Palliative sedation at home in the Netherlands: a nationwide survey among nurses

Aim. This paper is a report of a nationwide study conducted to assess experiences of nurses involved in palliative sedation at home after introduction of a physicians' guideline for palliative sedation. Background. Most studies investigating the practice of palliative sedation focus on physicians' practices and attitudes. However, little is known about experiences and attitudes of nurses. Methods. A web-based structured questionnaire was offered to 387 nurses providing medical technical care in 2007, assessing their experiences concerning decision-making, treatment policy and communication, focussing on the last patient receiving palliative sedation. Results. The questionnaire was filled out by 201 nurses (response rate 52%). The majority of respondents agreed with the indication for palliative sedation. However, 21% reported to have refused carrying out a palliative sedation in the preceding year. The general practitioner was not present at the start of palliative sedation in a third of the cases, but was available when needed. The sedation was considered insufficiently effective by 42% of the respondents. According to a third of the respondents, the level of sedation was not related to the required level of symptom relief nor were changes in dosage based on the severity of symptoms. Conclusion. Although the guideline for palliative sedation appears to be followed adequately in the majority of cases with respect to indication for palliative sedation and reportage. The survey findings revealed shortcomings in medication policy, communication, medical control over the start and continued monitoring of palliative sedation

White matter hyperintensities are related to pain intensity in an outpatient memory clinic population: preliminary findings

Tarik T Binnekade,1 Roberto SGM Perez,2 Andrea B Maier,3 Hanneke FM Rhodius-Meester,4 Nienke Legdeur,5 Marijke C Trappenburg,6,7 Didi Rhebergen,8–10 Frank Lobbezoo,11,12 Erik JA Scherder11Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands; 2Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands; 3Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia; 4Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; 5Department of Neurology, Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, Netherlands; 6Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands; 7Department of Internal Medicine, Amstelland Hospital, Amstelveen, The Netherlands; 8Department of Psychiatry, GGZ inGeest, Amsterdam, The Netherlands; 9Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; 10Department of Mental Health, Amsterdam UMC, Amsterdam, The Netherlands; 11Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; 12MOVE Research Institute Amsterdam, Amsterdam, The NetherlandsBackground: The association between pain and dementia is complicated and may depend on underlying brain pathology. It was hypothesized that both medial temporal atrophy (MTA) and global cortical atrophy (GCA) predicted no/mild pain, while white matter hyperintensities (WMH) predicted moderate/severe pain.Objectives: To study the association between pain intensity and measures of brain pathology, more specifically MTA, GCA, and WMH.Methods: In total, 115 consecutive patients visiting an outpatient memory clinic were included. In total, diagnoses included dementia (N=70), mild cognitive impairment (N=30), and subjective cognitive impairment (N=15). Without administering stimuli, pain intensity was assessed with the Brief Pain Inventory. MTA, GCA, and WMH were measured with a MRI visual rating scale. Logistic regression analyses to examine the relationship between WMH, MTA, GCA, and self-reported pain intensity (no/mild pain versus moderate/severe pain) were adjusted for confounders.Results: Mean age of the patients was 81 years (IQR: 78–85, 53% female). Moderate/severe pain was reported by 23.5% and associated with greater WMH (OR =3.34, 95% CI =1.01–10.97, p=0.047), but not MTA or GCA.Conclusions: In contrast to the present results, earlier studies have reported either a positive or negative relationship between pain and brain volume. It is suggested that the presence of dementia may explain the absence of a relationship between pain and brain volume. WMH is positively related with pain in an older memory outpatient population. Considering the small sample size, our findings should be interpreted with caution. Hence, our conclusions are preliminary findings, warranting future replication.Keywords: pain, dementia, Alzheimer’s disease, brain atrophy, white matter hyperintensitie