Olanzapine provided adequate, ongoing relief of nausea and vomiting with an acceptable adverse effect profile in 13 of 14 evaluable patients. Particularly in comparison with metoclopramide and haloperidol, olanzapine should be considered for first-line therapy for nausea and vomiting in this population. Further evaluation of dose ranging and safety is required.
The winding down and withdrawal of the Liverpool Care Pathway (LCP) following the Neuberger Report has been met with mixed reviews. It appears that responsibility for failures of clinical care has been laid at the feet of a care pathway rather than the practitioners who used it, a rather curious outcome given that the LCP was primarily a system of documentation, a tool with no intrinsic therapeutic properties. The Neuberger inquiry was the result of persistent and repeated reports of poor-quality end-of-life care associated with the use of the LCP. There were indeed problems with the LCP regarding the process of diagnosing dying and its approach to supportive care, particularly artificial nutrition and hydration. Some of the problems were the product of personal or professional ideology influencing goals of care rather than patient-centred considerations. These problems were not insurmountable, however, and were being addressed by the organisation responsible for the LCP. With the removal of the LCP, we are left with no bench mark for end-of-life care, only aspirational goals for individualised care plans. It seems unlikely that practitioners who could not provide appropriate care with the LCP will do so without it.
Olanzapine is an atypical antipsychotic indicated for the treatment of schizophrenia and known to be effective in the management of delirium. In addition to its use for these indications olanzapine has also been used in the management of chemotherapy induced nausea and vomiting and otherwise difficult to control nausea and vomiting in palliative care settings. Although considered to be well tolerated with a lower incidence of extrapyramidal effects than first generation antipsychotics there are a small number of reports of olanzapine inducing delirium. Reported here are two cases of "probable" acute cognitive impairment following treatment of nausea with olanzapine. The cognitive impairment associated with olanzapine is probably mediated through its activity at cholinergic receptors a known risk factor for delirium particularly in the elderly.
[Though long familiar with the erratic blocks or (as they are now more generally called) boulders of the west of England, and though I had written many papers on the subject, which appeared in the ‘Quart. Journ. Geol Soc.’ and ‘Geological Magazine,’ I lately saw the necessity for a systematic revision of what I had done, and more especially for an extension of my observations in a south and southeast direction, where they could be made to throw some clear light on the nature and sequence of glacial events. As no attempt has hitherto been made to treat the subject of erratics as a distinct branch of science, and as most readers might probably expect to find in a paper on the subject little more than an inventory of facts, it may be well to begin with a few remarks and definitions calculated to excite a scientific interest in the subsequent detailed statements.]
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