaluate the efficacy of a new intervention for rehabilitation therapists, using the Op-reha Guide (Guide to Optimal and Patient-Centred Rehabilitation Practice for Patients in Palliative Care Units [PCUs]) in rehabilitation practice. This guide consists of recommended actions and attitudes for rehabilitation therapists and aims to optimise therapists’ actions according to the patient’s needs and condition. It shares goals with terminal cancer patients to maintain their activities of daily living (ADL). Methods This study uses a multicentre, prospective, randomised controlled trial (RCT) design with two parallel groups in PCUs where specialised rehabilitation will be routinely performed for terminal cancer patients by rehabilitation therapists. Participants will be randomised (1:1) to intervention (the Op-reha Guide) and control groups (usual rehabilitation). We will then conduct an observational study in PCUs that do not perform specialised rehabilitation for terminal cancer patients; this will be considered the usual care group, and the efficacy of usual rehabilitation will be quantitatively evaluated. Inclusion criteria are hospitalisation in PCU, European Cooperative Oncology Group Performance Status of 2 or 3, and clinical estimation of life expectancy of 3 weeks or more. Patients with severe symptom burden will be excluded. We hypothesise that the Op-reha Guide will be more effective in maintaining the ADL of terminal cancer patients hospitalised in PCUs than usual rehabilitation. The primary endpoint is defined as the change in (total) modified Barthel Index from baseline to Day 22. Quality of life will be a secondary endpoint. In total, 135 patients will be recruited from 16 Japanese sites between July 2019 and December 2021. Discussion This will be the first trial to evaluate the efficacy of specialised rehabilitation for terminal cancer patients hospitalised in PCUs, and will contribute to the evidence on the efficacy of implementing rehabilitation for terminal cancer patients. Trial registration UMIN-CTR, UMIN000037298 R000042525 (date of registration 7 July 2019).

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