Background Health-care professionals are confronted with patients who wish to end their lives through voluntarily stopping eating and drinking (VSED). During VSED, symptoms such as agitation, thirst or psychological distress may arise, thus making close medical accompaniment necessary. Dealing with these symptoms can put a high burden on palliative care teams. Furthermore, divergent perceptions of the ethical classification of VSED may lead to moral distress. The aim of this study was to assess the influence of experience gained over time on the burden of palliative care professionals while accompanying patients during VSED and to assess the perceptions of coping strategies. Methods This is a prospective single-centre study conducted at the Interdisciplinary Centre for Palliative Care at University Hospital Duesseldorf, Germany. At two points in time (T1, T2) one year apart, team members of all professions who were actively involved in the accompaniment were eligible to complete a pretested questionnaire. Results Team members perceived the symptom complex of psychological distress, anxiety, and agitation to be the most burdensome symptoms for the patients (T1: 28/49, 57.1%; T2: 33/59, 55.9%). Thirst was the second most observed symptom (T1: 17/49, 34.7%, T2: 19/59, 32.2%). These were also the most burdensome symptoms for individual team members. Most team members found there were no general moral concerns. There was a decrease in the perceived importance of support strategies such as ethical counselling (85.7% versus 63.6%). Conclusions Accompanying patients during VSED is a challenge for health-care professionals. When comparing T2 to T1, less emphasis lies on the importance of ethical counselling or psychiatric assessment to build a foundation for the accompaniment. Moral and ethical concerns seem to play a minor role. More in-depth studies covering a bigger sample size as well as qualitative studies are needed.

Abstract Background Palliative care teams work under challenging conditions in a sensitive setting with difficult tasks. The multi-professional team can play an important role. Mindfulness and compassion-based practices are used to build resilience. Our aim was to examine (1) feasibility and acceptability, (2) satisfaction and impact, and (3) opportunities and limitations of a mindfulness course. Methods An eight-week mindfulness and compassion course was delivered in a university-based specialized palliative care unit. A meditation teacher provided preparatory evening sessions and meditation exercises that could be integrated into daily activities. The scientific analysis of the course was based on a questionnaire developed for quality assessmentThe first two parts consisted of demographic, Likert-type, and free-text items. Part 3 consisted of learning objectives that were self-assessed after finishing the course (post-then). In the analysis, we used descriptive statistics, qualitative content analysis, and comparative self-assessment. Results Twenty four employees participated. 58% of participants attended 4 or more of the 7 voluntary mindfulness days. 91% expressed moderate to high satisfaction and would recommend the palliative care program to others. Three main categories emerged in the qualitative content analysis: providing feedback on the course, personal impact, and impact on professional life. The opportunity for self-care in a professional context was highlighted. Learning gains (CSA Gain) were high (38.5–49.4%) in terms of knowledge and techniques, moderate (26.2–34.5%) in terms of implementation of learned skills, and rather low (12.7–24.6%) in terms of changes to attitude. Conclusion Our evaluation shows that the participants of a mindfulness and compassion course considered it as a feasible and welcome tool to familiarize a multi-professional palliative care team with self-care techniques. Trial registration Internal Clinical Trial Register of the Medical Faculty, Heinrich Heine University Düsseldorf, No. 2018074763 (registered retrospectively on 30th July 2018).

