Current opinion in supportive and palliative care
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Persistent postsurgical pain (PPP) is an important cause of pain morbidity following surgery for almost any cause, but there is a greater evidence base for pain after cancer surgery. Historically, both patients and practitioners have struggled to recognize and accept this growing problem. This review will seek to highlight the awareness of this increasing epidemic and will discuss evidence base for diagnosis, risk factors and current strategies for prevention and treatment, especially after cancer surgery. ⋯ An estimated 40,000 patients in the UK will develop PPP, of whom at least 5-10% will have severe pain. Lack of clear definition and lack of awareness have been barriers to diagnosis and access to treatment. Several risk factors associated with PPP have been identified and reduction of these factors may prevent its development. At present, there are large gaps in the evidence base and more large controlled trials are warranted.
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Curr Opin Support Palliat Care · Jun 2013
ReviewPalliative care in Japan: a review focusing on care delivery system.
Providing palliative care in Japan is one of the most important health issues. Understanding palliative care delivery systems of other countries is useful when developing and modifying palliative care systems worldwide. This review summarizes the current status of palliative care in Japan, focusing on the structure and process development. ⋯ Palliative care in Japan has progressed rapidly, and the Cancer Control Act has played a very important role in developing palliative medicine. Challenges include developing a structure for palliative care in the community or regional palliative care programs, establishing a method to measure and improve the quality of palliative care at a national level, developing evidence-based medicine and policy making, and palliative care for the noncancerous population.
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Curr Opin Support Palliat Care · Jun 2013
ReviewModels of delivering palliative and end-of-life care in the UK.
The development of palliative and end-of-life care in the UK has been shaped by history and circumstances within and outside palliative care itself. The main focus of this review is to describe adult palliative care services in England, although much of the historical developments apply across the whole of the UK, and some of the later developments affect children's services as well. ⋯ Although there is comprehensive coverage of palliative care obtainable across the UK and good access to medication and equipment, there remains a lot of inequity to challenge and address, including those relating to geography, diagnosis, age and ethnicity.
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Curr Opin Support Palliat Care · Jun 2013
ReviewModels of delivering palliative and end-of-life care in sub-Saharan Africa: a narrative review of the evidence.
This narrative review examines evidence for models of palliative and end-of-life (eol) care delivery in sub-Saharan Africa (SSA) since 2010. It highlights recent developments, on-going challenges and innovative approaches used to address obstacles to increased access to care. ⋯ Although community and HBC programs remain primary models of palliative and eol care delivery in SSA, there is an urgent need to develop a public health approach that integrates care into national health systems to increase accessibility.
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Curr Opin Support Palliat Care · Jun 2013
ReviewPharmacological treatment of constipation in palliative care.
The prevalence of constipation in palliative care patients varies. There is uncertainty about the choice from varying recommendations for pharmacological management of constipation and a varying clinical practice in palliative care settings. The purpose of the review was to evaluate the current recommendations of therapy guidelines and to determine the effectiveness and safety of laxative administration for the management of constipation in palliative care patients. ⋯ There are limited data available on the conventional pharmacological treatment of constipation in palliative care patients due to insufficient randomized controlled trials. However, subcutaneously administered methylnaltrexone was found to be effective in aiding of laxation and well tolerated with limited or transient side effects in palliative care patients.