Palliative medicine
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The lack of a clear definition of the palliative care patient hampers the comparison of results across different studies and impedes implementation of research findings in everyday practice. ⋯ We propose elements of the patients' health status (e.g. a progressive, life-threatening disease with no possibility of obtaining remission or stabilisation, or modifying the course of the illness) and the care delivered to them (e.g. a holistic interdisciplinary approach that focuses on supporting the quality of the end of life) to be included in the definition of a palliative care patient. We also suggest considering the patients' readiness to accept palliative care and a vision of palliative care shared by the patient and all caregivers involved as potentially important elements in this definition.
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Palliative medicine · Mar 2013
ReviewClassroom-based and distance learning education and training courses in end-of-life care for health and social care staff: a systematic review.
Staff from a range of health and social care professions report deficits in their knowledge and skills when providing end-of-life and palliative care, and education and training has been advocated at a range of levels. ⋯ Classroom-based education and training is useful for enhancing professionals' skills and perceived preparedness for delivering end-of-life care but should be reinforced by actual practice experience.
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Palliative medicine · Mar 2013
Review Case ReportsProgressive multifocal leukoencephalopathy and palliative care: a report of three cases and review of the literature.
Progressive multifocal leukoencephalopathy (PML) is a rare but usually fatal demyelinating disease of the central nervous system in patients who are immunocompromised. It is characterized by rapid neurological deterioration associated with progressive white matter changes on imaging and is confirmed by isolation of the causative virus in the cerebrospinal fluid or brain tissue. Currently there are no effective treatments for PML and outcomes remain poor even after reversal of the immunocompromised state. This case series describes three patients with different underlying pathologies and varying presentations who were all diagnosed with PML and referred to a palliative care service.
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Palliative medicine · Mar 2013
ReviewThe effect of policy on end-of-life care practice within nursing care homes: a systematic review.
The number of older people in the UK is increasing. A significant proportion of end of life care for this population is currently provided and will increasingly be provided within nursing care homes. ⋯ The studies provided limited evidence on improved outcomes following the implementation of these interventions. Further research is needed, both within the UK and internationally, that measures the process and impact of implementing these initiatives.
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Palliative medicine · Mar 2013
Case ReportsContinuous subcutaneous infusion of lidocaine for persistent hiccup in advanced cancer.
Persistent hiccup can cause anorexia, weight loss, disabling sleep deprivation, anxiety, and depression. Therefore, relief of persistent hiccup is important for advanced cancer patients and their family. Most reports on this condition are case series reports advocating the use of baclofen, haloperidol, gabapentin, and midazolam. ⋯ Intravenous administration of lidocaine is common but efficacy has also been reported for subcutaneous infusion. In advanced cancer patients, subcutaneous infusion is easy, advantageous, and accompanied by less discomfort. We report a case of severe and sustained hiccup caused by gastric cancer that was successfully treated with a continuous subcutaneous infusion of lidocaine (480 mg (24 ml)/day) without severe side effects.