Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Dec 2007
ReviewPsychological, social and spiritual distress at the end of life in heart failure patients.
Chronic heart failure patients have palliative care needs that include psychosocial and spiritual support, particularly towards the end of life, when breathlessness and resultant immobility become increasingly severe. This review informs clinicians of the importance of understanding, assessing and managing patients' psychosocial and spiritual needs. ⋯ We hope this review will inform cardiac and palliative care staff about the prevalence of psychosocial and spiritual distress in advanced chronic heart failure, and highlight the importance of their assessment and management. There is an urgent need for research in this field, including the rigorous development and evaluation of service models and nonpharmacological interventions.
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Curr Opin Support Palliat Care · Dec 2007
ReviewDifficult conversations and chronic heart failure: do you talk the talk or walk the walk?
Effective communication is critical for palliative and supportive care in heart failure. This article contains a review of available information to assist clinicians in undertaking discussions regarding prognosis, treatment decisions and advance care planning. ⋯ When having these difficult conversations, clinicians need to assess the individual's need and wishes for information as well as their social and cultural background. They also need to consider the setting, timing and content of the discussion, as well as strategies to promote coping and adjustment. Most importantly, patients need a treatment plan to address palliative and supportive care needs to be implemented at the time of breaking this bad news, so that they and their families do not feel abandoned. Learning effective communication skills, implementing strategies for debriefing and the fostering of a team approach, may minimize burden on health providers and improve palliative and supportive care for people with heart failure.
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Curr Opin Support Palliat Care · Dec 2007
ReviewVertebral augmentation in osteoporosis and bone metastasis.
Osteoporosis is a disorder characterized by decreased bone density, disruption of trabecular architecture, and increased susceptibility to fractures. There are approximately 700,000 vertebral body compression fractures in the United States each year with approximately 70,000 of these resulting in hospitalization, with an average hospital stay per patient of eight days. Osteolytic lesions of the spine are also a growing problem, affecting as many as 70% of patients with metastatic disease or multiple myeloma. Tumor-induced osteolysis may lead to pain, dysfunction, and ultimately vertebral collapse. If left untreated, vertebral body compression fractures occur with progressive kyphosis over multiple levels, cord compromise, and intractable pain. The purpose of this review is to discuss recent advances in percutaneous minimally invasive vertebral augmentation techniques used in the treatment of compression fractures. ⋯ More studies are needed to assess the long-term effectiveness of early vertebral augmentation in the treatment of compression fractures. Early vertebral augmentation has, however, shown excellent early pain relief in those with severe pain or progressive collapse, up to a period of two years after its implementation.