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Latest & greatest articles for palliative care
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Reform of drug control policy for palliative carein Romania. Unrelieved pain from cancer and HIV/AIDS is a substantial worldwide public-health problem. Inadequate pain relief is partly due to excessively strict national drug-control policies that constrain medical use of essential medicines such as morphine. Romania's drug-control policies are more than 35 years old and impose an antiquated regulatory system that is based on inpatient post-surgical management of acute pain that restricts (...) prescription authority and makes access to opioid treatment difficult for outpatients with severe chronic pain due to cancer or HIV/AIDS. A Ministry of Health palliative-carecommission used WHO guidelines to assess and recommend changes to Romania's national drug control law and regulations. The Romanian parliament has adopted a new law that will simplify prescribing requirements and allow modern pain management. Achievement of adequate pain relief is a vital part of worldwide health and will be dependent
Integrating palliative carefor liver transplant candidates: "too well for transplant, too sick for life". Chronic liver disease results in more than 1 million physician visits and more than 300,000 hospitalizations per year in the United States. More than 27,000 patients annually progress to end-stage liver disease (ESLD), liver failure, or death. Patients with ESLD experience such complications as encephalopathy, malnutrition, muscle wasting, ascites, esophagogastric variceal hemorrhage (...) , spontaneous bacterial peritonitis, fatigue, and depression. Despite significant improvements in palliation, patients' quality of life diminishes and their disease will often inexorably progress. Liver transplantation, a valid treatment option, increases life and reduces many symptoms. With the current shortage of organs, up to 10% to 15% of these patients die without receiving an organ. Many patients also are not candidates for transplantation due to comorbid illness. In addition, some patients receive
Acceptability of low molecular weight heparin thromboprophylaxis for inpatients receiving palliative care: qualitative study. OBJECTIVE: To find out what inpatients with advanced cancer who are receiving palliative carethink about the effect of thromoprophylaxis on overall quality of life. DESIGN: Qualitative study using audiotaping of semistructured interviews. SETTING: Regional cancer centre in Wales. PARTICIPANTS: 28 inpatients with advanced metastatic cancer receiving palliative careand (...) their quality of life by giving them a feeling of safety and reassurance. Antiembolic stockings were considered uncomfortable and had a negative impact on quality of life. Patients were concerned that because they had advanced disease they might not be eligible for thromboprophylaxis. CONCLUSION: Low molecular weight heparin is acceptable to inpatients with advanced cancer receiving palliative careand has a positive impact on overall quality of life. Antiembolic stockings are an unacceptable intervention
Meeting palliative careneeds in post-acute care settings: "to help them live until they die". One fourth of US deaths take place in long-term care facilities. As the population ages and hospitals shorten length of stay, these settings will deliver more terminal care. Using an illustrative case of an older patient with metastatic melanoma whose life expectancy was weeks to months, we discuss when potential benefits outweigh the risks of transfer from the hospital to post-acute care settings (...) . To improve continuity of care, we outline communication of treatment goals and orders that anticipate symptom escalation. We discuss criteria physicians can use to identify the settings most able to ensure access to high-quality palliative care. Physicians and patients must consider the advantages and disadvantages of inpatient hospice, nursing homes, and residential care facilities. Post-acute care settings vary in delivery of hospice and other palliative careservices, professional nursing services
Improving the quality of palliative carefor ambulatory patients with lung cancer. PROBLEM: Most patients with advanced lung cancer currently receive much of their health care, including chemotherapy, as outpatients. Patients have to deal with the complex and time consuming logistics of ambulatory cancer care. At the same time, members of staff often waste considerable time and energy in organisational aspects of care that could be better used in direct interaction with patients. DESIGN (...) : Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding satisfaction with working conditions. SETTING: Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care. KEY MEASURES FOR IMPROVEMENT: Waiting time and time wasted during consultations; calmer working situation at the clinic