BackgroundRepeat hospitalizations, complications, and psychosocial burdens are common in patients with left ventricular assist devices (LVAD). Specialist palliative care (sPC) involvement supports patients during decision-making until end-of-life. In the United States, guidelines recommend early specialist palliative care (esPC) involvement prior to implantation. Yet, data about sPC and esPC involvement in Europe are scarce.Materials and MethodsThis is a retrospective descriptive study of deceased LVAD patients who had received sPC during their LVAD-related admissions to two university hospitals in Duesseldorf, Germany and Basel, Switzerland from 2010 to 2021. The main objectives were to assess: To which extent have LVAD patients received sPC, how early is sPC involved? What are the characteristics of those, how did sPC take place and what are key challenges in end-of-life care?ResultsIn total, 288 patients were implanted with a LVAD, including 31 who received sPC (11%). Twenty-two deceased LVAD patients (19 male) with sPC were included. Mean patient age at the time of implantation was 67 (range 49–79) years. Thirteen patients (59%) received LVAD as destination therapy, eight patients (36%) were implanted as bridge to transplantation (BTT), and one as an emergency LVAD after cardiogenic shock (5%). None of the eight BTT patients received a heart transplantation before dying. Most (n = 13) patients lived with their family and mean Eastern Cooperative Oncology Group (ECOG) performance status was three. Mean time between LVAD implantation and first sPC contact was 1.71 years, with a range of first sPC contact from 49 days prior to implantation to more than 6 years after. Two patients received esPC before implantation. In Duesseldorf, mean time between first sPC contact and in-hospital death was 10.2 (1–42) days. In Basel, patients died 16 (0.7–44) months after first sPC contact, only one died on the external sPC unit. Based on thorough examination of two case reports, we describe key challenges of sPC in LVAD patients including the necessity for sPC expertise, ethical and communicative issues as well as the available resources in this setting.ConclusionDespite unequivocal recommendations for sPC in LVAD patients, the integration of sPC for these patients is yet not well established.

During the COVID-19 pandemic, the care of critically ill and dying patients in isolation wards, intensive care units (ICUs), and regular wards was severely impaired. In order to support physicians in communicative and palliative care skills, an e-learning tool was developed as part of the joint project "Palliative Care in Pandemic Times" (PallPan). This study investigates the feasibility of this e-learning tool. Secondly, we aim to analyze changes in knowledge and attitude upon completion of the e-learning tool. A 38-item questionnaire-based evaluation study with assessment of global and specific outcomes including ICU and non-ICU physicians was performed. In total, 24 questionnaires were included in the anonymous analysis. Feasibility was confirmed by a very high rate of overall satisfaction (94% approval), with relevance reaching 99% approval. Overall, we detected high gains in knowledge and noticeably lower gains on the attitude plane, with the highest gain in naming reasons for incorporating palliative care. The lowest learning gain on the attitude plane was observed when the participants were confronted with their own mortality. This study shows that e-learning is a feasible tool for gaining knowledge and even changing the attitudes of physicians caring for critically ill and dying patients in a self-assessment evaluation.

A 41-year-old man from Southern India (index) and his 10-year-old son were referred to our department with a history of diverse cutaneous and extracutaneous symptoms affecting the ectodermal appendages. The index patient presented with sparse scalp hair, eyebrows, and eyelashes (Figure 1a). His son had fragile and brittle scalp hair, as well as sparse eyebrows and eyelashes (Figure 2a). Both had dysplastic and brittle nails; (pseudo) acanthosis nigricans (Figures 1b, 2b); generalized maculo-papular hyperpigmentation (Figure 1b and 2c); xerosis cutis; increased skin fragility; and hypohidrosis (Figures 1, 2). The index patient also had dental malformations and supernumerary teeth (Figure 1d), while his son had dysplastic mammillae, lacrimal duct stenosis, and a unilateral impairment of conductive hearing. Both patients had syndactyly of the second and third toes, and a widening of the gap between the first and second toes, of both feet (Figure 1c). Ectrodactyly was excluded via radiography (data not shown). The personal and family medical history of both patients was otherwise unremarkable. Molecular genetic investigations were performed in both patients and in selected relatives, in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the ethics committee of the Medical Faculty of the University of Bonn. Whole-exome sequencing (WES) was performed at the Cologne Center for Genomics (CCG). Details of the sequencing protocol are provided elsewhere [1]. Sanger sequencing was performed to verify the variants and enable segregation analyses. WES identified the heterozygous variant c.1922C>T p.(Ala641Val) in exon 14 of TP63 encoding Tumor Protein P63 (NM_003722.5) in the index patient and his son. This variant leads to the substitution of an alanine residue at the transactivation inhibition domain (TID) of the α isoforms of p63, and is annotated as likely pathogenic in a single entry in the ClinVar database, although no description of the respective phenotype is provided. The variant was not detected in the unaffected parents of the index patient, or in his unaffected wife. This indicates that the mutation was a de novo event in the index patient, and was transmitted from him to his son. Clinical Letter

