Palliative medicine
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Palliative medicine · Jul 2014
ReviewQuality end-of-life care for dementia: What have family carers told us so far? A narrative synthesis.
People with dementia do not always receive good quality end-of-life care, with undertreated pain, aggressive medical interventions and limited access to hospice care being common. Family carers often provide the majority of informal care for people with dementia, therefore may be best placed to comment on quality of care. ⋯ It is difficult to define what constitutes high-quality end-of-life care for people with dementia from the perspective of family carers. Their views expressed in the literature appear to demonstrate more variation of preference of care and treatment and their uncertainty of this.
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Palliative medicine · Jul 2014
General practitioners' perspectives on the avoidability of hospitalizations at the end of life: A mixed-method study.
Many patients are hospitalized in the last months of life. Little is known about the avoidability of these hospitalizations. ⋯ A proactive approach could avoid some of the hospitalizations at the end of life, in the opinion of general practitioners. More insight is needed into communication and psychological barriers for timely discussions about end-of-life issues.
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Palliative medicine · Jul 2014
The 'surprise' question in advanced cancer patients: A prospective study among general practitioners.
Using the 'surprise' question 'Would you be surprised if this patient died in the next year?' may improve physicians' prognostic accuracy and identify people appropriate for palliative care. ⋯ When general practitioners used the 'surprise' question for their patients with advanced cancer, the accuracy of survival prognosis was very high. This has clinical potential as a method to identify patients who might benefit from palliative care.
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Palliative medicine · Jul 2014
What justifies a hospital admission at the end of life? A focus group study on perspectives of family physicians and nurses.
Despite a majority preferring not to die in hospital and health policies aimed at increasing home death, the proportion of hospital deaths remains high. Gaining insight into professional caregiver perspectives about what justifies them could be helpful in understanding the persistently high rates of such hospital admissions and hospital deaths. ⋯ A number of situations have been identified in which nurses and family physicians consider a hospital admission to be justified. Adequate advance care planning and improved psychosocial support to both family and professional caregivers could reduce the number of hospital deaths.
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Palliative medicine · Jul 2014
Nasogastric tube insertion followed by intravenous and oral erythromycin in refractory nausea and vomiting secondary to paraneoplastic gastroparesis: A case report.
Gastroparesis is an under-recognised cause of refractory nausea and vomiting in patients with malignancy. The most common aetiologies are paraneoplastic and postsurgical dysmotility. There are little data on the efficacy of treatment to direct the management of patients with this symptom. We present a case and brief summary of current literature. ⋯ Further research is needed into the management of gastroparesis in palliative care patients. In particular, we suggest that initial drainage with a nasogastric tube followed by a course of erythromycin warrants further study.