Palliative medicine
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Palliative medicine · Mar 2005
Effects of spiritual care training for palliative care professionals.
Little is known about the effects of spiritual care training for professionals in palliative medicine. We therefore investigated prospectively the effects of such training over a six-month period. All 63 participants of the three and a half-day training were asked to fill out three questionnaires: before and after the training, as well as six months later. ⋯ Forty-eight participants (76%) completed all three questionnaires (91% women, median age 49 years; 51% nurses, 16% hospice volunteers, 14% physicians). Significant and sustained improvements were found in self-perceived compassion for the dying (after the training: P=0.002; 6 months later: P=0.025), compassion for oneself (P <0.001; P =0.013), attitude towards one's family (P =0.001; P =0.031), satisfaction with work (P < 0.001; P = 0.039), reduction in work-related stress (P < 0.001; P = 0.033), and attitude towards colleagues (P = 0.039; P = 0.040), as well as in the FACIT-Sp (P < 0.001; P = 0.040). Our results suggest that the spiritual care training had a positive influence on the spiritual well-being and the attitudes of the participating palliative care professionals which was preserved over a six-month period.
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Palliative medicine · Mar 2005
Low dose diamorphine reduces breathlessness without causing a fall in oxygen saturation in elderly patients with end-stage idiopathic pulmonary fibrosis.
There is very little evidence regarding the safety and efficacy of opioids for the control of dyspnoea in the terminal stages of idiopathic pulmonary fibrosis (IPF). We conducted an open case series study of 11 elderly opioid-naive patients referred for management of severe breathlessness before and after their first injection of 2.5 mg diamorphine subcutaneously. Subjective breathlessness, measured by a 100 mm visual analogue scale, fell by a mean of 47 mm in the first 15 min (P < 0.0001) and the mean heart rate fell by 12/min (P = 0.007). ⋯ These changes were maintained at 30 min. Follow up treatment with oral morphine remained effective in reducing the symptom of breathlessness and no patient showed signs of respiratory depression. Low dose opioids are effective and safe in the palliative management of IPF in frail elderly patients.
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Palliative medicine · Jan 2005
Randomized Controlled Trial Clinical TrialSelf-administered nitrous oxide for the management of incident pain in terminally ill patients: a blinded case series.
The treatment of incident pain in terminally ill cancer patients receiving long-term opioid therapy remains a challenge. Self-administered inhaled nitrous oxide has been used for short-term analgesia in this setting, with mixed results. It is unclear whether nitrous oxide exhibits cross-tolerance with opioids, and there is the possibility of a strong placebo effect in previous unblinded reports. ⋯ The patient population was very heterogeneous with respect to disease, pain scores and concurrent treatments. Nitrous oxide was beneficial during incidents in five of seven patients; the remaining two patients reported an overall preference for the nitrous oxide day. We conclude that a trial of self-administered inhaled nitrous oxide should be considered in patients with difficult incident pain.
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Palliative medicine · Jan 2005
Clinical TrialLow-dose levomepromazine in refractory emesis in advanced cancer patients: an open-label study.
Seventy patients with advanced cancer and refractory emesis were treated with subcutaneous boluses of levomepromazine (median daily dose: 6.25 mg; range: 3.12-25) in an open-label prospective study. Treatment was associated with a decrease in nausea from a median of 8/10 at baseline (IQR 7-8) to a median of 1 (IQR 0-2) after two days of treatment (P<0.0001); vomiting ceased in 92% of cases. ⋯ The most frequently reported side effect was sedation, with a median of 2/10 (25-75% percentile 1-3), which was not correlated with the dose of levomepromazine. This study suggests that treatment with low-dose levomepromazine is an effective and safe option for advanced cancer patients who fail to respond to first-line antiemetic treatment.