Palliative sedation: beliefs and decision-making among Spanish palliative care physicians.

Purpose: To describe physician attitudes to deep palliative sedation.

Methods: A nationwide e-survey of Spanish palliative care specialists was performed using vignettes which described patients close to death with intractable symptoms. Sedation levels were defined according to the Richmond Agitation-Sedation Scale.

Fentanyl treatment for end-of-life dyspnoea relief in advanced cancer patients.

Purpose: We assessed the effects of subcutaneous-endovenous fentanyl on dyspnoea in a cohort of advanced cancer patients.

Methods: We performed a retrospective study in a cohort of advanced cancer patients with dyspnoea at rest who received subcutaneous or intravenous fentanyl. Patients with no shortness of breath at rest or at minimal exertion, no rescue doses per 24 h, were deemed to be responders to fentanyl.

Spanish Validation of the Care Evaluation Scale for Measuring the Quality of Structure and Process of Palliative Care From the Family Perspective.

Context: A reliable and valid measure of the structure and process of end-of-life care is important for improving the outcomes of care.

Objectives: This study evaluated the validity and reliability of the Spanish adaptation of a satisfaction tool of the Care Evaluation Scale (CES), which was developed in Japan to evaluate palliative care structure and process from the perspective of family members.

Methods: Standard forward-backward translation and a pilot test were conducted.

Fentanyl for episodic dyspnoea in cancer patients.

Two different patterns of breathlessness have been identified: chronic or continuous breathlessness and breathlessness crisis (acute, incident, episodic, breakthrough breathlessness). Meta-analysis and systematic reviews prove that opioids are beneficial in either opioid-naïve or -tolerant patients. However, data from two recent randomised controlled trials were not able to show the effectiveness of fentanyl for the relief of exertion-induced dyspnoea.

Appropriateness and reliability testing of the modified Richmond Agitation-Sedation Scale in Spanish patients with advanced cancer.

Context: A tool to quantify agitation severity and sedation level in patients with advanced cancer is needed.

Objectives: To test the appropriateness and reliability of the Richmond Agitation-Sedation Scale (RASS) in Spanish patients with advanced cancer.

Methods: The original RASS was translated into Spanish according to the standard guidelines.

Quality of care in palliative sedation: audit and compliance monitoring of a clinical protocol.

Context: The European Association for Palliative Care and the U.S. National Hospice and Palliative Care Organization have published statements that recommend an audit of palliative sedation practices.

A strategy for conversion from subcutaneous to oral ketamine in cancer pain patients: effect of a 1:1 ratio.

Context: No consensus exists about the most appropriate dose ratio for conversion from parenteral to oral ketamine.

Objectives: To confirm that a 1:1 dose ratio is suitable for converting subcutaneous (s.c.

Morphine-methadone opioid rotation in cancer patients: analysis of dose ratio predicting factors.

The dose ratio that is effective when switching opioid therapy from morphine to methadone in cancer patients varies widely. There are no conclusive data explaining the source of this variability. We analyzed 54 cancer patients undergoing opioid rotation to clarify those factors that influenced the morphine/methadone dose ratio (MMEDR) at Day 10 after the switch.

Chronic cluster-like headache secondary to prolactinoma: uncommon cephalalgia in association with brain tumors.

Headache is a common and disabling aspect of pituitary disease. Chronic and episodic migraine are the most common clinical syndromes of headaches related to pituitary tumors, although other types of headache, such as trigeminal autonomic cephalalgias (TACs), can also be present. TACs include short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing; paroxysmal hemicrania; and cluster headache.

Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain.

Background: Patients with cancer often are rotated from other opioids to methadone to improve the balance between analgesia and side effects. To the authors' knowledge, no clear guidelines currently exist for the safe and effective rotation from transdermal fentanyl to methadone.

Methods: The authors evaluated a protocol for switching opioid from transdermal fentanyl to oral methadone in 17 patients with cancer.