Folgen
-
Questions? Comments? Send us a message!
Hiccups, while often seen as a minor inconvenience, can become a significant health issue when they are persistent or intractable. This episode explores the science behind hiccups, their potential medical causes, and treatment options, particularly the use of gabapentin as an off-label solution.
• Discussion of the three types of hiccups: acute, persistent, and intractable
• Explanation of the hiccup reflex arc and its neurological basis
• Overview of the myriad causes of intractable hiccups, including central nervous system and psychological factors
• Introduction and definition of gabapentin, including its off-label use for hiccups
• Presentation of case studies demonstrating the efficacy of gabapentin
• Examination of potential side effects of gabapentin relative to other treatments
• Alternatives to gabapentin, including other medications and non-pharmacological home remedies
• Ethical considerations regarding off-label prescriptions and open communication with doctorsSupport the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Questions? Comments? Send us a message!
This case report details a patient with chronic lymphocytic leukemia whose initially misdiagnosed joint pain was ultimately attributed to the rare syndrome of remitting seronegative symmetrical synovitis with pitting edema (RS3PE). The report discusses RS3PE's characteristics, often overlooked due to its rarity and lack of definitive diagnostic criteria, emphasizing the importance of recognizing it in palliative care settings. The paper explores RS3PE's association with malignancy, its clinical presentation mimicking other rheumatological disorders, and its effective treatment with corticosteroids. Furthermore, the study investigates the potential role of vascular endothelial growth factor (VEGF) in RS3PE's pathophysiology. Early diagnosis is crucial for effective pain management and avoiding reliance on ineffective opioid treatments.
Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Fehlende Folgen?
-
Questions? Comments? Send us a message!
This retrospective study from a 21-hospital system analyzed the effect of palliative medicine consultations on 30-day hospital readmission rates for patients with six diagnoses (heart failure, sepsis, pneumonia, COPD, AMI, and stroke). The research found statistically significant reductions in readmissions for heart failure, sepsis, and pneumonia patients who received consultations. While reductions were observed in other groups (stroke, AMI, COPD), these were not statistically significant. The study suggests that palliative care consultations may improve patient outcomes and reduce healthcare costs, warranting further investigation and potential policy changes. The findings add to existing literature supporting the value of palliative care in mitigating readmissions.
Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Questions? Comments? Send us a message!
This article presents an ethics case study concerning a 52-year-old male declared brain dead, whose family refuses to remove life support. Multiple perspectives—medical, nursing, chaplain, social work, legal, and ethical—are offered, exploring the conflict between the family's emotional denial of death and the medical team's obligation to uphold accepted medical standards. The case highlights the complexities of defining death in the modern era, the importance of cultural sensitivity in end-of-life care, and the challenges of navigating legal and ethical considerations when families disagree with medical assessments. The discussion examines various ethical frameworks, including Kantian ethics and utilitarianism, to guide decision-making. Ultimately, the article emphasizes the need for compassion and patience in dealing with grieving families while upholding medical and legal standards.
Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Questions? Comments? Send us a message!
This case report details a rare instance of post-radiation lichen planus in a 64-year-old male, following radiation therapy for squamous cell carcinoma. The report examines the patient's medical history, clinical presentation, and treatment response to topical triamcinolone. The authors review existing literature on lichen planus, emphasizing its T-cell mediated inflammatory nature and its rare association with radiation therapy. The study highlights the need for further research to understand the pathophysiology and improve treatment of this complication. The case underscores the importance of considering radiation-induced lichen planus in patients with relevant exposure and symptoms.
Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Questions? Comments? Send us a message!
This case report and accompanying discussion detail Posterior Reversible Encephalopathy Syndrome (PRES), a neurological condition presenting with seizures, visual disturbances, and altered mental status. Often misdiagnosed as more severe conditions like intracranial hemorrhage, PRES demonstrates reversible brain swelling on MRI. The case highlights a patient initially suspected of intracerebral hemorrhage whose diagnosis was revised to PRES, leading to successful treatment and recovery. The article also explores the etiology, diagnosis, treatment, and prognosis of PRES, including emerging links to COVID-19 infections. The authors emphasize the importance of thorough neuroimaging to ensure accurate diagnosis and avoid premature withdrawal of life support.
Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Questions? Comments? Send us a message!
The BJR method is a novel mathematical approach to methadone conversion that aims to improve upon existing methods by providing a smoother, less discontinuous, and less linear output for a reasonable and safe methadone dose. Here's how it improves upon existing conversion approaches:
Addresses Limitations of the Plonk Method: The Plonk method uses a linear equation to calculate methadone dosage, which assumes a linear relationship between methadone and morphine. This method is considered useful only in the lower range of morphine equivalent doses (300-600mg), and it calculates overly high doses of methadone at higher morphine doses. The BJR method, in contrast, uses a parabolic equation, which is thought to more accurately reflect the relationship between morphine and methadone dosage.
Reduces Discontinuities of the Ayonrinde Method: The Ayonrinde method uses a changing-ratio approach that takes into account the need for lower relative doses of methadone with escalating morphine equivalents. However, this method has significant discontinuities at the ratio transition points. The BJR method produces a smoother curve without these abrupt changes.
Provides a Starting Dose: Unlike the Ayonrinde method which intercepts the y-axis at zero, the BJR method, similar to the Plonk method, outputs a starting dose for opioid-naive patients. The BJR method's y-intercept is set at 15mg, which is the starting dose for opioid-naive patients, though this may be adjusted to 7.5mg or less for frail elderly patients.
Moderates Doses at Higher Levels: At higher doses of oral morphine, the BJR method outputs lower doses of methadone than other methods, including the Ayonrinde method. This is intended to improve patient safety by reducing the risk of excessive sedation and respiratory depression.
Simplified Formula: The BJR method provides a simple formula for methadone conversion, which does not require conversion tables and protocols. This can be a useful tool in palliative medicine. The formula is as follows: methadone mg = 1.5 * √(morphine mg) + 15
In summary, the BJR method is designed to address some of the limitations of existing methadone conversion methods, aiming to provide a safer, more accurate, and more convenient approach to methadone dosing. The method has shown promising results in case studies, and it provides a simplified model for conversion that may be useful in palliative medicine. However, it requires further validation before it can become a standard of care.
**NOTE: THIS IS FOR ACADEMIC PURPOSES ONLY. DO NOT ACT ON ANYTHING IN THIS PODCAST WITHOUT CONSULTING AN EXPERIENCED MEDICAL PROFESSIONAL.**Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Questions? Comments? Send us a message!
The case study underscores the potential for misinterpreting spiritual distress as psychiatric illness, resulting in inappropriate treatment.
Clinicians should learn several key lessons from the case of Mr. G, primarily emphasizing the importance of addressing patients' spiritual needs alongside their physical ailments.Open communication: Clinicians should initiate open-ended questions about a patient's spiritual beliefs as part of a routine assessment. Questions like "do you consider yourself religious" or "do you want to discuss spiritual matters with me" can help identify patients who wish to discuss these topics. Clinicians should also be attentive to cues from patients that may indicate spiritual concerns. For example, a patient commenting on a painting in the doctor’s office can be a cue to explore the patient's spiritual or emotional state.
Holistic approach: The case illustrates the importance of a whole-person approach to care, recognizing that physical symptoms can be intertwined with spiritual and emotional distress. In Mr. G's case, his physical symptoms and anxiety about death were directly connected to his belief that he needed to be baptized to avoid hell.
Avoid assumptions: Clinicians should avoid making assumptions about a patient's beliefs or motivations, and not dismiss them as psychiatric issues. Mr. G's statements about a "demon" in his abdomen were initially misinterpreted as paranoia, when they were a manifestation of his spiritual concerns.
Spiritual needs may drive medical decisions: Spiritual distress can lead patients to make medical decisions that might seem illogical from a purely medical perspective, such as requesting aggressive life-sustaining measures when they are terminally ill. Mr. G's desire to "do everything" to stay alive was driven by his fear of dying unbaptized.