Palliative carein the final days of life: "they were expecting it at any time". Providing care to actively dying patients presents unique challenges for the clinician. Patients in their final days require careful symptom management. Families need support and coaching as death approaches. Care does not end with the death of the patient but continues through death pronouncement, family notification of the death, discussion of autopsy, and immediate bereavement support. Skills (...) in these and related areas are discussed in the context of one man's death, as illuminated by comments made after death by his daughter and his physician. This case also highlights the often differing perspectives of families and clinicians as they work to deal with a patient's death. A goal of mastering the palliativeskillsnecessary to competently care for an actively dying patient is to enable a patient to die peacefully and relatively free of discomfort. Achieving such competency should also help to relieve
Does palliative careimprove outcomes for patients with HIV/AIDS: a systematic review of the evidence Does palliative careimprove outcomes for patients with HIV/AIDS: a systematic review of the evidence Does palliative careimprove outcomes for patients with HIV/AIDS: a systematic review of the evidence Harding R, Karus D, Easterbrook P, Raveis V H, Higginson I J, Marconi K CRD summary The review assessed the effectiveness of palliative carein patients with the human immunodeficiency virus (...) /acquired immune deficiency syndrome. The authors found improvements across a number of domains. However, further studies are needed because of a lack of experimental methods and standardised measures. The authors' cautious conclusion seems to reflect the limited evidence available. Authors' objectives To determine the effectiveness of palliative carein improving outcomes for patients with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Searching MEDLINE (1980 to 2003), CINAHL (1982 to 2003
A systematic review of the scientific evidence for the efficacy of a palliative careapproach in advanced dementia A systematic review of the scientific evidence for the efficacy of a palliative careapproach in advanced dementia A systematic review of the scientific evidence for the efficacy of a palliative careapproach in advanced dementia Sampson E L, Ritchie C W, Lai R, Raven P W, Blanchard M R CRD summary This review assessed the efficacy of palliative caremodels in patients (...) with dementia. The authors concluded that there is currently little evidence on which to base any conclusions. Given the limited evidence identified, the authors' cautious conclusions are likely to be reliable. Authors' objectives To assess the efficacy of a palliative caremodel in patients with dementia. Searching MEDLINE, EMBASE, PsycINFO, CINAHL, the British Nursing Index, AMED, Web of Science and SIGLE were searched from inception to October 2003. The third quarter of the Cochrane Database
Guidelines for a palliativeapproachto residential aged care Guidelines for a palliativeapproachto residential aged care: A systematic review of the literature | National Health and Medical Research Council Toggle navigation Search form Search Guidelines for a palliativeapproachto residential aged care: A systematic review of the literature Guidelines for a palliativeapproachto residential aged care: A systematic review of the literature Summary information Publishing date: 2005 Status (...) : This publication is more than 5 years of age and may no longer reflect current evidence or best practice Reference number: AC14 Available in print: No - PDF only Further information: Synopsis Guidelines for a PalliativeApproachin Residential Aged Care are evidence-based guidelines developed by the Australian PalliativeResidentialAgedCare (APRAC) project team. The guidelines aim to provide support and guidance for the delivery of a palliativeapproachin residential aged care facilities across Australia
The use of drugs beyond licence in palliative careand pain management The use of drugs beyond licence in palliative careand pain management A position statement prepared on behalf of the Association for PalliativeMedicineand the British Pain Society November 2005 To be reviewed November 2008. Copyright: The Association for PalliativeMedicineand the British Pain Society, 2005 i Published by: The British Pain Society 21 Portland Place London W1B 1PY. Website: www.britishpainsociety.org (...) First published by the Pain Society, March 2002 First revised edition, November 2005 ISBN 0-9546703-4-5 i THE USE OF DRUGS BEYOND LICENCE IN PALLIATIVE CAREAND PAIN MANAGEMENT A position statement prepared on behalf of the Association for PalliativeMedicineand the British Pain Society This statement summarises the views of the Association for PalliativeMedicine (APM) and the British Pain Society in relation to the use of drugs beyond their product licence (or marketing authorisation) in clinical
