Should we include monitors to improve assessment of awareness and pain in unconscious palliatively sedated patients? A case report
Background: Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. Case presentation: A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, an...
Saved in:
Published in | Palliative medicine Vol. 33; no. 6; pp. 712 - 716 |
---|---|
Main Authors | , , , , , , |
Format | Journal Article Web Resource |
Language | English |
Published |
London, England
SAGE Publications
01.06.2019
Sage Publications Ltd |
Subjects | |
Online Access | Get full text |
ISSN | 0269-2163 1477-030X 1477-030X |
DOI | 10.1177/0269216319835149 |
Cover
Abstract | Background:
Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question.
Case presentation:
A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions.
Case management:
The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor).
Case outcome:
The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise.
Conclusion:
This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients. |
---|---|
AbstractList | Background:Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question.Case presentation:A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions.Case management:The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor).Case outcome:The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise.Conclusion:This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients. Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions. The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor). The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise. This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients. Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question.BACKGROUNDAwareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question.A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions.CASE PRESENTATIONA woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions.The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor).CASE MANAGEMENTThe decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor).The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise.CASE OUTCOMEThe patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise.This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.CONCLUSIONThis case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients. Background: Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. Case presentation: A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions. Case management: The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor). Case outcome: The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise. Conclusion: This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients. |
Author | Deschepper, Reginald Six, Stefaan Laureys, Steven Bilsen, Johan Theuns, Peter Musch, Liza Poelaert, Jan |
