Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2016
Effective Management of Breathlessness in Advanced Cancer Patients with a Program-Based, Multidisciplinary Approach: The "SOB Program" in Hong Kong.
Breathlessness is common in patients with advanced cancer. Using a multidisciplinary approach for relieving this challenging symptom was believed to be just a theory. The "SOB Program" was implemented in our institution in March 2013. ⋯ A multidisciplinary approach for breathlessness control is both feasible and practical. Similar services can be promoted in other palliative care centers.
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J Pain Symptom Manage · Mar 2016
Comparative StudyThe Influence of Low Salivary Flow Rates on the Absorption of a Sublingual Fentanyl Citrate Formulation for Breakthrough Cancer Pain.
Salivary gland hypofunction may affect the absorption of drugs through the oral mucosa, which in turn may affect their clinical efficacy (e.g., onset of action). ⋯ The pharmacokinetics of the sublingual fentanyl orally disintegrating tablet appear to be negatively affected by the presence of salivary gland hypofunction, although the moistening of the oral cavity before dosing results in a pharmacokinetic profile similar to that seen with the giving of pilocarpine hydrochloride.
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The maintenance of dignity is an important concept in palliative care, and the loss of dignity is a significant concern among patients with advanced cancer. ⋯ The prevalence of a problematic loss of dignity among patients with severe chronic obstructive pulmonary disease is at least as high as among those receiving palliative cancer care. Loss of dignity may represent a concern among people with medical illnesses more broadly, and not just in the context of "death with dignity" at the end of life. Furthermore, interdisciplinary care may help to restore a sense of dignity to those individuals who are able to participate in rehabilitation.
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J Pain Symptom Manage · Mar 2016
Physicians' Reflections on Death and Dying Upon Completion of a Palliative Medicine Fellowship.
Patient and family dissatisfaction may result when they are not satisfied with the physician/patient interaction, although the physician may feel he/she worked hard to provide information to the patient and family. New approaches to visual analysis can (1) identify significant insights from physicians' personal and clinical experiences in providing compassionate palliative care and end-of-life care and (2) provide an effective and practical vehicle for communicating with patients, their families, and other professional caregivers. ⋯ We propose the communication of positive, hopeful, even peaceful perceptions of death and dying was likely the result of effective personal and professional skills gained through physicians' clinical experiences during the fellowship.
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J Pain Symptom Manage · Mar 2016
Advance Care Discussions: Pediatric Clinician Preparedness and Practices.
Few data exist regarding clinician preparedness to participate in advance care discussions (ACD) and the practices surrounding these discussions for children with life-threatening conditions. ⋯ Many clinicians believe they are prepared to participate in ACD, but practices are not consistent with expert recommendations for optimal ACD. Educational interventions aimed at improving clinician knowledge, attitudes, and behavior, and greater clinician support may enhance health care provider ACD preparedness and skills.