The power of simple interventions: Addressing a patient's spiritual needs can have profound positive impacts. In Mr. G's case, a simple baptism provided immense relief, alleviating both his spiritual distress and his physical pain.
Interdisciplinary collaboration: Clinicians should be willing to collaborate with other professionals, such as chaplains, to provide comprehensive care. The chaplain in this case was able to offer a solution that the physician was not equipped to provide. The chaplain’s ability to perform the baptism "anywhere" highlights the accessibility of spiritual interventions.
Listen to the patient: The case emphasizes the importance of listening to the patient. As one patient in a survey noted, "the patient is telling you something," meaning that clinicians need to pay close attention to both verbal and nonverbal cues that indicate what is important to the patient. In Mr. G's case, understanding the framework from which he was operating was essential.
Reflection and growth: The physician in the case study admitted his actions were "morally and ethically reprehensible" when he attempted to change the patient's code status after the patient became unresponsive, demonstrating the importance of reflection and learning from past errors. The physician also recognized the need to talk to patients about spiritual matters and learned that failing to do so could result in needless suffering. This case was instrumental in igniting his interest in hospice and palliative care.
By acknowledging the importance of spiritual well-being and actively addressing it as part of patient care, clinicians can significantly improve the quali
Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Questions? Comments? Send us a message!
This ethics roundtable discussion centers on the case of JG, a 45-year-old man who attempted suicide and subsequently suffered severe brain damage. The article presents differing perspectives from medical, nursing, risk management, ethics, pastoral, social work, and legal professionals regarding the ethical implications of his wife's request to withdraw life support and the physician's recommendation for a tracheostomy. The central ethical dilemmas explored involve patient autonomy versus beneficence and non-maleficence, especially given JG's compromised capacity to make decisions and the uncertainty surrounding his prognosis. The discussion highlights the complexities of surrogate decision-making, informed consent, and the role of the medical team in balancing patient wishes with the potential for recovery. Ultimately, the authors seek to examine the intricate considerations surrounding end-of-life care in the context of a patient's expressed desire to forgo treatment.
Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Questions? Comments? Send us a message!
This ethics roundtable discussion analyzes a case study where a patient's daughter-in-law, the primary caregiver, seeks to withdraw life support, but state law restricts surrogacy to blood relatives or spouses. The discussion explores the ethical and legal implications of this restrictive law, highlighting the conflict between the patient's best interests and the letter of the law. Experts in palliative medicine, spiritual health, law, and ethics contribute varying perspectives on surrogacy, advance care planning, and the need for legal reform to better accommodate diverse family structures and patient preferences. The authors advocate for a more flexible and ethically sound approach to surrogate decision-making.
Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Questions? Comments? Send us a message!
Ethical and legal considerations surrounding a comatose Jehovah's Witness patient's need for a life-saving blood transfusion are debated. The patient's parents, also Jehovah's Witnesses, refuse consent, while her brother advocates for the transfusion, claiming she wasn't a practicing member. The case highlights the conflict between parental surrogacy rights, the patient's autonomy, and the physician's responsibility to provide beneficial care. Multiple perspectives—medical, nursing, social work, legal, and ethical—are offered, emphasizing the importance of understanding the patient's wishes and the limitations of surrogacy decisions based on the surrogate's beliefs. The lack of advance directives and the resulting ethical dilemma are also discussed.
Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
-
Questions? Comments? Send us a message!
Who makes the decision if the patient lacks capacity? Multiple healthcare professionals offer varying perspectives on the ethical and legal dilemma surrounding the care of a 93-year-old comatose patient (JH). A conflict exists between JH's legally appointed Power of Attorney (POA), his hired caregiver, who wants aggressive treatment, and his son, who advocates for comfort care only. The central issue is whether to honor the POA's decision despite concerns about potential conflicts of interest and the medical futility of continued aggressive treatment. Legal and ethical frameworks are explored, along with a proposed six-step process for resolving such disputes, highlighting the complexities of surrogate decision-making in end-of-life care. Ultimately, the case underscores the need for clear advance directives and a collaborative approach to navigating difficult medical and ethical decisions.
Support the show
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