Author_xml | – sequence: 1 givenname: Stefaan orcidid: 0000-0003-3584-6818 surname: Six fullname: Six, Stefaan email: Stefaan.Six@vub.be – sequence: 2 givenname: Steven surname: Laureys fullname: Laureys, Steven – sequence: 3 givenname: Jan surname: Poelaert fullname: Poelaert, Jan – sequence: 4 givenname: Johan surname: Bilsen fullname: Bilsen, Johan – sequence: 5 givenname: Peter surname: Theuns fullname: Theuns, Peter – sequence: 6 givenname: Liza surname: Musch fullname: Musch, Liza – sequence: 7 givenname: Reginald surname: Deschepper fullname: Deschepper, Reginald |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30843476$$D View this record in MEDLINE/PubMed |
BookMark | eNp9kc9rFTEQxxep2Nfq3ZMEvHhZnWTzks1JSqk_oOBBBW8hm52tKdnkmWRf6dW_3Dy29fBATwkzn--Xme-cNSchBmyalxTeUirlO2BCMSo6qvpuS7l60mwol7KFDn6cNJtDuz30T5uznG8BaAeCP2tOO-h5x6XYNL-__oyLH8kdEhesX0YkcwyuxJRJicTNuxT3SEzOmPOMoZA4EXNnEoZaICaMZGdcqGKyBBtDti4uuda8d6a4Pfp7knE0BQ9gcdUhvycXxJqMJOEupvK8eToZn_HFw3vefP9w9e3yU3v95ePny4vr1nJQpVVSjZ1UVIAUXCquOFMcRoBeTtYwQUEM0zAAk8aaUXC0OKGiMNAt3XYwdedNt_p6hzeoYxqc3jMdjVv_i7_RxuoBNWOi14xvOUBVvVlVNYhfC-aiZ5ctem8C1k01o31f05cgKvr6CL2NSwp1p-rIlGJSbWmlXj1QyzDjqHfJzSbd68ebVECsgE0x54STtq7U6GIoyTivKejD8fXx8asQjoSP3v-RtKskmxrJ33H_yf8BqH-8kA |
CitedBy_id | crossref_primary_10_1177_13872877241297147 crossref_primary_10_1177_0269216320974264 crossref_primary_10_1177_0269216321996990 crossref_primary_10_1177_02692163211022943 crossref_primary_10_1136_bmjspcare_2020_002511 crossref_primary_10_1016_j_jpainsymman_2020_02_015 crossref_primary_10_1016_j_medpal_2020_11_009 crossref_primary_10_1089_jpm_2020_0508 crossref_primary_10_1177_08258597211063687 crossref_primary_10_1007_s40122_022_00368_y crossref_primary_10_3917_jibes_324_0103 crossref_primary_10_1007_s40122_020_00214_z crossref_primary_10_1089_jpm_2021_0113 crossref_primary_10_3390_ijerph192114358 crossref_primary_10_1016_j_revinf_2023_02_014 crossref_primary_10_1093_jmp_jhad040 crossref_primary_10_1186_s12904_024_01371_0 |
Cites_doi | 10.1177/082585971503100109 10.1016/j.jpainsymman.2016.12.335 10.1136/bmj.2.5920.656 10.1177/0269216311425421 10.1371/journal.pone.0147720 10.1186/s12904-018-0316-2 |
ContentType | Journal Article Web Resource |
Copyright | The Author(s) 2019 |
Copyright_xml | – notice: The Author(s) 2019 |
DBID | AAYXX CITATION CGR CUY CVF ECM EIF NPM 7QJ ASE FPQ K6X K9. NAPCQ 7X8 Q33 |
DOI | 10.1177/0269216319835149 |
DatabaseName | CrossRef Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed Applied Social Sciences Index & Abstracts (ASSIA) British Nursing Index British Nursing Index (BNI) (1985 to Present) British Nursing Index ProQuest Health & Medical Complete (Alumni) Nursing & Allied Health Premium MEDLINE - Academic Université de Liège - Open Repository and Bibliography (ORBI) |
DatabaseTitle | CrossRef MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) ProQuest Health & Medical Complete (Alumni) Nursing & Allied Health Premium British Nursing Index Applied Social Sciences Index and Abstracts (ASSIA) MEDLINE - Academic |
DatabaseTitleList | ProQuest Health & Medical Complete (Alumni) MEDLINE MEDLINE - Academic |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1477-030X |
EndPage | 716 |
ExternalDocumentID | oai_orbi_ulg_ac_be_2268_245400 30843476 10_1177_0269216319835149 10.1177_0269216319835149 |
Genre | Research Support, Non-U.S. Gov't Journal Article Case Reports |