COVID-19 patients who may require invasive therapeutic procedures such as extracorporeal membrane oxygenation (ECMO) have high symptom burden and in-hospital mortality. In addition, awake patients on ECMO are new in the intensive care unit (ICU) setting. Inpatient specialist palliative care (sPC) provides support such as symptom control on a physical, psychosocial and spiritual level. The field of sPC in COVID-19 patients is still new and important to investigate. We aim to analyze sPC of COVID-19 patients in the ICU with regard to patient characteristics and symptoms from a palliative care perspective. We conducted a retrospective analysis (03/2020–04/2021) and identified 51 ICU patients receiving sPC. The statistical analysis included descriptive statistics and comparisons of symptoms. The first sPC contact of patients (mean age 69.5 years, 62.7% male) was around 14 days after COVID-19 confirmation, and 43% were treated with ECMO therapy. The baseline symptom burden was high with a focus on weakness (100%), tiredness (98%), dyspnea (96%) and family burden (92%). The symptom intensity significantly decreased during the time period of sPC and COVID-19 treatment (t(99) = 3.119, p = 0.003, d = 0.437). These results help intensivists and sPC clinicians to identify symptoms and the need for sPC in COVID-19 patients. However, studies with prospective and controlled designs need to follow.

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 20, Issue 6 p. 871-875 Clinical LetterOpen Access Phänotypische Vielfalt bei Varianten im TP63-Gen Ariane Schmetz, Corresponding Author Ariane Schmetz [email protected] Institut für Humangenetik, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf Diese beiden Autoren haben in gleichem Maße zu der vorliegenden Arbeit beigetragen. Korrespondenzanschrift Ariane Schmetz Institut für Humangenetik, HHU Universitätsstraße 1 40225 Düsseldorf Deutschland E-Mail: [email protected]Search for more papers by this authorXing Xiong, Xing Xiong Institut für Humangenetik, Universität Bonn, Medizinische Fakultät und Universitätsklinikum Bonn Diese beiden Autoren haben in gleichem Maße zu der vorliegenden Arbeit beigetragen.Search for more papers by this authorNicole Cesarato, Nicole Cesarato Institut für Humangenetik, Universität Bonn, Medizinische Fakultät und Universitätsklinikum BonnSearch for more papers by this authorFitnat Buket Basmanav, Fitnat Buket Basmanav Institut für Humangenetik, Universität Bonn, Medizinische Fakultät und Universitätsklinikum BonnSearch for more papers by this authorPetra Gierthmuehlen, Petra Gierthmuehlen Klinik für Zahnärztliche Prothetik, Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität DüsseldorfSearch for more papers by this authorJörg Schaper, Jörg Schaper Zentrum für seltene Erkrankungen, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität DüsseldorfSearch for more papers by this authorDaniel Schlieper, Daniel Schlieper Interdisziplinäres Zentrum für Palliativmedizin, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität DüsseldorfSearch for more papers by this authorMaria Wehner, Maria Wehner Institut für Humangenetik, Universität Bonn, Medizinische Fakultät und Universitätsklinikum BonnSearch for more papers by this authorHolger Thiele, Holger Thiele Cologne Center for Genomics (CCG), Universität zu Köln, Medizinische Fakultät und Universitätsklinikum KölnSearch for more papers by this authorJorge Frank, Jorge Frank Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen Diese beiden Autoren haben in gleichem Maße zu der vorliegenden Arbeit beigetragen.Search for more papers by this authorRegina C. Betz, Regina C. Betz Institut für Humangenetik, Universität Bonn, Medizinische Fakultät und Universitätsklinikum Bonn Diese beiden Autoren haben in gleichem Maße zu der vorliegenden Arbeit beigetragen.Search for more papers by this authorSilke Redler, Silke Redler Institut für Humangenetik, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf Zentrum für seltene Erkrankungen, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität DüsseldorfSearch for more papers by this author Ariane Schmetz, Corresponding Author Ariane Schmetz [email protected] Institut für Humangenetik, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf Diese beiden Autoren haben in gleichem Maße