Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Jun 2008
ReviewOxygen for relief of dyspnea: what is the evidence?
Refractory dyspnea is a common and distressing symptom complicating respiratory illness, including chronic obstructive pulmonary disease, and life-limiting illnesses in general, including cancer. Oxygen is often prescribed for relief of dyspnea and several consensus guidelines support this practice. The goal of this review is to outline the evidence for the use of oxygen for relief of dyspnea, with specific attention to situations in which oxygen is not already funded through long-term oxygen treatment guidelines (i.e., when PaO2 is >/=55 mmHg; also known as palliative oxygen). ⋯ The data highlighted in this review support the belief that certain individuals benefit from the use of palliative oxygen but continue to suggest that definitive randomized trials are required to fully establish the benefit of palliative oxygen and to delineate characteristics predictive of benefit.
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Curr Opin Support Palliat Care · Jun 2008
ReviewMeasurement of dyspnoea in the clinical rather than the research setting.
Refractory dyspnoea is a common and difficult to treat symptom in advanced disease. Accurate assessment helps to guide treatment and prognosis. ⋯ Despite a variety of measurement tools none can be recommended as gold standard for the assessment of dyspnoea. A combination of unidimensional and multidimensional tools seems to be the best for clinical assessment. Measurement of dyspnoea has to be seen in context with the person's history, physical examination and diagnostic tests.
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Chronic cough is common and distressing, especially against the background of life-threatening illness. It is a symptom that has received scant attention, often eclipsed by pain, breathlessness, nausea and vomiting. ⋯ The availability of simple assessment tools places the imperative on clinicians to be more systematic in assessment of cough and its interventions. The mainstay of oral therapy for symptom control remains dextromethorphan, codeine and morphine. The potential for research is huge: from basic scientific understanding to clinical trials of innovative therapies.
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Curr Opin Support Palliat Care · Jun 2008
ReviewAssessment and management of pain in older adults with dementia: a review of current practice and future directions.
The purpose of this paper is to consolidate the literature around pain assessment and management in older adults with dementia and to make recommendations for future research and practice developments. This review is provided following the introduction of guidelines for the assessment of pain that were published last year. ⋯ Pain in older adults has received increasing attention within the literature during the last decade, and in the past 12 months, there have been a number of papers published that highlight several key issues in the area. In terms of pharmacology and complementary therapies, there is still a need to evaluate their use in older adults in general. We have seen guidelines introduced and we need to consider how well these are being implemented. However, most importantly, we are now seeing increasing evidence supporting the use of three behavioural pain assessment scales, which look promising for the future.