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Abstract
Leading highly functional health care teams in all practice settings is sustained through the identification of a conceptual framework to guide education and practice. This article presents an interdisciplinary framework for palliative and hospice education and practice. The framework builds on theoretical caring to convey elements of relational, holistic and compassion; articulates interprofessional tenets for guiding values; and aligns with constructs for palliative and hospice best practices. The framework invites those at the bedside and in leadership to be intentional in attending to education and the necessary activities that address the day-to-day operations of palliative and hospice care, as well as, honoring all interdisciplinary collaboration that supports quality outcomes and inspires actions that transform.
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Chen A, Loquias EJ, Roshan R, Levene R, Zelhof R, Hickey T, Cooney GA, Gonzalez F. Safe Use of Subcutaneous Diphenhydramine in the Inpatient Hospice Unit. Am J Hosp Palliat Care 2016; 34:954-957. [PMID: 27625354 DOI: 10.1177/1049909116668160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Diphenhydramine (DPH) is most commonly used via oral, topical, intramuscular (IM) and intravenous (IV) routes for the palliation of pruritus, treatment of extrapyramidal symptoms, management of parkinsonism and for allergic reactions. However, many hospice patients are unable to take oral medications and/or do not have IV access. Moreover, topical administration has a relatively slow rate of absorption. For this reason, in the hospice setting it is not uncommon for diphenhydramine to be administered via the subcutaneous (SC) route secondary to its ease of access, low infection rates and its low levels of discomfort. In contrast, outside the hospice setting, subcutaneous DPH has not been widely used, primarily because of a handful of case reports published in the 1990's that report skin necrosis following subcutaneous administration of DPH for local anesthesia. Since these early case reports, however, there has been very little in the way of research to examine this further. The aim of this study is to provide objective data concerning the safe use of subcutaneous diphenhydramine, as part of our efforts to improve upon safe practices in our organization. METHODS This is a retrospective review of records from 6 of our inpatient hospice units obtained from our pharmacy database for patients who received at least one subcutaneous injection of diphenhydramine between 2012-2015. Selected patients were then subsequently screened for post-administration skin necrosis, as recorded in our quality assurance database during the same time period. RESULTS A total of 648 diphenhydramine subcutaneous injections were administered in109 individual patients. None of the patients were reported to have an adverse cutaneous reaction. CONCLUSIONS This retrospective review demonstrates that subcutaneous diphenhydramine injection is a safe alternative to oral and other parenteral routes, and may be particularly valuable in terminally ill patients, who are often unable to swallow and are without IV access.
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Affiliation(s)
- Aileen Chen
- 1 University of Miami/JFK Medical Center Palm Beach Regional Graduate Medical Education Consortium, Hospice and Palliative Medicine Program, West Palm Beach, FL, USA
| | - Erwin J Loquias
- 1 University of Miami/JFK Medical Center Palm Beach Regional Graduate Medical Education Consortium, Hospice and Palliative Medicine Program, West Palm Beach, FL, USA
| | - Ramesh Roshan
- 2 Trustbridge Health, West Palm Beach, Florida, FL, USA
| | - Richard Levene
- 1 University of Miami/JFK Medical Center Palm Beach Regional Graduate Medical Education Consortium, Hospice and Palliative Medicine Program, West Palm Beach, FL, USA.,2 Trustbridge Health, West Palm Beach, Florida, FL, USA
| | | | - Terry Hickey
- 2 Trustbridge Health, West Palm Beach, Florida, FL, USA
| | - Gail Austin Cooney
- 1 University of Miami/JFK Medical Center Palm Beach Regional Graduate Medical Education Consortium, Hospice and Palliative Medicine Program, West Palm Beach, FL, USA.,2 Trustbridge Health, West Palm Beach, Florida, FL, USA
| | - Faustino Gonzalez
- 1 University of Miami/JFK Medical Center Palm Beach Regional Graduate Medical Education Consortium, Hospice and Palliative Medicine Program, West Palm Beach, FL, USA.,2 Trustbridge Health, West Palm Beach, Florida, FL, USA
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Hatoum G, Meshkin C, Alkhunaizi S, Levene R, Formoso-Onofrio J. The Risk of Misdiagnosing the Primary Site Responsible for Bone Metastases in Patients With Chronic Lymphocytic Leukemia and a Second Primary Carcinoma. World J Oncol 2015; 6:332-334. [PMID: 29147427 PMCID: PMC5649722 DOI: 10.14740/wjon873e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/11/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a common malignancy which may coexist with other primary cancers. CLL is rarely the cause of solitary bone lesions; such lesions in the context of CLL are believed to result from either Richter's transformation or metastasis from another primary malignancy. Renal cell carcinoma (RCC), on the other hand, is a malignancy which frequently metastasizes to bone and may cause an osteolytic solitary bone lesion. The origin of a solitary bone lesion in a patient with multiple potential primary malignancies has prognostic implications and affects treatment protocol, and as such must be diagnosed accurately. We describe a patient with CLL and a history of RCC who is found to have an incidental solitary bone lesion of the T11 vertebra. After two separate CT-guided biopsies revealed various lymphoid cell predominance and no evidence of RCC, treatment with low dose external beam radiation therapy (EBRT) was employed. Post-therapy MRI showed further propagation of the lesion. Surgical corpectomy was subsequently performed and postoperative pathology of the lesion was consistent with RCC. The patient was treated with bisphosphonates and a higher dose of EBRT. Our case illustrates the importance of surgical excisional biopsy for accurately diagnosing the primary source metastatic to the bone in a patient with CLL and another potential primary cancer.
