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Article ; Online: Patients' death: "Everybody hurts… sometimes"**Everybody Hurts, R.E.M. 1992.

Tesoro, Rosa / Escher, Monica

2023 Volume 12, Issue 4, Page(s) 673–675

Language	English
Publishing date	2023-05-08
Publishing country	China
Document type	Editorial
ZDB-ID	2828544-X
ISSN	2224-5839 ; 2224-5839
ISSN (online)	2224-5839
ISSN	2224-5839
DOI	10.21037/apm-23-257
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Sédation palliative en unité hospitalière.

Silhadi, Sabrina / Hentsch, Lisa / Singovski, Simon / Escher, Monica

Revue medicale suisse

2023 Volume 19, Issue 847, Page(s) 1986–1990

Abstract: A person at the end of life may present uncomfortable symptoms becoming refractory to an adequate treatment. In this case, the initiation of palliative sedation is indicated. Most sedated inpatients die outside a specialized palliative care unit. ... ...

Title translation	Palliative sedation in a hospital unit.
Abstract	A person at the end of life may present uncomfortable symptoms becoming refractory to an adequate treatment. In this case, the initiation of palliative sedation is indicated. Most sedated inpatients die outside a specialized palliative care unit. Palliative sedation must be initiated and adapted according to the best clinical practices. This article describes the processes associated with palliative sedation in a hospital unit.
MeSH term(s)	Humans ; Hospital Units ; Anesthesia ; Cognition ; Death ; Inpatients
Language	French
Publishing date	2023-10-25
Publishing country	Switzerland
Document type	English Abstract ; Journal Article
ZDB-ID	2177010-4
ISSN	1660-9379
ISSN	1660-9379
DOI	10.53738/REVMED.2023.19.847.1986
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Article ; Online: Recurrent Persistent Hiccups on Opioid Treatment: A Case Report and Literature Review.

Xausa, Giacomo / Escher, Monica / Singovski, Simon / Hentsch, Lisa

Journal of pain & palliative care pharmacotherapy

2022 Volume 37, Issue 1, Page(s) 82–90

Abstract: Hiccups are a rare but potentially debilitating side effect of opioid treatment, with only a handful of reported cases in the medical literature. The pathophysiological mechanism linking opioids and hiccups is unknown, and a lack of evidence exists ... ...

Abstract	Hiccups are a rare but potentially debilitating side effect of opioid treatment, with only a handful of reported cases in the medical literature. The pathophysiological mechanism linking opioids and hiccups is unknown, and a lack of evidence exists concerning the optimal management of the condition. We report on a 64-year-old man diagnosed with advanced renal cancer and painful osteolytic metastases, presenting persistent hiccups while on opioid treatment. Hiccups recurred after multiple challenges with codeine, morphine and hydromorphone on separate occasions. Hiccups ceased only after opioid discontinuation, although various pharmacological treatments were tried to shorten the duration of hiccups. Eventually, fentanyl was introduced and was well tolerated by the patient, without any recurrence of hiccups. The chronological correlation between opioid initiation and the onset of hiccups, as well as opioid discontinuation and the termination of hiccups leads to the conclusion that a causal role of codeine, morphine and hydromorphone in this occurrence is likely. Individual susceptibility probably plays a central role in the development of opioid-related hiccups. Opioid rotation is a promising strategy in the management of opioid-related hiccups, particularly when the mere discontinuation of the opioid is not a viable option, such as in the oncology and palliative care field.
MeSH term(s)	Male ; Humans ; Middle Aged ; Analgesics, Opioid ; Hydromorphone/adverse effects ; Hiccup/chemically induced ; Pain/drug therapy ; Morphine/adverse effects ; Codeine/adverse effects ; Neoplasms/complications
Chemical Substances	Analgesics, Opioid ; Hydromorphone (Q812464R06) ; Morphine (76I7G6D29C) ; Codeine (UX6OWY2V7J)
Language	English
Publishing date	2022-12-15
Publishing country	England
Document type	Review ; Case Reports ; Journal Article
ZDB-ID	2078852-6
ISSN	1536-0539 ; 1536-0288
ISSN (online)	1536-0539
ISSN	1536-0288
DOI	10.1080/15360288.2022.2157070
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Zs.A 2463: Show issues

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Article: Améliorer l’accès aux soins palliatifs pour les patients atteints d’insuffisance cardiaque chronique - Avancées et défis.