GrantInformation_xml | – fundername: Fonds Wetenschappelijk Onderzoek grantid: G.0566.15N funderid: https://doi.org/10.13039/501100003130 |
GroupedDBID | --- -TM .2E .2F .2G .2J .2N .XZ 0-V 01A 08G 0R~ 123 18M 1~K 29O 31R 31S 31U 31X 31Y 31Z 36B 3EH 4.4 53G 54M 5VS 7RV 7X7 88E 8FI 8FJ 8R4 8R5 AABCJ AABMB AABOD AACKU AACMV AACTG AADUE AAEWN AAGGD AAGLT AAGMC AAJIQ AAJOX AAJPV AAKGS AANSI AAPEO AAQDB AAQXH AAQXI AARDL AARIX AATAA AATBZ AAUAS AAWTL AAXOT AAYTG AAZBJ ABAFQ ABAWC ABAWP ABCCA ABCJG ABDWY ABEIX ABFWQ ABHKI ABHQH ABIDT ABIVO ABJZC ABKRH ABLUO ABPGX ABPNF ABQKF ABQXT ABRHV ABUJY ABUWG ABVFX ABYTW ACARO ACDSZ ACDXX ACFEJ ACFMA ACFYK ACGBL ACGFO ACGFS ACGZU ACJER ACJTF ACLFY ACLHI ACLZU ACOFE ACOXC ACROE ACRPL ACSIQ ACUAV ACUIR ACXKE ACXMB ADBBV ADDLC ADEBD ADEIA ADGHP ADMPF ADNBR ADNMO ADNON ADRRZ ADSTG ADTBJ ADUCT ADUKL ADVBO ADYCS ADZYD ADZZY AECGH AECVZ AEDTQ AEGXH AEKYL AENEX AEPTA AEQLS AERKM AESZF AEUHG AEWDL AEWHI AEXFG AEXNY AFEET AFKBI AFKRA AFKRG AFMOU AFQAA AFUIA AFWMB AGHKR AGKLV AGNHF AGPXR AGQPQ AGWFA AGWNL AHDMH AHHFK AHMBA AIAGR AIGRN AJABX AJEFB AJMMQ AJSCY AJUZI AJXAJ ALIPV ALKWR ALMA_UNASSIGNED_HOLDINGS ALSLI AMCVQ AN0 ANDLU ARALO ARTOV ASOEW ASPBG AUTPY AUVAJ AVWKF AYAKG AZFZN AZQEC B3H B8M B8O B8R B8Z B93 B94 BBRGL BDDNI BENPR BKEYQ BKIIM BKNYI BKSCU BNQBC BPACV BPHCQ BSEHC BVXVI BWJAD BYIEH C45 CAG CBRKF CCPQU CDWPY CFDXU COF CORYS CQQTX CS3 CUTAK DB0 DC- DC0 DD- DD0 DE- DF0 DO- DOPDO DU5 DV7 DV9 DWQXO D~Y EBS EJD EMOBN EX3 F5P FEDTE FHBDP FYUFA GNUQQ GROUPED_SAGE_PREMIER_JOURNAL_COLLECTION GX1 H13 HEHIP HF~ HMCUK HVGLF HZ~ J5H J8X K.F K.J K9- M0R M1P M2M M2S N9A NAPCQ O9- OB2 OVD P.B P2P PCD PHGZM PHGZT PQQKQ PROAC PSQYO PSYQQ Q1R Q2X Q7K Q7L Q7R Q7U Q7X Q82 Q83 ROL S01 SASJQ SAUOL SCNPE SDB SFB SFC SFK SFN SFT SGA SGO SGP SGR SGV SGX SGZ SHG SNB SPJ SPQ SPV SQCSI STM TEORI UKHRP WOW ZGI ZONMY ZPPRI ZRKOI ZSSAH ZXP AAYXX AJGYC CITATION ALTZF CGR CUY CVF ECM EIF M4V NPM 7QJ AAPII AJHME AJVBE ASE FPQ K6X K9. 7X8 AAEJI PJZUB POGQB PPXIY PRQQA Q33 |
ID | FETCH-LOGICAL-c409t-979d379160764794942940d0087fca26106bfbb027acad64ecefe910b151530f3 |
ISSN | 0269-2163 1477-030X |
IngestDate | Fri Jul 25 15:34:02 EDT 2025 Sun Sep 28 09:05:12 EDT 2025 Wed Aug 13 06:39:13 EDT 2025 Thu Apr 03 06:59:03 EDT 2025 Thu Apr 24 23:04:43 EDT 2025 Tue Jul 01 05:19:23 EDT 2025 Tue Jun 17 22:47:45 EDT 2025 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 6 |
Keywords | Palliative care pain measurement deep sedation unconsciousness patient monitoring |
Language | English |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-c409t-979d379160764794942940d0087fca26106bfbb027acad64ecefe910b151530f3 |
Notes | ObjectType-Case Study-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-4 ObjectType-Report-1 ObjectType-Article-3 content type line 23 scopus-id:2-s2.0-85062656661 |
ORCID | 0000-0003-3584-6818 |
PMID | 30843476 |
PQID | 2229927951 |
PQPubID | 33103 |
PageCount | 5 |
ParticipantIDs | liege_orbi_v2_oai_orbi_ulg_ac_be_2268_245400 proquest_miscellaneous_2188983706 proquest_journals_2229927951 pubmed_primary_30843476 crossref_citationtrail_10_1177_0269216319835149 crossref_primary_10_1177_0269216319835149 sage_journals_10_1177_0269216319835149 |
ProviderPackageCode | CITATION AAYXX |
