Patient education and counseling
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To describe routine injury prevention counseling; to observe how three visit components - printed prompts, parent remarks, and parent behaviors - affect such counseling; to describe the process and content of discussions about car seats as an example of routine injury prevention. ⋯ Physicians bring up the injury topics that are prompted. However, most discussion is superficial. Printed prompts that address counseling process as well as content might be beneficial.
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A phenomenological stand, where the situation is understood explicitly from the subjective experience of the person as opposed to the Cartesian dualistic paradigm regarding the body as a material object, was the fundament for an educational programme for people with generalised chronic musculoskeletal pain. In a randomised controlled study these came out significantly better than the control group with respect to pain and pain coping, taking care of themselves, life satisfaction and health care consumption. Through participation in the group, persons with chronic pain were invited to identify their body from the first person perspective, and possibly become aware of the experienced-based knowledge embedded in their bodies. ⋯ A philosophy of teaching, where participation and activity are central elements, is presented and elaborated. The theoretical rationale and different educational methods used in the 12 sessions are described. Possible differences between this programme and cognitive therapies are discussed.
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Dutch palliative care stands on the eve of important changes. Further development of palliative care has become part of official national health care policy. One of the aims is prevention of euthanasia. ⋯ With regard to this topic, two questions need to be carefully distinguished. On the one hand, there is the factual question of whether a further development of palliative care can prevent euthanasia, on the other hand we have the normative question of whether palliative care should be further developed to prevent euthanasia. Both questions are analyzed.
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Palliative care is a fairly recent development in The Netherlands. The first palliative unit in a hospital setting was the Palliative Care Unit (PCU) in the Dr Daniel den Hoed Clinic, a specialized oncology hospital, now part of the Academic Hospital Rotterdam (AZR-Daniel). This PCU was designed to function as an academic laboratory, where palliative care concepts are being developed, put into practice, and evaluated. ⋯ However, the high stress levels of this innovative palliative team warrant attention. We discuss how support meetings could be a more effective way of caring for staff. They should be accompanied by adequate resources, a supportive management structure, and an extensive educational program.
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This issue presents a review of several issues in Dutch palliative care, paying attention to readjusting a distorted image due to the euthanasia practice in the Netherlands. A few articles stress the evolution of palliative care (especially in the UK and the Netherlands), developed palliative care services in the Netherlands, and new developments in the Netherlands concerning the prevention of euthanasia through palliative care. ⋯ Finally, some articles focus on ethical considerations in the treatment of pain in hospice movement, ethical evaluation of clinical trials in palliative care, and the role of informed consent in palliative radiotherapy, stressing the participation of patients and proxies in treatment decisions. Conclusions are presented on the consequences for educational and counselling aspects of palliative care.