Hentsch, Lisa / Escher, Monica / Pautex, Sophie / Meyer, Philippe

Revue medicale suisse

2022 Volume 18, Issue 783, Page(s) 1052–1056

Abstract: Following the therapeutic progress of the last decades, patients suffering from chronic heart failure (HF) are living longer than ever before. However, recovery from a HF syndrome remains rare and patients more often have to live with chronic HF which ... ...

Title translation	Improving access to palliative care for patients with heart failure: advances and challenges.
Abstract	Following the therapeutic progress of the last decades, patients suffering from chronic heart failure (HF) are living longer than ever before. However, recovery from a HF syndrome remains rare and patients more often have to live with chronic HF which considerably impacts their quality of life. For several years, national and international cardiology societies have recommended the early integration of palliative care for HF patients. Although the impact of palliative care on the quality of life, depression and general symptom management of patients with HF has now been clearly established, its implementation is still scarce. The objective of this review is to highlight recommendations and models of care for the implementation of palliative care for patients with HF.
MeSH term(s)	Cardiology ; Chronic Disease ; Heart Failure/therapy ; Humans ; Palliative Care ; Quality of Life
Language	French
Publishing date	2022-05-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2177010-4
ISSN	1660-9379
ISSN	1660-9379
DOI	10.53738/REVMED.2022.18.783.1052
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Article ; Online: Futility of end-of-life and emergency surgery in extreme high-risk patients: anesthetists' versus surgeons' perspective.

Tesoro, Rosa / Suppan, Mélanie / Dupuis, Arnaud / Escher, Monica / Haller, Guy

Brazilian journal of anesthesiology (Elsevier)

2022 Volume 72, Issue 3, Page(s) 434–436

MeSH term(s)	Anesthetists ; Death ; Humans ; Medical Futility ; Nurse Anesthetists ; Surgeons
Language	English
Publishing date	2022-04-22
Publishing country	Brazil
Document type	Letter
ISSN	2352-2291
ISSN (online)	2352-2291
DOI	10.1016/j.bjane.2022.04.003
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Article: Prescription des opiacés en médecine de premier recours : le cas des douleurs chroniques non cancéreuses.

Singovski, Simon / Pautex, Sophie / Escher, Monica

Revue medicale suisse

2020 Volume 18, Issue 787, Page(s) 1238–1241

Abstract: Pain, including chronic non-cancer pain (CNCP), is a common reason for primary care consultation. CNCP encompasses a heterogeneous group of patients, whose care is often complex. The increase in opioid prescription in Switzerland and worldwide is ... ...

Title translation	Opiod prescription in primary care: the case of chronic non cancer pain.
Abstract	Pain, including chronic non-cancer pain (CNCP), is a common reason for primary care consultation. CNCP encompasses a heterogeneous group of patients, whose care is often complex. The increase in opioid prescription in Switzerland and worldwide is associated with CNCP, while opioid use for this indication is debated. Several studies suggest a limited effect on pain and function, while adverse effects are frequent. This article aims to summarize what is known about opioid prescription for CNCP and international guidelines and highlight important aspects for the general practitioner.
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Chronic Pain/drug therapy ; Chronic Pain/etiology ; Humans ; Opioid-Related Disorders/drug therapy ; Prescriptions ; Primary Health Care
Chemical Substances	Analgesics, Opioid
Language	French
Publishing date	2020-07-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2177010-4
ISSN	1660-9379
ISSN	1660-9379
DOI	10.53738/REVMED.2022.18.787.1238
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Article ; Online: Physicians' perspective on potentially non-beneficial treatment when assessing patients with advanced disease for ICU admission: a qualitative study.