zu der vorliegenden Arbeit beigetragen. Korrespondenzanschrift Ariane Schmetz Institut für Humangenetik, HHU Universitätsstraße 1 40225 Düsseldorf Deutschland E-Mail: [email protected]Search for more papers by this authorXing Xiong, Xing Xiong Institut für Humangenetik, Universität Bonn, Medizinische Fakultät und Universitätsklinikum Bonn Diese beiden Autoren haben in gleichem Maße zu der vorliegenden Arbeit beigetragen.Search for more papers by this authorNicole Cesarato, Nicole Cesarato Institut für Humangenetik, Universität Bonn, Medizinische Fakultät und Universitätsklinikum BonnSearch for more papers by this authorFitnat Buket Basmanav, Fitnat Buket Basmanav Institut für Humangenetik, Universität Bonn, Medizinische Fakultät und Universitätsklinikum BonnSearch for more papers by this authorPetra Gierthmuehlen, Petra Gierthmuehlen Klinik für Zahnärztliche Prothetik, Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität DüsseldorfSearch for more papers by this authorJörg Schaper, Jörg Schaper Zentrum für seltene Erkrankungen, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität DüsseldorfSearch for more papers by this authorDaniel Schlieper, Daniel Schlieper Interdisziplinäres Zentrum für Palliativmedizin, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität DüsseldorfSearch for more papers by this authorMaria Wehner, Maria Wehner Institut für Humangenetik, Universität Bonn, Medizinische Fakultät und Universitätsklinikum BonnSearch for more papers by this authorHolger Thiele, Holger Thiele Cologne Center for Genomics (CCG), Universität zu Köln, Medizinische Fakultät und Universitätsklinikum KölnSearch for more papers by this authorJorge Frank, Jorge Frank Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen Diese beiden Autoren haben in gleichem Maße zu der vorliegenden Arbeit beigetragen.Search for more papers by this authorRegina C. Betz, Regina C. Betz Institut für Humangenetik, Universität Bonn, Medizinische Fakultät und Universitätsklinikum Bonn Diese beiden Autoren haben in gleichem Maße zu der vorliegenden Arbeit beigetragen.Search for more papers by this authorSilke Redler, Silke Redler Institut für Humangenetik, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf Zentrum für seltene Erkrankungen, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität DüsseldorfSearch for more papers by this author First published: 16 June 2022 https://doi.org/10.1111/ddg.14770_g AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. 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Zusammenfassung Hintergrund Bei terminal herzinsuffizienten Patienten gewinnt die Implantation von Linksherzunterstützungssystemen (LVAD) als Therapieoption zunehmend an Bedeutung. Diese Systeme werden als Überbrückung bis zu einer Herztransplantation (BTT) oder als definitive Therapie (DT) eingesetzt. Sie können die Lebensqualität verbessern und die Lebenszeit verlängern. Trotzdem bleibt die Prognose besonders bei DT oder bei Wechsel von BTT zu DT mit Blick auf die Lebenszeit und auftretende Komplikationen ungünstig. Bisher ist ungeklärt, ob eine LVAD-Implantation eine Indikation für eine frühzeitige Integration von Palliativmedizin darstellt. Ziel der Arbeit Erfassung der aktuellen Studienlage über den Einfluss einer palliativmedizinischen Behandlung bei LVAD-Patienten. Material und Methoden Im Mai 2020 wurde eine systematische Literaturrecherche in 6 verschiedenen Datenbanken durchgeführt. Ergebnisse Von den 491 Treffern der Literaturrecherche wurden 21 Arbeiten in diese Übersichtsarbeit eingeschlossen. Durch die frühzeitige Integration der Palliativmedizin vor LVAD-Implantation erhöhte sich die Anzahl der Patienten mit vorausschauender Versorgungsplanung und Vorsorgeinstrumenten. Außerdem zeigte sich ein positiver Einfluss auf das familiäre Umfeld, das Symptommanagement und die Umstände des Versterbens. Es gibt verschiedene Formate für die Integration palliativmedizinischer Konzepte in die LVAD-Therapie. Diskussion Die frühzeitige und kontinuierliche Einbindung der Palliativmedizin im Verlauf einer LVAD-Therapie kann die Behandlungsqualität verbessern. Die Ausarbeitung von spezifischen Handlungsempfehlungen ist in Abhängigkeit vom Therapieziel (BTT oder DT) sinnvoll. Empfohlen werden Schulungen für Palliativmediziner und LVAD-Spezialisten.