Palliative CarePalliative Care | The King's Fund Fill 1 Main navigation Health and care services Leadership, systems and organisations Patients, people and society Policy, finance and performance Search term Apply Palliative Care: Perspectives for dying people This content relates to the following topics: Share this content Authors Jenni Burt Cathy Shipman Julia Addington-Hall Patrick White Publication details ISBN 978 1 85717 500 4 Pages 12 Palliative care – care for people in their final (...) stages of life – is gaining increasing recognition, but for it to be extended to all communities, primary care trusts (PCTs) need to be able to commission these services more effectively. Drawing on a two-year research project carried out by , funded by The King's Fund, this publication examines palliative careprovision in London, looking at how and why services vary between . It explores the views of key health professionals on current services and on each others' roles, featuring the voices of GPs
What do patients receiving palliative carefor cancer and their families want to be told? A Canadian and Australian qualitative study. OBJECTIVE: To obtain feedback from patients receiving palliative careand their relatives from various ethnic backgrounds about their experiences of the disclosure process and their satisfaction with information sharing during the illness. DESIGN: A qualitative study with semistructured single interviews. SETTING: Perth, Western Australia, and Winnipeg, Manitoba (...) , Canada. PARTICIPANTS: 72 participants registered with palliative care: 21 patient-family dyads in Perth and 14 dyads and 2 patients in Winnipeg. RESULTS: Participants described their experiences in great detail. The analysis indicates that in information sharing the process is as important as the content. The timing, management, and delivery of information and perceived attitude of practitioners were critical to the process. This applied to information interactions at all stages of the illness. Main
Palliative carefor patients with heart failure. Heart failure accounts for more hospitalizations among Medicare beneficiaries than any other condition. Its symptoms, including shortness of breath, fatigue, and edema, can be frightening and diminish quality of life. Although treatment advances have allowed patients to live longer with a better quality of life, heart failure remains a leading cause of death in the United States. Half of heart failure patients die within 5 years of diagnosis (...) failure, including symptom management and discussing advance directives, prognosis, and hospice care. By combining optimal medical management with palliative care, physicians can best care for heart failure patients and their families.
What are the palliative careneeds of older people and how might they be met? WHO/Europe | What are the palliative careneeds of older people and how might they be met? Français Deutsch Pусский S search Databases Interactive atlases Evidence resources European health report Our flagship report maps health trends, charts progress towards achieving health goals and provides an advance base for health policy Resources Social media Events Organization Governance Partners Networks Jobs (...) and internships What are the palliative careneeds of older people and how might they be met? What are the palliative careneeds of older people and how might they be met? Download Summary The issue Ageing populations are characteristic of many countries. The pattern of disease at the end of life is changing and more people are living with serious chronic circulatory and respiratory diseases as well as with cancer. More people will need help at the end of life, in a social context of changing family structure
Drug therapy for anxiety in palliative care. BACKGROUND: Anxiety is common among patients with advanced disease. It can be a natural response to impending death, but may also result from an underlying anxiety disorder, pain, or other untreated or poorly managed symptoms. OBJECTIVES: The primary objective of this review was to identify and evaluate studies examining medications used to treat patients suffering from anxiety during the terminal phases of disease. SEARCH STRATEGY: We searched (...) the following sources: MEDLINE (1966 to July 2003), EMBASE (1980 to July 2003), CINAHL (1982 to July 2003), PsycLit (1974 to July 2003), PsycInfo (1990 to July 2003), and the Cochrane Library (Issue 2, 2003) for literature pertaining to this topic published in any language using a detailed search strategy. SELECTION CRITERIA: Prospective, randomized trials with or without blinding involving the use of pharmacological agents for the treatment of anxiety at the end of life were sought. DATA COLLECTION