Anderson Wendy G, Flint Lynn A, Horton Jay R, Johnson Kimberly, Mourad Michelle, Sharpe Bradley A
Division of Hospital Medicine, University of California, San Francisco, San Francisco, California; Palliative Care Program, University of California, San Francisco, San Francisco, California.
J Hosp Med. 2013 Dec;8(12):715-20. doi: 10.1002/jhm.2110. Epub 2013 Nov 8.
Seriously ill patients frequently receive care in hospitals, and palliative care is a core competency for hospitalists. We aimed to summarize and critique recent research that has the potential to impact the clinical practice of palliative care in the hospital.
We reviewed articles published between January 2012 and May 2013, identified through a hand-search of leading journals and PubMed. The authors collectively selected 9 articles based on their scientific rigor and relevance to hospital practice. We review their findings, strengths, and limitations and make recommendations for practice.
Key findings include: indwelling pleural catheters and talc pleurodesis provide similar relief of dyspnea in patients with malignant pleural effusions; oxygen many not be needed to prevent dyspnea in many dying patients; docusate may not be needed in addition to sennosides to treat opioid-induced constipation; atropine is no more effective than placebo in treating respiratory rattles in dying patients; many older adult survivors of in-hospital cardiopulmonary resuscitation (CPR) are alive up to 1 year after discharge; observing CPR may decrease family post-traumatic stress; surrogates of intensive care unit patients often interpret prognostic information optimistically; many patients with metastatic cancer feel that chemotherapy may cure their disease; viewing a goals-of-care video may decrease preference for CPR in patients being admitted to skilled nursing facilities.
Recent research provides important insights into the effectiveness of medications and interventions for symptom management, outcomes of CPR for patients and families, and Journal of Hospital Medicine 2013;8:715-720. © 2013 Society of Hospital Medicine.
重症患者经常在医院接受治疗,姑息治疗是住院医师的一项核心能力。我们旨在总结和评论近期可能影响医院姑息治疗临床实践的研究。
我们回顾了2012年1月至2013年5月发表的文章,这些文章通过手工检索主要期刊和PubMed确定。作者根据其科学严谨性和与医院实践的相关性共同挑选了9篇文章。我们回顾了它们的研究结果、优点和局限性,并提出实践建议。
主要研究结果包括:留置胸膜导管和滑石粉胸膜固定术在恶性胸腔积液患者中缓解呼吸困难的效果相似;许多临终患者可能不需要吸氧来预防呼吸困难;在治疗阿片类药物引起的便秘时,除番泻叶外可能不需要使用多库酯;阿托品在治疗临终患者的呼吸啰音方面并不比安慰剂更有效;许多住院心肺复苏(CPR)的老年幸存者出院后存活长达1年;观察CPR可能会减轻家属的创伤后应激;重症监护病房患者的替代决策者往往乐观地解读预后信息;许多转移性癌症患者认为化疗可能治愈他们的疾病;观看护理目标视频可能会降低入住专业护理机构患者对CPR的偏好。
近期研究为药物和干预措施在症状管理方面的有效性、CPR对患者及其家属的结局以及《医院医学杂志》2013年;8:715 - 720提供了重要见解。© 2013医院医学协会。