Current opinion in supportive and palliative care
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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.
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To summarize recent research findings about the use and effects of integrated care pathways for end-of-life care. ⋯ The use of integrated care pathways for dying patients has the potential to improve care by promoting best practice and standardizing care. In addition, these pathways may improve documentation and provide a mechanism for measuring patient outcomes. Although recent studies on the use of these integrated care pathways are descriptive, some publications have demonstrated improved patient outcomes and processes of care. As their use expands, more studies on the effects and outcomes of these care pathways are anticipated.
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Curr Opin Support Palliat Care · Oct 2007
ReviewPublic palliative care: review of key developments and implementation issues.
This review identifies and briefly describes palliative care programmes that are integrated into the national or regional health care plans of various countries. ⋯ Success in making palliative care a public discipline that is fully integrated into a country's health care system requires considerable effort in terms of advocacy and lobbying. International support from and networking with experienced individuals who are involved in more mature programmes is crucial to changing attitudes and transforming ideas into action, and strategic and sustainable plans.
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Palliative care is a discipline that provides satisfactory symptom relief to most patients with advanced life-threatening disease. There remain circumstances, however, in which patients experience distressing symptoms and unbearable suffering that cannot be adequately relieved. In these situations palliative sedation may be valuable as a last resort. Palliative sedation is a controversial issue and research in this area is complex for ethical and practical reasons. A review of some critical aspects, giving special attention to those areas that require further research, is therefore timely. ⋯ This review addresses recent literature concerning definitions of palliative sedation and intolerable/refractory suffering, indications and drug use. The current state of the art is summarized and future lines of research are proposed.
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Curr Opin Support Palliat Care · Oct 2007
ReviewDrug management of terminal symptoms in advanced cancer patients.
This review addresses recent research into drug management of terminal major symptoms such as breathlessness, terminal delirium and death rattle. ⋯ Conducting well designed trials in the setting of terminal cancer is complex and ethically questionable. Most data retrieved are based mainly on clinical experience. Further high quality research is required to inform clinical recommendations regarding terminal care.