Downar J, Rodin D, Barua R, Lejnieks B, Gudimella R, McCredie V, Hayes C, Steel A.
In this retrospective review from Canada, 300 in hospital Rapid response team (RRT) consultations were reviewed in the light that although RRTs were created to stabilise acutely ill inpatients a proportion of these will be patients in the last days of their life. The study showed that most consultation were for elderly patients with a chronic illness, with over 90% of patients being for resuscitation. After RRT review one third were admitted to the intensive care unit within 48 hours and 25% died. 9% had a patient/family meeting on the ward after the consultation, leading to nearly 90% changing their resuscitation status. Of these, less than 20% were referred to the palliative or spiritual care teams, or prescribed symptom control medications. Furthermore, 63% of these patients died before discharge. It was concluded that in the acute hospital setting RRT consultation is an important milestone for many patients approaching end-of-life.
J Crit Care. 2013 Jan. [Epub ahead of print]
Rehabilitation in Advanced, Progressive, Recurrent Cancer: A Randomized Controlled Trial.
Jones L, Fitzgerald G, Leurent B, Round J, Eades J, Davis S, Gishen F, Holman A, Hopkins K, Tookman A.
This two-arm, wait-list randomised controlled trial, assessed the clinical and cost-effectiveness of a rehabilitation intervention delivered by a hospice-based multidisciplinary team vs. usual care for patients with advanced, progressive, recurrent haematological and breast cancer, with a follow-up at three months. From the 41 enrolled participants, 36 completed the trial. There was improvement in the psychological subscale of the Supportive Care Needs Survey (primary outcome). There was also improvement in the physical and patient care subscales of the Supportive Care Needs Survey, and self-reported health state. The incremental cost-effectiveness ratio was calculated to be £19,390 per quality-adjusted life year. The authors recommend implementation alongside evaluation in wider clinical settings and patient populations.
J Pain Symptom Manage. 2012 Nov. [Epub ahead of print]
Bruera E, Hui D, Dalal S, Torres-Vigil I, Trumble J, Roosth J, Krauter S, Strickland C, Unger K, Palmer JL, Allo J, Frisbee-Hume S, Tarleton K.
In a randomized, placebo-controlled, double-blind trial of 129 patients with cancer from six hospices, patients who were mildly to moderately dehydrated and in the last weeks of life either received subcutaneous hydration (1 L of normal saline) or placebo (100 mL of normal saline subcutaneously) over 4 hours every day until the they became unresponsive or died. The effect of hydration on symptoms associated with dehydration, quality of life, and survival in patients with advanced cancer was determined at baseline and day 4±2 days for the first week and then every 3 to 5 days (fatigue and biochemistry tests were performed at baseline and day 7). There were no differences between the two groups for change in the sum of the scores of dehydration symptoms (fatigue, myoclonus, sedation and hallucinations); Edmonton Symptom Assessment Scale; Dehydration, Delirium, Fatigue and Myoclonus Assessment scales; creatinine, urea, and overall survival.
J Clin Oncol. 2013 Jan 1;31(1):111-8.
by Jason Boland