PublicationCentury | 2000 |
PublicationDate | 2019-06-01 |
PublicationDateYYYYMMDD | 2019-06-01 |
PublicationDate_xml | – month: 06 year: 2019 text: 2019-06-01 day: 01 |
PublicationDecade | 2010 |
PublicationPlace | London, England |
PublicationPlace_xml | – name: London, England – name: England – name: London |
PublicationTitle | Palliative medicine |
PublicationTitleAlternate | Palliat Med |
PublicationYear | 2019 |
Publisher | SAGE Publications Sage Publications Ltd |
Publisher_xml | – name: SAGE Publications – name: Sage Publications Ltd |
References | Brinkkemper, van Norel, Szadek 2013; 27 Broucqsault-Dedrie, De Jonckheere, Jeanne 2016; 11 Barbato, Barclay, Potter 2017; 54 Ramsay, Savege, Simpson 1974; 2 Six, Laureys, Poelaert 2018; 17 Barbato, Barclay, Potter 2015; 31 bibr4-0269216319835149 Deschepper R (bibr1-0269216319835149) 2014 bibr5-0269216319835149 bibr3-0269216319835149 bibr2-0269216319835149 bibr7-0269216319835149 bibr6-0269216319835149 |
References_xml | – volume: 27 start-page: 54 issue: 1 year: 2013 end-page: 67 article-title: The use of observational scales to monitor symptom control and depth of sedation in patients requiring palliative sedation: a systematic review publication-title: Palliat Med – volume: 17 start-page: 62 year: 2018 article-title: Comfort in palliative sedation (Compas): a transdisciplinary mixed method study protocol for linking objective assessments to subjective experiences publication-title: BMC Palliat Care – volume: 2 start-page: 656 year: 1974 end-page: 659 article-title: Controlled sedation with alphaxalone-alphadolone publication-title: Br Med J – volume: 54 start-page: 186 issue: 2 year: 2017 end-page: 193 article-title: Correlation between observational scales of sedation and comfort and bispectral index scores publication-title: J Pain Symptom Manage – volume: 31 start-page: 57 issue: 1 year: 2015 end-page: 59 article-title: Sedation and analgesia in unconscious palliative care patients: can bispectral index monitoring add to our understanding? publication-title: J Palliat Care – volume: 11 start-page: e0147720 issue: 1 year: 2016 article-title: Measurement of heart rate variability to assess pain in sedated critically ill patients: a prospective observational study publication-title: PLoS ONE – ident: bibr6-0269216319835149 doi: 10.1177/082585971503100109 – start-page: 663 volume-title: Annual update in intensive care and emergency medicine year: 2014 ident: bibr1-0269216319835149 – ident: bibr7-0269216319835149 doi: 10.1016/j.jpainsymman.2016.12.335 – ident: bibr5-0269216319835149 doi: 10.1136/bmj.2.5920.656 – ident: bibr2-0269216319835149 doi: 10.1177/0269216311425421 – ident: bibr3-0269216319835149 doi: 10.1371/journal.pone.0147720 – ident: bibr4-0269216319835149 doi: 10.1186/s12904-018-0316-2 |
RestrictionsOnAccess | restricted access |
SSID | ssj0013064 |
Score | 2.3464165 |
Snippet | Background:
Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question.... Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. A woman in... Background:Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into... Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into... |
