Total small bowel resection in a patient who refused surgery: why did the surgeon do it?

Gastric surgery may result in internal herniation of bowel, weeks to years after the initial surgery and can result in rapid onset of death if not promptly treated. We present a case in which a patient with this complication underwent surgery despite his clear refusal of surgery. The patient had a remote history of gastrectomy for malignancy.

A Pilot Study of a Palliative Care Service Embedded in a Hepatology Clinic at a Large Public Hospital.

End-stage liver disease (ESLD) patients carry heavy symptom burdens and risk receiving aggressive and sometimes unwanted care at end of life. Palliative care (PC), which aims to alleviate symptoms and facilitate goal-concordant care in serious illness, may offer substantial benefits for ESLD patients but is not widely provided. To assess the impact of PC integrated within hepatology (PCIH) services on health care utilization, advance care planning (ACP), and hospice enrollment.

Improving Palliative Care Knowledge among Hospitalized Hispanic Patients: A Pilot Study.

Lack of knowledge of palliative care has been identified as a primary barrier to access to care, with a recent survey reporting that Hispanics have the lowest rate of palliative care knowledge compared with other racial/ethnic groups. The purpose of this pilot study was to determine if there were trends toward improved palliative care knowledge after viewing four-minute video of a palliative care patient. We conducted a pre- and posttest pilot study among 50 Spanish-speaking, hospitalized Hispanic patients 40 years old and older in a large public hospital.

Doing More with the Same: Comparing Public and Private Hospital Palliative Care within California.

Public and private hospitals treat different patient populations, which may impact resources to deliver palliative care (PC). Compare public and private hospital PC service structures, processes, and treatment outcomes. Retrospective data analysis of the Palliative Care Quality Network between 2018 and 2019.

Evaluation of Time-Limited Trials Among Critically Ill Patients With Advanced Medical Illnesses and Reduction of Nonbeneficial ICU Treatments.

Importance: For critically ill patients with advanced medical illnesses and poor prognoses, overuse of invasive intensive care unit (ICU) treatments may prolong suffering without benefit.

Objective: To examine whether use of time-limited trials (TLTs) as the default care-planning approach for critically ill patients with advanced medical illnesses was associated with decreased duration and intensity of nonbeneficial ICU care.

Design, Setting, And Participants: This prospective quality improvement study was conducted from June 1, 2017, to December 31, 2019, at the medical ICUs of 3 academic public hospitals in California.

For People Dying to Talk, It Finally Pays to Listen with Reimbursable Advance Care Planning.

Whether at the beginning, middle, or end of life, health care delivery choices abound. Yet only recently have conversations specifically regarding preferences for care at the end of life become a reimbursable intervention, deemed equivalent in importance to a medical procedure. Quite distinct from other procedures, in which expectations for outcomes are explicit and measurable, outcomes have been left intentionally vague for advanced care planning (ACP) conversations.

Support for Patients and Family Caregivers in Lung Cancer: Educational Components of an Interdisciplinary Palliative Care Intervention.

Consistent with the recommendations of the Institute of Medicine Report on quality cancer care, attention to symptom management and quality of life concerns of patients with lung cancer should be addressed throughout the disease trajectory. As part of a NCI-funded Program Project grant, this paper reports on the patient and family caregiver education component of a nurse-lead, tailored palliative care intervention for patients with early (I-III, n=130) and late (IV, n=142) stage lung cancer. Patients and family caregivers received 4 separate educational sessions organized around the Quality of Life model domains (physical, psychological, social, and spiritual well-being).

Decreased responsiveness to oxycodone: A case of a pharmacokinetic drug interaction?

Concurrent administration of oxycodone and phenytoin may cause, through induction of CYP3A4 enzymes, decreased analgesic effects of oxycodone. However, no descriptions of this interaction exist. A patient who was on oxycodone for chronic back pain was admitted to the hospital.

Improving Palliative Cancer Care.

Over a decade ago, the Institute of Medicine (IOM) presented Ensuring Quality Cancer Care in the United States, with recommendations for change (IOM, 1999). However, barriers to integrating palliative care (PC) to achieve high-quality care in cancer still remain. As novel therapeutic agents evolve, patients are living longer, and advanced cancer is now considered a chronic illness.

Palliative care, Version 1.2014. Featured updates to the NCCN Guidelines.

The NCCN Guidelines for Palliative Care provide interdisciplinary recommendations on palliative care for patients with cancer. These NCCN Guidelines Insights summarize the NCCN panel's discussions and guideline updates from 2013 and 2014. These include modifications/additions to palliative care screening and assessment protocols, new considerations for discussing the benefits and risks of anticancer therapy, and approaches to advance care planning.

Long-term habituation in the marine mollusc Tritonia diomedea.

Tritonia diomedea is one of several gastropod molluscs used to study cellular mechanisms of learning and memory. Previous studies in this organism have focused on short-term habituation and sensitization. This report presents the first detailed description of long-term habituation in Tritonia.