Code Status Discussions at Hospital Admission Are Not Associated With Patient and Surrogate Satisfaction With Hospital Care: Results From the Multicenter Hospitalist Study.

Am J Hosp Palliat Care. 2010 Aug 16;

Authors: Anderson WG, Pantilat SZ, Meltzer D, Schnipper J, Kaboli P, Wetterneck TB, Gonzales D, Arora V, Zhang J, Auerbach AD

Background: Physicians may avoid code status discussions for fear of decreasing patient or surrogate satisfaction. METHODS: Charts of patients admitted to medical services at 6 university hospitals were reviewed for documentation of a code status discussion in the first 24 hours of admission. Satisfaction with care provided during the hospitalization was assessed by telephone 1 month after discharge. RESULTS: Of the 11 717 patients with 1-month follow-up, 1090 (9.3%) had a code status discussion documented. Patient or surrogate satisfaction did not differ by whether a discussion was documented. The lack of association persisted after adjusting for patient’s severity of illness and using propensity adjustment for likelihood of having a discussion. CONCLUSIONS: Discussing code status on admission to the inpatient setting did not affect patient or surrogate satisfaction.

PMID: 20713421 [PubMed - as supplied by publisher]

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Noninvasive ventilation in immunosuppressed patients.

Am J Hosp Palliat Care. 2010 Mar;27(2):134-8

Authors: Namendys-Silva SA, Hernández-Garay M, Herrera-Gómez A

In immunosuppressed patients (ISP) with acute respiratory failure (ARF), invasive mechanical ventilation (IMV) is associated with high mortality rate. Noninvasive ventilation (NIV) is a type of mechanical ventilation that does not require an artificial airway. It has seen increasing use in critically ill patients to avoid endotracheal intubation. Acute respiratory failure due to pulmonary infections is an important cause of illness in ISP and their treatment. Immunosuppressive treatments have showed an increase not only in the survival but also in the susceptibility to infection. Several authors have underlined the worst prognosis for neutropenic patients with ARF requiring endotracheal intubation and IMV. The NIV seems to be an interesting alternative in ISP because of the lower risk of complications; it prevents endotracheal intubation and its associated complications with survival benefits in this population.

PMID: 19776370 [PubMed - indexed for MEDLINE]

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Oral morphine overdose in a cancer patient antagonized by prolonged naloxone infusion.

Am J Hosp Palliat Care. 2008 Oct-Nov;25(5):401-5

Authors: Upadhyay S, Jain R, Chauhan H, Gupta D, Mishra S, Bhatnagar S

An 80-year-old male was diagnosed with carcinoma in the lung with multiple bony metastases and had been prescribed pain medications as per World Health Organization analgesic ladder guidelines. However, he was not getting adequate pain relief and there were difficulties in titration of the morphine doses on an outpatient basis. Therefore, he was hospitalized for dose titration of oral morphine and was coprescribed amitriptyline and ranitidine. During the titration of the analgesic dose, he developed severe symptoms of morphine overdose. He was immediately treated with intravenous naloxone. After prolonged infusion of naloxone, he achieved his baseline vital parameters without any permanent sequel to the overdose event. This case report describes the possible causes of oral morphine overdose in the elderly and its successful treatment. To prevent such complications, one has to be very cautious of other factors such as drug interactions, particularly in the elderly.

PMID: 18539764 [PubMed - indexed for MEDLINE]

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A day in the life: a case series of acute care palliative medicine–the Cleveland model.

Am J Hosp Palliat Care. 2008 Feb-Mar;25(1):24-32

Authors: Lagman R, Walsh D, Heintz J, Legrand SB, Davis MP

Palliative care in advanced disease is complex. Knowledge and experience of symptom control and management of multiple complications are essential. An interdisciplinary team is also required to meet the medical and psychosocial needs in life-limiting illness. Acute care palliative medicine is a new concept in the spectrum of palliative care services. Acute care palliative medicine, integrated into a tertiary academic medical center, provides expert medical management and specialized care as part of the spectrum of acute medical care services to this challenging patient population. The authors describe a case series to provide a snapshot of a typical day in an acute care inpatient palliative medicine unit. The cases illustrate the sophisticated medical care involved for each individual and the important skill sets of the palliative medicine specialist required to provide high-quality acute medical care for the very ill.

PMID: 18292480 [PubMed - indexed for MEDLINE]

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