Zusammenfassung Hintergrund Die interdisziplinäre Zusammenarbeit zwischen Intensivmedizin und Palliativmedizin kann die Versorgungsqualität verbessern. Das Ausmaß dieser Zusammenarbeit ist aber bisher kaum untersucht. Ziel der Arbeit Es sollten die angebotenen und in Anspruch genommenen palliativmedizinischen Unterstützungsangebote auf den Intensivstationen deutscher onkologischer Spitzenzentren erfasst werden. Material und Methoden Durchgeführt wurde eine quantitativ-qualitative, deskriptive Umfrage an den 16 von der Stiftung Deutsche Krebshilfe geförderten Zentren. Die im quantitativen Teil erfragten Häufigkeiten werden als Mittelwert und Median mit den jeweiligen Streumaßen dargestellt, während die im qualitativen Teil erhobenen Triggerfaktoren mit einer Inhaltsanalyse nach Mayring ausgewertet wurden. Ergebnisse Von Juli bis August 2017 konnten Angaben aus 15 von 16 onkologischen Spitzenzentren (94 %) erfasst werden. Im Jahr 2016 wurden im Median 33 Intensivpatienten (Min. 0, Max. 100) palliativmedizinisch vorgestellt und 9 Patienten (Min. 1, Max. 30) auf eine Palliativstation verlegt. Regelmäßige intensivmedizinisch-palliativmedizinische Visiten sowie ein Screening-Tool zur Einbindung der spezialisierten Palliativmedizin sind an zwei onkologischen Spitzenzentren implementiert. Anhand von 23 genannten Triggern, die auf der Intensivstation eine palliativmedizinische Mitbehandlung ausgelöst haben, lassen sich nach qualitativer Analyse die drei Kategorien „Entscheidung und Einstellung des Teams“, „Zustand des Patienten“ und „Wunsch von Patienten und Angehörigen“ ableiten. Diskussion Trotz eines verfügbaren Angebots werden palliativmedizinische Ressourcen in den intensivmedizinischen Abteilungen der onkologischen Spitzenzentren immer noch selten genutzt. In die tägliche Routine integrierte Angebote wie Screening-Tools oder gemeinsame Visiten könnten die Ausnutzung der angebotenen palliativmedizinischen Ressourcen erhöhen und die Versorgungsqualität verbessern.

Background Patients in palliative care need rapid-acting pharmacological options for psychological distress. N-methyl-D-aspartate antagonist ketamine is known to have a fast onset of anti-depressant and anxiolytic action. Its S-enantiomer S-ketamine (or esketamine) is an analgesic used as a routine treatment for refractory pain as an intravenous infusion (0.25 mg/kg over 45 min). This study investigates whether S-ketamine pain therapy has a positive impact on psychological distress caused by anxiety and depression in palliative care. Methods Patient routine data from a palliative care unit of a tertiary care hospital were used in a retrospective analysis after positive ethics approval. Eight patients, who received analgesic S-ketamine treatment, were compared to a control group matched by gender and age. The main analysis was conducted using three-way mixed MANOVA followed by two-way mixed ANOVA. Target variables were the values for anxiety and depression in the state-trait anxiety-depression inventory STADI. The predictor variables were the time of measurement before (T1) and after (T2) S-ketamine application and group membership. Results Comparison of the S-ketamine group (n = 8; 4 male, 4 female; average age 52 years) with the control group (n = 8; 3 male, 5 female; average age 55 years) revealed a significant multivariate effect on anxiety and depression F(1, 14) = 4.78; p = 0.046; r = 0.50. The univariate comparisons showed a significant reduction of the anxiety scores from T1 to T2 in the S-ketamine group compared to the control group F(1, 14) = 10.14; p = 0.007; r = 0.65. With regard to depression, there was no significant reduction from T1 to T2 in the group comparison F(1, 14) = 1.60; p = 0.23; r = 0.32. No long-lasting effects on pain were found. Conclusions Our findings show that psychological distress of patients in palliative care may improve after a single administration of S-ketamine, which mainly alleviates anxiety in those patients. Limitations of this study arise from non-randomization, retrospective analysis and low sample size. Therefore, further prospective and ideally randomized studies are necessary.

