The use of pentobarbital in cases of severe delirium: a case series.

Delirium is a common syndrome present at the end of life and causes significant distress for patients and families. Sleep disruption is a common precipitating factor for delirium and restoration of sleep may be instrumental in attenuating symptoms. In this cases series, we present three patients who were unresponsive to escalating doses of standard delirium medications, but whose delirium resolved once improved sleep was achieved using Pentobarbital.

The nature and timing of family-provider communication in late-stage cancer: a qualitative study of caregivers' experiences.

Context: Family members of people with advanced cancer can experience intensified distress and uncertainty during the final stages of their loved one's illness. Enhanced comprehension about disease progression, symptom management, and options for care can help families adapt, cope, and plan for the future.

Objectives: Guided by concepts from the Sense of Coherence Theory, which illuminates factors that contribute to adaptation in stressful situations, the objective of this study was to explore and describe family caregivers' accounts of the nature and timing of communication they had with a loved one's health care provider(s) during the advanced stages of cancer and before hospice enrollment.

Effects of methylphenidate on fatigue and depression: a randomized, double-blind, placebo-controlled trial.

Context: Fatigue is highly prevalent in populations with advanced illness and is often associated with depressed mood. The role of psychostimulant therapy in the treatment of these conditions remains ill defined.

Objectives: To evaluate the response of fatigue and depression in patients with advanced illness to titrated doses of methylphenidate (MP) as compared with placebo.

Length of survival in hospice for cancer patients referred from a comprehensive cancer center.

This retrospective study examined 180 hospice patients referred from a comprehensive cancer center over 6 months in 2002 to (1) identify the variables associated with shorter length of survival (LOS) in hospice and (2) examine the LOS in hospice for those who previously participated in clinical trials and/or phase I studies. The median LOS in hospice for this cohort was 35 days. In multivariate analysis, low Palliative Performance Score (PPS) at hospice enrollment and male gender were associated with shorter LOS in hospice: males with low PPS had the shortest LOS while females with high PPS had the longest LOS.

Outcomes from a national multispecialty palliative care curriculum development project.

Background: In 1998 we completed a successful regional pilot project in palliative care curriculum development among 32 internal medicine residency programs recruited from the mid-western United States. Between 1999 and 2004 this project was expanded to include 358 U.S.

Length of survival of patients with cancer in hospice: a retrospective analysis of patients treated at a major cancer center versus other practice settings.

This is a retrospective study of the length of survival (LOS) in hospice of patients with cancer treated at a major cancer center compared to other treatment sites. Of 670 patients, the 185 (28%) treated at a major cancer center had unique characteristics, including higher median Palliative Performance Score (PPS) at the time of hospice enrollment (45 versus 40, p = 0.009), and longer median LOS in hospice (35 versus 21 days, p = 0.

Understanding family responses to life-limiting illness: In-depth interviews with hospice patients and their family members.

Understanding family dynamics is a key component in providing comprehensive care for persons with progressive illnesses and their caregivers. The purpose of this study was to investigate what families experience during an advancing illness and to describe their pattems of response. In-depth interviews (n=108) were conducted with families two weeks after hospice admission.

Effect of a social services intervention among 911 repeat users.

Objective: To determine whether emergency medical services (EMS) 911 frequent users would benefit from social services intervention.

Methods: The design was a descriptive prospective subject evaluation. All nonhomeless frequent EMS users (>3x in 1 month) were identified monthly from December 2 to May 3 and contacted by 2 social workers.

Final transitions: family caregiving at the end of life.

Background: This study aimed to understand how caregivers make the transition to end-stage caregiving and to illuminate its unique aspects using a stress process model.

Methods: Qualitative in-depth interviews were conducted with 74 caregivers of a family member who had been receiving hospice care for at least 2 weeks. Interviews were tape recorded, transcribed, and coded for emergent themes using constant comparative analysis.

Neuropathic pain: implications for the surgeon.

Pharmacologic therapy for neuropathic pain is based on an evolving understanding of its underlying mechanisms, and often requires a patient,methodical sequence of trials that include the "four As": analgesics,antidepressants, anticonvulsants, and antiarrhythmics. Critical for success is a willingness to stay engaged with the patient to evolve a mutually acceptable plan and goals of care with realistic outcomes that emphasize symptom control and maximization of function. Such management is within the capabilities of surgeons for most patients, whereas the use of consultation and interdisciplinary supportive interventions from comprehensive pain management centers, if available, is helpful in more difficult cases.

Surgical palliative care.

Surgery has always played a pivotal role in care of the patient with cancer, independent of treatment intent. Recent advances have expanded that role, not only in terms of modalities available, but more broadly in terms of the expectations of the surgeon as physician involved in the interdisciplinary care of the patient with symptomatic, incurable disease.

The surgeon-patient relationship in advanced illness.

Surgeons are relatively new to palliative care, but there is a growing recognition of the contributions they can and should make. These go as much to the psychosocial support of the patient as they do to the technical aspects of their craft. The same qualities of proactivity and mastery of technique that stand the surgeon in good stead in the operating room can be acquired and mastered to make him or her equally effective in the hitherto nontraditional arenas of palliative care.

The dying patient: pain management at the hospice level.

Hospice care has irrevocably changed the landscape of healthcare. First seen as an alternative to dying in the impersonal, highly technical environment of the hospital, it provides comprehensive palliative, supportive care in patient-oriented settings, usually at home or, in some instances, special hospice units. Now the challenges of hospice care largely go beyond the philosophic to include the organizational, demographic, and pragmatic difficulties of providing such care in various settings.

The effect of an alphanumeric paging system on patient compliance with medicinal regimens.

There are numerous actual and potential impediments to patient compliance with medicinal regimens. The implications of poor compliance include worsening disease states or symptoms, with resultant increased costs of care. Using a population of hospice patients at high risk for noncompliance, this study evaluated the use of an alphanumeric paging system as a memory prosthetic, finding that compliance rose from a mean of 56 percent to 96 percent when the system was used.

Breast cancer and dietary and plasma concentrations of carotenoids and vitamin A.

A case-control study of breast cancer was conducted in Buffalo. Participants completed a food frequency questionnaire and donated a fasting blood sample before definitive workup for breast masses. Dietary and plasma concentrations of carotenoids and retinol for 83 women found to have breast cancer were compared with those of 113 women found to be free of breast cancer (control subjects).