Escher, Monica / Nendaz, Mathieu R / Cullati, Stéphane / Hudelson, Patricia

BMJ open

2021 Volume 11, Issue 5, Page(s) e046268

Abstract: Objective: The use of intensive care at the end of life can be high, leading to inappropriate healthcare utilisation, and prolonged suffering for patients and families. The objective of the study was to determine which factors influence physicians' ... ...

Abstract	Objective: The use of intensive care at the end of life can be high, leading to inappropriate healthcare utilisation, and prolonged suffering for patients and families. The objective of the study was to determine which factors influence physicians' admission decisions in situations of potentially non-beneficial intensive care. Design: This is a secondary analysis of a qualitative study exploring the triage process. In-depth interviews were analysed using an inductive approach to thematic content analysis. Setting: Data were collected in a Swiss tertiary care centre between March and June 2013. Participants: 12 intensive care unit (ICU) physicians and 12 internists routinely involved in ICU admission decisions. Results: Physicians struggled to understand the request for intensive care for patients with advanced disease and full code status. Physicians considered patients' long-term vital and functional prognosis, but they also resorted to shortcuts, that is, a priori consensus about reasons for admitting a patient. Family pressure and unexpected critical events were determinants of admission to the ICU. Patient preferences, ICU physician's expertise and collaborative decision making facilitated refusal. Physicians were willing to admit a patient with advanced disease for a limited amount of time to fulfil a personal need. Conclusions: In situations of potentially non-beneficial intensive care, the influence of shortcuts or context-related factors suggests that practice variations and inappropriate admission decisions are likely to occur. Institutional guidelines and timely goals of care discussions with patients with advanced disease and their families could contribute to ensuring appropriate levels of care.
MeSH term(s)	Critical Care ; Decision Making ; Humans ; Intensive Care Units ; Patient Admission ; Physicians ; Qualitative Research
Language	English
Publishing date	2021-05-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-046268
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Article: Palliative care provision for people living with heart failure: The Geneva model.

Hentsch, Lisa / Sobanski, Piotr Z / Escher, Monica / Pautex, Sophie / Meyer, Philippe

Frontiers in cardiovascular medicine

2022 Volume 9, Page(s) 933977

Abstract: As life expectancy rises and the survival rate after acute cardiovascular events improves, the number of people living and dying with chronic heart failure is increasing. People suffering from chronic ischemic and non-ischemic heart disease may ... ...

Abstract	As life expectancy rises and the survival rate after acute cardiovascular events improves, the number of people living and dying with chronic heart failure is increasing. People suffering from chronic ischemic and non-ischemic heart disease may experience a significant limitation of their quality of life which can be addressed by palliative care. Although international guidelines recommend the implementation of integrated palliative care for patients with heart failure, models of care are scarce and are often limited to patients at the end of life. In this paper, we describe the implementation of a model designed to improve the early integration of palliative care for patients with heart failure. This model has enabled patients to access palliative care when they normally would not have and given them the opportunity to plan their care in line with their values and preferences. However, the effectiveness of this interdisciplinary model of care on patients' quality of life and symptom burden still requires evaluation.
Language	English
Publishing date	2022-08-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2022.933977
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Article ; Online: Physicians' predictions of long-term survival and functional outcomes do not influence the decision to admit patients with advanced disease to intensive care: A prospective study.

Escher, Monica / Nendaz, Mathieu / Scherer, Fabienne / Cullati, Stéphane / Perneger, Thomas

Palliative medicine

2020 Volume 35, Issue 1, Page(s) 161–168

Abstract: Background: Long-term survival and functional outcomes should influence admission decisions to intensive care, especially for patients with advanced disease.: Aim: To determine whether physicians' predictions of long-term prognosis influenced ... ...