SourceID | liege proquest pubmed crossref sage |
SourceType | Open Access Repository Aggregation Database Index Database Enrichment Source Publisher |
StartPage | 712 |
SubjectTerms | Accidents Aged, 80 and over Analgesia Anesthesia Aphasia Awareness - physiology Case management Case reports Chronic pain deep sedation Deep Sedation - methods Discomfort Drugs Fatal Outcome Feasibility Female Hemiplegia Human health sciences Humans Hypnotics and Sedatives - therapeutic use Monitoring, Physiologic - instrumentation Monitoring, Physiologic - methods Nausea Pain Pain - diagnosis Pain - drug therapy Pain management Pain Management - methods pain measurement Palliative care Palliative Care - methods Paralysis Patient admissions Patient assessment patient monitoring Public health, health care sciences & services Santé publique, services médicaux & soins de santé Sciences de la santé humaine Sedation Stroke Suffering Unconsciousness Unconsciousness - physiopathology Vomiting |
Title | Should we include monitors to improve assessment of awareness and pain in unconscious palliatively sedated patients? A case report |
URI | https://journals.sagepub.com/doi/full/10.1177/0269216319835149 https://www.ncbi.nlm.nih.gov/pubmed/30843476 https://www.proquest.com/docview/2229927951 https://www.proquest.com/docview/2188983706 http://orbi.ulg.ac.be/handle/2268/245400 |
Volume | 33 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1bb9MwFLbKJiFeEHcCAxkJkFDJliau0zyhgVZN0zaQ1kp9s2zHYZWidmpTCjzyQ_itnOM4l40yAS9VmquV8-X42Oc7nwl5CSFFP-sr4-vEcJ8xafykz2KfRVk6CI3SxhbSnpzywzE7mvQnnc7PFmtpVahd_X1jXcn_WBX2gV2xSvYfLFvfFHbANtgXfsHC8PtXNj47xwWqu2sU_tD5Csmo9hNdWNmGqZ0vMF1Zi2_apP8ay7_Qv1mJADm1VEfo3aCR2hJiLyROwaAbzL91lwanBNJKf3X5KhqCL9HQ97l0Qzu6_VRf-VvO_mz6FRllmWxxgOSqwlG5tlrtpucml2ZRdI-ak99PoQ_HSqtzt8_NVGBxFG_PVLRJSCXLryEuLa0EbOKHPefuTOmOWRz74IYmbX9dCmc4XLadb-wI2cb945u7CJukxqfhw3rJAGsZkqY7rCgApx_FcHx8LEYHk9ENsh3GEJthMfmk12SpglKerGp5kwbfu3r_S2HPdo6EiE1jmkt8QhvijO6Q225sQvdLoN0lHTO7R26eOEveJz9KvNG1oQ5vtMIbLebU4Y02eKPzjNZ4o4A3iniDi2kLb7SNN-rwRiu8vaP7FNFGS7Q9IOPhwejDoe_W8PA1C5LCT-IkjeIEZQw5LmaQQPzDghSVEDMtYfgecJUpFYSx1DLlzGiTGQhhFQbaUZBFD8nWbD4zjwkN46wXKWbCgGsWcSUh1OQZS3mYpRH4FY_sVa9YaCdwj-us5KJXadpfMYpH3tRXXJTiLtec-9ZaTcwXaiq-hAJ12e32Kv8spBbKCBjKDESImpaBR3Yq4wrnMZZwHIK_MIZBjUde1IfBn2OSTs4MvHMBIfcgQUUq7pFHJSjqtkXBgEUshiOvESXNjf_U6CfXt-IpudV8pztkq1iszDOIsQv13AL9FyEG0UM |
linkProvider | Geneva Foundation for Medical Education and Research |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Should+we+include+monitors+to+improve+assessment+of+awareness+and+pain+in+unconscious+palliatively+sedated+patients%3F+A+case+report&rft.jtitle=Palliative+medicine&rft.au=Six+Stefaan&rft.au=Laureys%2C+Steven&rft.au=Poelaert+Jan&rft.au=Bilsen+Johan&rft.date=2019-06-01&rft.pub=Sage+Publications+Ltd&rft.issn=0269-2163&rft.eissn=1477-030X&rft.volume=33&rft.issue=6&rft.spage=712&rft.epage=716&rft_id=info:doi/10.1177%2F0269216319835149&rft.externalDBID=NO_FULL_TEXT |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0269-2163&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0269-2163&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0269-2163&client=summon |