When caring for patients nearing the end of live (EOL), healthcare providers must carefully assess the potential benefits and drawbacks of common medical interventions, such as starting antibiotic treatment. Antibiotic use during this stage can be a challenging and multifaceted situation, encompassing important clinical, social, and ethical considerations. While physicians may be motivated to prescribe antibiotics to terminally ill patients in hopes of prolonging survival and alleviating symptoms, it's crucial to recognize that these drugs can have significant implications for individuals at the EOL. Factors like advanced age, frailty, and multiple medication use make these patients more vulnerable to adverse events caused by antibiotics. For instance, fluoroquinolones, a specific type of antibiotics, have been linked to central nervous system toxicity and neurological side effects, including seizures. Geriatric patients, who often have underlying risk factors, are particularly susceptible to fluoroquinolone-induced seizures. However, there have also been reports of otherwise healthy individuals experiencing seizures as a result of fluoroquinolone use. This report sheds light on the complexities associated with initiating antibiotic therapy in patients nearing the EOL.
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http://dx.doi.org/10.1089/jpm.2023.0123 | DOI Listing |
Dan Med J
November 2024
Department of Emergency Medicine and Trauma Care, Aalborg University Hospital.
Introduction: Among all Danish dying patients, 80% rely on non-specialised palliative care, an area lacking national and international guidelines. In this pilot study, we developed and tested an acute basic palliation concept (ABPC), a structured end-of-life (EOL) care plan for patients discharged from the emergency department to die at home compared with standard care.
Methods: This study compared symptom scores and EOL care statement scores during a standard care period with an ABPC period using unvalidated questionnaires.
Clin Nephrol
December 2024
Dialysis initiation during an emergency hospital admission is associated with increased complications, more temporary access, and higher mortality. Even in patients known to nephrologists, more than one-third start dialysis in an unplanned fashion. This retrospective case-control study sought to identify features of the pre-dialysis period that are associated with unplanned dialysis initiation in patients known to nephrology services.
View Article and Find Full Text PDFCureus
November 2024
Department of Obstetrics and Gynecology, Fertility Institute, Assisted Reproduction Unit, Athens, GRC.
The study focuses on spontaneous conception after menopause in a woman with primary ovarian insufficiency (POI), with an emphasis on the role of anti-Müllerian hormone (AMH) in fertility management. This case involves a 33-year-old woman with POI who has experienced both aided and spontaneous pregnancies. She had low AMH and high follicle-stimulating hormone (FSH) levels, which typically indicate a limited ovarian reserve.
View Article and Find Full Text PDFClin Colon Rectal Surg
January 2025
Divisions of Colon and Rectal Surgery and Hospice and Palliative Medicine, Virginia Commonwealth University, Richmond, Virginia.
Patients with advanced colorectal cancer nearing the end of life require a multidisciplinary approach to address the unique challenges they face. Using a case vignette, we outline the various stages of a patient's journey with advanced rectal cancer and the common obstacles to their care as they interface with the medical system. We highlight how Black persons might be vulnerable to differences in screening, treatment, procedural interventions, end-of-life care, and health care decision-making.
View Article and Find Full Text PDFJ Palliat Med
December 2024
Palliative Care Service, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
The needs of patients living with malignant neoplasm, and those of their families and care partners, require a multidimensional and interdisciplinary approach. By systematically assessing these needs with validated tools, healthcare professionals can identify and monitor therapeutic objectives, interventions, and results. At the Catalan Institute of Oncology (ICO), we set out to update the ICO Toolkit-a set of instruments for assessing the physical, emotional, and social needs of palliative care patients.
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