Abstract	Background: Long-term survival and functional outcomes should influence admission decisions to intensive care, especially for patients with advanced disease. Aim: To determine whether physicians' predictions of long-term prognosis influenced admission decisions for patients with and without advanced disease. Design: A prospective study was conducted. Physicians estimated patient survival with intensive care and with care on the ward, and the probability of 4 long-term outcomes: leaving hospital alive, survival at 6 months, recovery of functional status, and recovery of cognitive status. Patient mortality at 28 days was recorded. We built multivariate logistic regression models using admission to the intensive care unit (ICU) as the dependent variable. Setting/participants: ICU consultations for medical inpatients at a Swiss tertiary care hospital were included. Results: Of 201 evaluated patients, 105 (52.2%) had an advanced disease and 140 (69.7%) were admitted to the ICU. The probability of admission was strongly associated with the expected short-term survival benefit for patients with or without advanced disease. In contrast, the predicted likelihood that the patient would leave the hospital alive, would be alive 6 months later, would recover functional status, and would recover initial cognitive capacity was not associated with the decision to admit a patient to the ICU. Even for patients with advanced disease, none of these estimated outcomes influenced the admission decision. Conclusions: ICU admissions of patients with advanced disease were determined by short-term survival benefit, and not by long-term prognosis. Advance care planning and developing decision-aid tools for triage could help limit potentially inappropriate admissions to intensive care.
MeSH term(s)	Critical Care ; Hospitalization ; Humans ; Intensive Care Units ; Patient Admission ; Physicians ; Prospective Studies
Language	English
Publishing date	2020-10-16
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639247-7
ISSN	1477-030X ; 0269-2163
ISSN (online)	1477-030X
ISSN	0269-2163
DOI	10.1177/0269216320963931
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Article: Physicians' Views and Agreement about Patient- and Context-Related Factors Influencing ICU Admission Decisions: A Prospective Study.

Cullati, Stéphane / Perneger, Thomas V / Scherer, Fabienne / Nendaz, Mathieu / Escher, Monica

Journal of clinical medicine

2021 Volume 10, Issue 14

Abstract: Background: Single patient- and context-related factors have been associated with admission decisions to intensive care. How physicians weigh various factors and integrate them into the decision-making process is not well known.: Objectives: First, ... ...

Abstract	Background: Single patient- and context-related factors have been associated with admission decisions to intensive care. How physicians weigh various factors and integrate them into the decision-making process is not well known. Objectives: First, to determine which patient- and context-related factors influence admission decisions according to physicians, and their agreement about these determinants; and second, to examine whether there are differences for patients with and without advanced disease. Method: This study was conducted in one tertiary hospital. Consecutive ICU consultations for medical inpatients were prospectively included. Involved physicians, i.e., internists and intensivists, rated the importance of 13 factors for each decision on a Likert scale (1 = negligible to 5 = predominant). We cross-tabulated these factors by presence or absence of advanced disease and examined the degree of agreement between internists and intensivists using the kappa statistic. Results: Of 201 evaluated patients, 105 (52.2%) had an advanced disease, and 140 (69.7%) were admitted to intensive care. The mean number of important factors per decision was 3.5 (SD 2.4) for intensivists and 4.4 (SD 2.1) for internists. Patient's comorbidities, quality of life, preferences, and code status were most often mentioned. Inter-rater agreement was low for the whole population and after stratifying for patients with and without advanced disease. Kappa values ranged from 0.02 to 0.34 for all the patients, from -0.05 to 0.42 for patients with advanced disease, and from -0.08 to 0.32 for patients without advanced disease. The best agreement was found for family preferences. Conclusion: Poor agreement between physicians about patient- and context-related determinants of ICU admission suggests a lack of explicitness during the decision-making process. The potential consequences are increased variability and inequity regarding which patients are admitted. Timely advance care planning involving families could help physicians make the decision most concordant with patient preferences.
Language	English
Publishing date	2021-07-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm10143068
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