The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Oct 2006
Medical students as hospice volunteers: the benefits to a hospice organization.
Hospices have regulatory requirements to provide volunteers who can assist families in a variety of ways. Hospices also typically provide large amounts of uncompensated education for students in various life sciences as part of their mission to promote quality care for those at the end-of-life. ⋯ Hospice of Central New York developed a service-learning elective where first-year medical students were trained as volunteers. Despite initial concerns that significant staff time would be required to develop and maintain this elective, it appears to be an efficient way to satisfy the need for volunteers while contributing to the education of the involved students.
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Am J Hosp Palliat Care · Oct 2006
Self-reported practice, confidence, and knowledge about palliative care of nurses in a Japanese Regional Cancer Center: longitudinal study after 1-year activity of palliative care team.
Knowledge and skill deficits about palliative care in medical professionals are among the most common barriers to quality palliative care. This study in a Japanese regional cancer center was conducted to clarify nurses' self-reported practices, confidence, and knowledge, and the changes in these parameters after the 1-year educational and clinical activity of a palliative care team. ⋯ In some areas of palliative care, hospital nurses did not adhere to recommended practices, had knowledge deficits, and were not generally confident with palliative care practices. However, daily palliative care team activities, including educational programs and clinical consultation service, could improve their practice and knowledge levels.
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Am J Hosp Palliat Care · Oct 2006
Comparative StudyPalliative sedation in a southern Appalachian community.
Of 1200 palliative care patients, 28 received palliative sedation. They were more likely than patients without palliative sedation to have an Eastern Cooperative Oncology Group performance status of at least 3, a cancer diagnosis, an expected survival of weeks or less, to have been monitored by the palliative care team for at least 1 week, to have delirium as the cause of decreased communication, to have dyspnea as a non-pain symptom, and to be less able to communicate symptoms. Almost 90% received palliative sedation for at least 24 hours for a median of 3 days (range, 0 to 24 days). ⋯ Symptoms were controlled in 82% and improved in the rest. Sedation developed in 79% but was not required for symptom control in 5. Patient survival from palliative care consultation was a median of 8 days (range, 0 to 32 days).
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Am J Hosp Palliat Care · Oct 2006
Parenteral morphine prescribing patterns among inpatients with pain from advanced cancer: a prospective survey of intravenous and subcutaneous use.
Prescribing patterns for parenteral morphine for symptom control in advanced cancer were studied in 50 consecutive hospital admissions (27 men, 23 women, median age, 62 years). Patients were interviewed daily (median time, 9 days) concerning analgesia while they were receiving parenteral morphine. Five major inpatient prescribing patterns were identified: (1) intravenous to oral, (2) intravenous to subcutaneous, (3) intravenous only, (4) subcutaneous only, and (5) mixed. ⋯ Patients with neuropathic pain required higher doses of morphine. These patterns of parenteral morphine application reflect the complexity of the challenge presented by the various cancer pain syndromes. Physicians should be knowledgeable about the appropriate and flexible use of different routes of administration for morphine and other opioids.
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Am J Hosp Palliat Care · Oct 2006
A road map for the last journey: home telehealth for holistic end-of-life care.
The Advanced Illness/Palliative Care (AIPC) program started as a 2-year pilot project to determine if a telehealth model of care would benefit veteran patients with life-limiting illness. The goals of the project were to manage the physical, emotional, functional, and spiritual care needs during the last 2 years of patients' lives and to foster an earlier enrollment of patients into hospice by educating providers about palliative care. The AIPC program partners the skills and expertise of both spiritual and medical care practitioners, along with cutting-edge home telehealth devices to improve symptom management and quality of life for veterans and families coping with end of life.