The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.
SELECTED END-STAGE CONDITIONS
Palliative care and hospice referral guidance in Parkinson disease (September 2021)
In patients with advanced Parkinson disease (PD), it can be difficult to determine the most appropriate timing for hospice referral, and there are no validated end-of-life prognostic tools. A working group sponsored by the Parkinson's Foundation has proposed guidance to identify patients who would likely benefit from hospice/palliative care . Referral should be considered in patients with critical nutrition impairment, life-threatening complications, or poorly responsive motor symptoms causing impaired self care in the prior year; rapid or accelerating motor or nonmotor disease progression and disability; or advanced dementia meeting hospice referral criteria based on Medicare eligibility guidelines or other prognostic tools. (See "Palliative approach to Parkinson disease and parkinsonian disorders", section on 'Life expectancy and hospice eligibility'.)
END OF LIFE AND HOSPICE CARE
Prophylactic treatment for airway secretions at the end of life (October 2021)
Excess airway secretions in patients at the end of life (death rattle) can be a troublesome symptom for caregivers and loved ones, but recommendations for treatment have been limited by lack of clinical trial data. In a randomized trial conducted in 162 patients in six hospices in the Netherlands, patients entering the dying phase were assigned to receive either prophylactic subcutaneous scopolamine butylbromide (not available in United States) or placebo . Death rattle occurred in a smaller percentage of patients in the scopolamine group (13 versus 27 percent). These results support the efficacy of anticholinergic agents for palliative management of airway secretions in patients nearing the end of life. We prefer glycopyrrolate. (See "Palliative care: The last hours and days of life", section on 'Airway secretions'.)