BACKGROUND:For intensive care patients with limited life expectancy the integration of palliative care in intensive care may be beneficial. However, little is known about the extent of this interdisciplinary collaboration. OBJECTIVES:The support given by palliative medicine in German oncological centers and used by the intensive care units should be recorded. MATERIAL AND METHODS:A descriptive survey was conducted in all of the 16 Comprehensive Cancer Centers (CCC) funded by German Cancer Aid. The questionnaires were sent to the head of department of the CCCs' specialized palliative care teams. Data were collected for the year 2016. Quantitative data were analysed to establish frequencies, given as mean and median. A qualitative section asked for trigger factors, i.e., patient characteristics triggering a palliative care consultation. Evaluation was inductively carried out by content analysis according to Mayring. RESULTS:Data from 15 of the 16 CCCs (94%) were obtained between July and August 2017. In 2016, the median of intensive care patients with palliative care consultations was 33 (minimum 0, maximum 100). The median of nine patients were transferred from an intensive care unit to a palliative care unit (minimum 1, maximum 30). Multidisciplinary ward rounds by both intensive and palliative care staff were available in two CCCs on a regular basis. Two CCCs implemented screening tools to integrate specialized palliative care into intensive care. From 23 responses concerning triggers, three categories were established, i.e., "team's decision and attitude", "patient's condition" and "desires of patients and relatives". CONCLUSIONS:Palliative care is available in German CCCs. However, the degree of integration of specialized palliative care into intensive care units is low. Screening tools are available to identify patients with complex needs and to trigger a palliative care consultation. These tools, as well as joint ward rounds of intensive and palliative care staff, can improve the quality of patient centred care.

BACKGROUND: For intensive care patients with limited life expectancy the integration of palliative care in intensive care may be beneficial. However, little is known about the extent of this interdisciplinary collaboration. OBJECTIVES: The support given by palliative medicine in German oncological centers and used by the intensive care units should be recorded. MATERIAL AND METHODS: A descriptive survey was conducted in all of the 16 Comprehensive Cancer Centers (CCC) funded by German Cancer Aid. The questionnaires were sent to the head of department of the CCCs' specialized palliative care teams. Data were collected for the year 2016. Quantitative data were analysed to establish frequencies, given as mean and median. A qualitative section asked for trigger factors, i.e., patient characteristics triggering a palliative care consultation. Evaluation was inductively carried out by content analysis according to Mayring. RESULTS: Data from 15 of the 16 CCCs (94%) were obtained between July and August 2017. In 2016, the median of intensive care patients with palliative care consultations was 33 (minimum 0, maximum 100). The median of nine patients were transferred from an intensive care unit to a palliative care unit (minimum 1, maximum 30). Multidisciplinary ward rounds by both intensive and palliative care staff were available in two CCCs on a regular basis. Two CCCs implemented screening tools to integrate specialized palliative care into intensive care. From 23 responses concerning triggers, three categories were established, i.e., team's decision and attitude, patient's condition and desires of patients and relatives. CONCLUSIONS: Palliative care is available in German CCCs. However, the degree of integration of specialized palliative care into intensive care units is low. Screening tools are available to identify patients with complex needs and to trigger a palliative care consultation. These tools, as well as joint ward rounds of intensive and palliative care staff, can improve the quality of patient centred care.

