Palliative medicine
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Cluster-randomized trials represent an important experimental design, supplementing ordinary randomized clinical trials. They are particularly relevant when evaluating interventions at the level of clinic, hospital, district or region. ⋯ Sample sizes will usually need to be greatly increased, an adequate number of clusters is essential, and the statistical analysis must allow for the cluster design. And one should rigorously guard against selection bias.
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Palliative medicine · Jan 2002
Palliative care and policy in England: a review of health improvement plans for 1999-2003.
Since 1987 health authorities in England have been required to make plans for palliative care provision, but their record in doing so has been patchy. The production of health improvement plans (HlmPs), in which each health authority must set out its priorities and actions designed to improve the health and well-being of its local population, provides an opportunity to examine the extent to which palliative care provision in the NHS is regarded as a priority by policy makers in England. ⋯ Among those that do have plans for palliative care, the vast majority of these plans are for people with cancer. What emerges most clearly is a sense in which specialist palliative care, especially for non-cancer patients, is perceived as an 'optional extra' by many health authorities rather than an integral and essential part of the overall supportive care strategy which they clearly are at pains to develop.
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Palliative medicine · Jan 2002
Euthanasia and physician-assisted suicide in Scandinavia--with a conceptual suggestion regarding international research in relation to the phenomena.
This article analyses and compares recent research on Scandinavian physicians' attitudes towards, as well as their practice of, euthanasia and physician-assisted suicide. The studies discussed are quite dissimilar in their design, resulting in considerable difficulties as far as comparability is concerned. Such difficulties are common in these fields of research. ⋯ These findings did not fit the physicians' practice. Danish physicians have performed euthanasia and physician-assisted suicide more often than Norwegian physicians. Swedish physicians, even though they are the most liberal when it comes to attitude, appear never to have performed euthanasia and very seldom physician-assisted suicide.
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Journal clubs are a valuable tool for medical education. This paper describes a unique daily journal club format utilized by our palliative care programme and presents the results of a questionnaire sent to trainees exploring satisfaction with its educational value. We reviewed the number and type of articles presented at the journal club over 1 year. ⋯ Palliative care fellows indicated significantly higher levels of satisfaction than family medicine residents, particularly in the areas of clinical applicability, acceptability of the daily schedule and overall educational value. The increased emphasis on evidence-based practice in palliative care suggests that a journal club could be a useful educational tool. The results from our experience could be applied to other palliative care programmes.