Nonconvulsive status epilepticus in a palliative care unit: when delirium is a seizure.

The search for an underlying cause of altered mental status not uncommonly becomes more challenging in the hospice and palliative care setting. Due to multiple coexisting conditions that affect mental status and shifting goals of care, discerning that single cause in this venue can become frustrating and even nonbeneficial at times. We present a case of nonconvulsive status epilepticus (NCSE), which multiple reports have shown to be a rarely contemplated cause of impaired consciousness.

Connected health: cancer symptom and quality-of-life assessment using a tablet computer: a pilot study.

Incorporation of tablet computers (TCs) into patient assessment may facilitate safe and secure data collection. We evaluated the usefulness and acceptability of a TC as an electronic self-report symptom assessment instrument. Research Electronic Data Capture Web-based application supported data capture.

Nausea and vomiting in advanced cancer.

Nausea and vomiting are very common symptoms in cancer both treatment and non-treatment related. Many complications of advanced cancer such as gastroparesis, bowel and outlet obstructions, and brain tumors may have nausea and vomiting or either symptom alone. In a non-obstructed situation, nausea may be more difficult to manage and is more objectionable to patients.

The care of the actively dying in an academic medical center: a survey of registered nurses' professional capability and comfort.

Background: Care of the dying is a significant component of nursing practice particularly in hospitals. Nurses who work in certain areas like oncology, intensive care unit (ICU) face the care of the dying, more so than other units.

Objectives: The survey was conducted to assess nurses' self-perception of their professional capability and comfort in the care of the actively dying.

Cancer-related insomnia.

Insomnia increases cancer symptom burden and impairs quality of life. The lack of standard definitions and treatment guidelines makes management difficult. Insomnia is common in most cancers but appears particularly so in lung, breast, and head and neck tumors.

The family conference in palliative medicine: a practical approach.

A family conference (FC) is an opportunity for the family and their physician to share their knowledge and concerns about the physical and psychosocial dimensions of care. Appropriate communication principles and practice are both important for an effective FC. The FCs guided by common sense principles and sound clinical practice (good structure, content, and process) have beneficial outcomes.

Oxycodone combined with opioid receptor antagonists: efficacy and safety.

Introduction: A mu receptor antagonist combined with oxycodone (OXY) may improve pain control, reduce physical tolerance and withdrawal, minimizing opioid-related bowel dysfunction and act as an abuse deterrent.

Areas Covered: The authors cover the use of OXY plus ultra-low-dose naltrexone for analgesia and the use of sustained-release OXY plus sustained-release naloxone to reduce the opioid bowel syndrome. The authors briefly describe the use of sustained-release OXY and naltrexone pellets as a drug abuse deterrent formulation.

Nausea and vomiting in advanced cancer: the Cleveland Clinic protocol.

Nausea and vomiting are common and distressing symptoms in advanced cancer. Both are multifactorial and cause significant morbidity, nutritional failure, and reduced quality of life. Assessment includes a detailed history, physical examination and investigations for reversible causes.

Delirium in palliative medicine: a review.

Delirium is a devastating complication of general medical and surgical populations but of particular importance in palliative medicine. It is a clinical syndrome that is often not recognized and, therefore, not treated appropriately. The presence of delirium is a predictor of increased morbidity and mortality, longer hospitalization, and more likely discharge to a nursing facility.

A pilot study of palliative medicine fellows' hospice home visits.

This was a prospective descriptive study of hospice physician home visits (HVs) conducted by Hospice and Palliative Medicine Fellows. Our objectives were 1) to improve our knowledge of hospice care at home by describing physician HVs 2) to identify the indications for physician HVs and the problems addressed during the HV. Data was collected on 58 consecutive patients using a standardized form completed before and after the home visit.

Fentanyl for breakthrough pain: a systematic review.

The purpose of this article is to systematically review the use of fentanyl as an analgesic for breakthrough pain. This article found that the oral transmucosal fentanyl (OTFC) had a quicker onset to analgesia than oral immediate-release opioids. Intranasal fentanyl (INFS) had a quicker onset to analgesia than buccal tablets, which in turn had a quicker onset to analgesia than OTFC.

A Phase II dose titration study of thalidomide for cancer-associated anorexia.

Context: Sixty-five percent of people with advanced cancer suffers from loss of appetite. Several inflammatory cytokines appear to cause appetite loss in animal models. Thalidomide is an immunomodulatory drug that has been associated with improved appetite in those with HIV infections and cancer.

Opioid and adjuvant analgesics: compared and contrasted.

An adjuvant (or co-analgesic) is a drug that in its pharmacological characteristic is not necessarily primarily identified as an analgesic in nature but that has been found in clinical practice to have either an independent analgesic effect or additive analgesic properties when used with opioids. The therapeutic role of adjuvant analgesics (AAs) is to increase the therapeutic index of opioids by a dose-sparing effect, add a unique analgesic action in opioid-resistant pain, or reduce opioid side effects. A notable difference between opioids and AAs is that unlike opioids some AAs are associated with permanent organ toxicity, for example, nonsteroidal anti-inflammatory drugs (NSAIDs) and renal failure.

Methodological challenges in supportive and palliative care cancer research.

As a growing medical field, palliative and supportive care should incorporate evidence-based medical practice. The gold standard research method continues to be the randomized clinical trial. This has been pursued with regard to cancer trials focused on cure.

Symptom control in advanced cancer: twenty principles.

In Palliative Medicine, symptom management is a clinical priority and one of the key skill sets of the palliative specialist. Symptom control principles have been derived from clinical practice in cancer pain management. They can also be applied to other cancer symptoms, and systematic application will help improve quality of life (QOL).

Malignant bowel obstruction: individualized treatment near the end of life.

Malignant bowel obstruction requires a highly individualized approach, tailored to the patient's medical condition, prognosis, and goals of care. Surgery should not be routinely done. Less-invasive approaches such as gastric and colonic stenting are useful.

Symptom management: an important part of cancer care.

Physicians can do a better job of palliating symptoms and improving the quality of life of cancer patients if they understand the principles of symptom management. We review the general principles of symptom management for fatigue, anorexia, constipation, dyspnea, nausea, and vomiting.

The relationship between symptom prevalence and severity and cancer primary site in 796 patients with advanced cancer.

Knowledge of differences in symptom experience between cancer sites may help better understand symptom pathophysiology. A total of 38 symptoms in 796 consecutive patients with advanced cancer were retrospectively analyzed. Symptom prevalence and severity were compared among the 12 primary site groups (PSGs) by the chi-square test.

Review article: a systematic review of cancer-related fatigue measurement questionnaires.

Purpose: Cancer-related fatigue (CRF) is a common symptom experienced by patients in all stages and in cancer survivors. The main objectives of this review were to identify validated CRF instruments, and populations in whom these tools have been validated.

Methods: We used a systematic review methodology.

Opioid receptor targeting ligands for pain management: a review and update.

Importance Of The Field: Discovery and synthesis of analgesic ligands can potentially improve analgesia, reduce side effects, minimize psychologic dependence and delay analgesic tolerance.

Areas Covered In This Review: This review covers opioid peptides and analogs and bifunctional opioid ligands, and bifunctional opioid/non-opioid ligands as new, potentially useful analgesics. Several lines of investigation have resulted in potentially useful agents.

Comfort measures: practical care of the dying cancer patient.

Most patients with advanced malignancy will die of their disease. Care of the dying is therefore a fundamental skill for the oncologist. Although protocols exist in other countries, there is no established protocol in the United States.