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Affiliation(s)
- Georges Hatoum
- Comprehensive Cancer Center JFK Medical Center, Atlantis, FL 33462, USA
| | - Cyrus Meshkin
- Hospice & Palliative Medicine Fellowship Program, University of Miami Miller School of Medicine Palm Beach Regional Campus, Atlantis, FL 33462, USA
| | - Sufana Alkhunaizi
- Hospice & Palliative Medicine Fellowship Program, University of Miami Miller School of Medicine Palm Beach Regional Campus, Atlantis, FL 33462, USA
| | - Richard Levene
- Hospice & Palliative Medicine Fellowship Program, Hospice of Palm Beach County, University of Miami Miller School of Medicine Palm Beach Regional Campus, Atlantis, FL 33462, USA
| | - Julie Formoso-Onofrio
- Hospice & Palliative Medicine Fellowship Program, Hospice of Palm Beach County, University of Miami Miller School of Medicine Palm Beach Regional Campus, Atlantis, FL 33462, USA
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Gonzalez F, Roshan R, Levene R, Miskin B, Vazquez N. Management of Severe Hypoglycemia at the End of Life in Non-Diabetic Patients: A Case Study and Recommendations. J Med Cases 2015. [DOI: 10.14740/jmc2260w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Although research has shown that palliative chemotherapy is beneficial compared to lack of treatment (Schorge JO, Schaffer JI, Halvorson LM, et al. ed. Williams Gynecology. New York, NY: McGraw Hill Medical; 2008.), other studies show aggressive end-of-life treatment adversely affects quality of life and shortens life span (Arriba L, Fader A, Frasure H, von Gruenigen V. A review of issues surrounding quality of life among women with ovarian cancer. Gynecol Oncol. 2010;119(2):390-396.). Without a consensus on palliative chemotherapy, underutilization during end of life prevails, and likely will continue without additional research (Barbera L, Elit L, Krzyzanowska M, et al. End of life care for women with gynecologic cancers. Gynecol Oncol. 2010;118(2):196-201.). This article aims to evaluate and examine existing chemotherapy for palliation of malignant ascites secondary to ovarian cancer and compare commonly used regimens. Agents will be evaluated by their modes of administration. Oral agents include cyclophosphamide and thalidomide, and intraperitoneal vehicles include taxane-based agents, platinum-based agents, antibiotics, and biologic agents. In addition, cost, ethics, and quality of life discussions factor into this review. Palliative care’s goal is to find a balance between life expectancy and symptom relief with minimal adverse effects.
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Affiliation(s)
- Yuliya Malayev
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Richard Levene
- Hospice of Palm Beach County, University of Miami Miller School of Medicine, West Palm Beach, FL, USA
| | - Faustino Gonzalez
- Hospice of Palm Beach County, 5300 East Avenue, West Palm Beach, FL. 33407
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Trueger N, Levene R, Allison T, Cherkas D. 110 Resident Perception of Educational Value in the Clinical Arena: How Important Is Contact Time? Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- R. Levene
- Israel Fibre Institute PO Box 8001, Jerusalem, Israel
| | - Y. Cohen
- Polgat Industries Ltd., PO Box 15, Kiryat Gat, Israel
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Abstract
A triple procedure consisting of extracapsular cataract surgery, posterior chamber intraocular lens implantation, and glaucoma filtering operation was performed in 30 eyes of 28 patients. The follow-up time was six to 24 months, with a median of 11 months. Group I consisted of 21 eyes with advanced glaucoma and poor to marginal pressure control. After surgery, the pressure was less than or equal to 21 mm Hg in 62% but 86% still required medication. This intraocular pressure control is worse than that reported by others. Group II consisted of nine eyes with a functioning filtering bleb before surgery. The incision was made through the filtering bleb in order to facilitate the cataract surgery. A new filtering procedure was performed adjacent to the original one. There was loss of control in a significant number of eyes but, with rare exception, no better or worse than that reported with other approaches. In pseudophakia there is a poor correlation between pressure control and a visible bleb. The visual results for both groups were good, with 73% obtaining 20/40 or better visual acuity.
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Levene R. Lasers and glaucoma. Ann Ophthalmol 1984; 16:520-1. [PMID: 6742693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Levene R. Major early complications of laser trabeculoplasty. Ophthalmic Surg 1983; 14:947-53. [PMID: 6657175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A complication frequency of 3.1% visual loss and 1.8% emergency glaucoma surgery occurred in 224 and 159 eyes respectively after laser trabeculoplasty. The latter was associated with blacks and advanced cases of glaucoma. Both were highly associated with a 24-hour rise in pressure after laser.
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Lau TS, Taubenfligel W, Levene R, Farago G, Chan H, Koven I, Drucker WR. Pancreatic blood flow and insulin output in severe hemorrhage. J Trauma 1972; 12:880-4. [PMID: 5077665 DOI: 10.1097/00005373-197210000-00008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Klein J, Levene R, Dunkelblum E. Borane reactions X 1): Preparation of -1,2-diols by the hydroboration of enolates and enol-trimethylsilyl ethers. Tetrahedron Lett 1972. [DOI: 10.1016/s0040-4039(01)84952-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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