Topics in Palliative Medicine

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I. Introduction

This briefing document synthesizes key findings from several sources exploring the potential of cannabinoids in managing neuropathic pain. The sources include pre-clinical investigations, clinical trial reviews, and decision analysis models, offering a multifaceted view of the topic. We will examine the potential of Cannabidiolic Acid Methyl Ester (CBDA-ME), the effectiveness of cannabis-based medicines, and compare these to traditional pain management techniques.

II. Pre-Clinical Investigation: CBDA-ME

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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-labe...

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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...

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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...

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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 vari...

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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...

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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...

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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...

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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 t...

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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...

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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...

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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 s...

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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 e...