Depressionen und Ängste sind häufige Erkrankungen bei Palliativpatienten. Hier werden schnell einsetzende Therapieoptionen benötigt. Für den N-Methyl-D-Aspartat-Antagonist Ketamin ist eine schnell einsetzende antidepressive und anxiolytische Wirkung bekannt. Esketamin (Gesamtdosis: 0,25 mg/kg Körpergwicht als i.v. Infusion über 1 Stunde) wird in unserem Zentrum als Analgetikum bei therapierefraktären Schmerzen eingesetzt.

INTRODUCTION:The Liverpool Care Pathway for the Dying Patient is an instrument to deliver integrated care for patients in their last hours of life. Originally a paper-based system, this study investigates the feasibility of an electronic version.METHODS:An electronic Liverpool Care Pathway was implemented in a specialized palliative care unit of a German university hospital. Its use is exemplified by means of auditing and analysis of the proportion of recorded items.RESULTS:In the years 2013 and 2014 the electronic Liverpool Care Pathway was used for the care of 159 patients. The uptake of the instrument was high (67%). Most items were recorded. Apart from a high usability, the fast data retrieval allows fast analysis for auditing and research.CONCLUSIONS AND DISCUSSION:The electronic instrument is feasible in a computerized ward and has strong advantages for retrospective analysis.TRIAL REGISTRATION:Internal Clinical Trial Register of the Medical Faculty, Heinrich Heine University Düsseldorf, No. 2015124683 (7 December 2015).

One of the prime aims of intensive care is to cure patients or at least to extend life duration, sometimes to the extent of losing quality of life. Palliative care aims to improve the quality of life of patients with life-limiting conditions; however, some patients need both intensive and palliative care. About 5-10% of all deaths in Germany and 20% of all deaths in the USA occur in an intensive care unit (ICU) and many of those as well as other patients may benefit from palliative care consultation. Palliative care consultations are increasingly available for intensive care patients but are still infrequently used.We aimed to determine the current situation of palliative patients in ICU settings: what is the impact of palliative care interventions on the quality of care of ICU patients? To what extent is palliative care support at ICUs available and to what extent is it used? Which factors trigger palliative care consultations?We set out with a search of PubMed, Scopus and other databases in English and on a) the impact of palliative care interventions on the quality of care of ICU patients, b) the utilization of palliative care support in ICUs and c) the factors which trigger palliative care consultations. We included both quantitative and qualitative studies to reflect the views of all parties involved. To emphasize the situation in German-speaking countries we also searched Google Scholar with search terms in German and added those results to the review. Additionally, hand-searched studies in English and in German were included.We screened 695 abstracts and identified 18 relevant articles of which 15 were from the USA and Great Britain, 1 each was from Austria, Germany and Switzerland. Palliative care is a meaningful addition to ICU standard treatment: it can improve quality of care and helps reduce length of stay in an ICU. It is unclear if the reduced length of stay leads to economic benefits; however, the utilization of palliative care is inconsistent and infrequent as is its acceptance among ICU physicians. Trigger factors can be used to improve the integration of palliative care support in ICUs and point out patients' unmet palliative needs.Trigger factors can reduce barriers which hold back the integration of palliative care in ICUs. Early integration of palliative care can improve quality of care by offering psychological support to patients and their families and by providing collegial consultation. An ongoing prospective study is investigating the acceptance of trigger factors in the daily routine among ICU physicians in Germany.

Trotz eines immer häufiger vorhandenen Angebots werden palliativmedizinische Ressourcen in der Intensivmedizin nur selten genutzt.

End-of-life integrated care plans are used as structuring tools for the care of the dying. A widely adopted example is the Liverpool Care Pathway for the Dying Patient (LCP). Recently, several concerns were raised about LCP care, such as a worry that diagnosis of dying might be leading to a self-fulfilling trajectory, including hastening of death. However, data on rates of discontinuation of LCP care are lacking. In an observational study, we therefore investigated the incidence, features and trajectory of patients who were discontinued from the LCP. We hypothesised that (1) it is common to discontinue patients from the LCP, (2) quality of life does not decrease for discontinued LCP patients, and (3) discontinued patients live longer than patients who remain within LCP care.