Nonsurgical Rhinoplasty in Patients of African Descent: A Retrospective Review.

Background: There is a paucity of research on nonsurgical rhinoplasty in the population of African descent. In this group, underlying anatomy and aesthetic ideals vary, necessitating differences in the consultation process and in treatment. The authors present a case series from a single clinician's practice performing nonsurgical rhinoplasty on patients of African descent.

Ultralow-Dose Adjunctive Methadone with Slow Titration, Considering Long Half-Life, for Outpatients with Cancer-Related Pain.

The unique properties of methadone make it attractive for use in cancer pain. The use of very low initial doses of adjunctive methadone is a promising strategy given its simplicity and potentially reduced risk profile. To understand if an ultralow-dose (ULD) methadone protocol (1 mg by mouth daily initial dose with gradual titration) can improve pain control in outpatients with cancer-related pain not responsive to previous opioids and/or nonopioid analgesics.

Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer.

Background: Advanced lung cancer patients face significant physical and psychological burden leading to reduced physical function and quality of life. Separately, physical activity, nutrition, and palliative symptom management interventions have been shown to improve functioning in this population, however no study has combined all three in a multimodal intervention. Therefore, we assessed the feasibility of a multimodal physical activity, nutrition, and palliative symptom management intervention in advanced lung cancer.

Surgical cordotomy helps psychosocial suffering.

A young woman was admitted to our palliative care unit with severe pain to her right hip and leg. Her pain was uncontrolled despite aggressive use of opioids, adjuvant pain medications and spinal analgesia. She experienced significant psychological and social distress, but engaging in therapies with our multidisciplinary team proved difficult.

Description of Continuous Palliative Sedation Practices in a Large Health Region and Comparison with Clinical Practice Guidelines.

Published reports of continuous palliative sedation therapy (CPST) suggest heterogeneity in practice. There is a paucity of reports that compare practice with clinical guidelines. To assess adherence of continuous palliative sedation practices with criteria set forth in local clinical guidelines, and to describe other features including prevalence, medication dosing, duration, multidisciplinary team involvement, and concurrent therapies.

Outcomes From a Patient-Centered, Interprofessional, Palliative Consult Team in Oncology.

Palliative care aims to improve suffering and quality of life for patients with life-limiting disease. This study evaluated an interdisciplinary palliative consultation team for outpatients with advanced cancer at the Tom Baker Cancer Centre. This team traditionally offered palliative medicine and recently integrated a specialized psychosocial clinician.

Patient-family agreement on values and preferences for life-sustaining treatment: results of a multicentre observational study.

Objectives: To quantify agreement between patients and their family members on their own values and preferences for use or non-use of life-sustaining treatments for the patient.

Methods: Hospitalised patients aged 55 years or older with advanced pulmonary, cardiac, liver disease or metastatic cancer or aged 80 years or older from medical wards at 16 Canadian hospitals and their family members completed a questionnaire including eight items about values related to life-sustaining treatment and a question about preferences for life-sustaining treatments.

Results: We recruited a total of 313 patient-family member dyads.

'Talk to me': a mixed methods study on preferred physician behaviours during end-of-life communication from the patient perspective.

Background: Despite the recognized importance of end-of-life (EOL) communication between patients and physicians, the extent and quality of such communication is lacking.

Objective: We sought to understand patient perspectives on physician behaviours during EOL communication.

Design: In this mixed methods study, we conducted quantitative and qualitative strands and then merged data sets during a mixed methods analysis phase.

Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians.

Importance: Seriously ill hospitalized patients have identified communication and decision making about goals of care as high priorities for quality improvement in end-of-life care. Interventions to improve care are more likely to succeed if tailored to existing barriers.

Objective: To determine, from the perspective of hospital-based clinicians, (1) barriers impeding communication and decision making about goals of care with seriously ill hospitalized patients and their families and (2) their own willingness and the acceptability for other clinicians to engage in this process.

'Conditional candour' and 'knowing me': an interpretive description study on patient preferences for physician behaviours during end-of-life communication.

Objective: To understand patients' preferences for physician behaviours during end-of-life communication.

Methods: We used interpretive description methods to analyse data from semistructured, one-on-one interviews with patients admitted to general medical wards at three Canadian tertiary care hospitals. Study recruitment took place from October 2012 to August 2013.