The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Feb 2008
Characterizing hospice discharge patterns in a nationally representative sample of the elderly, 1993-2000.
The aim of this study is to identify the prevalence and correlates of individuals discharged alive from hospice in the Medicare program to determine whether the current hospice benefit matches the needs of dying patients. Using a nationally representative sample of age-eligible Medicare beneficiaries who died from 1993 to 2000, the use of hospice and other Medicare-financed care was analyzed during the last year of life for different groups of hospice users. ⋯ After controlling for survival time, costs per day survived are similar for all groups. This study suggests several motivations for being discharged alive that are worthy of more research.
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Am J Hosp Palliat Care · Feb 2008
Identification of quality indicators of end-of-life cancer care from medical chart review using a modified Delphi method in Japan.
End-of life care is one of the principle components of cancer care. Measurement of the quality of care provided for end-of-life cancer patients is an important issue. The aim of this study was to identify the quality indicators (QIs) for end-of-life cancer care for Japanese patients using a medical chart review. ⋯ Thirty QIs for end-of-life cancer care were ultimately identified within 4 domains: (1) symptom control, (2) decision-making and preference of care, (3) family care, and (4) psychosocial and spiritual concerns. These QIs will be useful for monitoring and evaluating end-of-life care for Japanese cancer patients. The QIs are feasible for use in any clinical setting and cover a comprehensive area in accordance with the World Health Organization's (WHO) definition of palliative care including physical, psychosocial, and spiritual concerns.
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Patients admitted to a palliative care unit have a limited life expectancy. Sometimes, however, the accuracy of the prognosis is compromised by atypical progress of a disease or incorrect assumptions. ⋯ However, palliative care requires a patient-oriented and active approach. To be aware of possible incomplete diagnostics is an important step in preventing adverse consequences of a wrong prognosis.
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Intractable hiccups are not common in the general population or in the palliative care population but can adversely impact quality of life and cause other complications such as weight loss and sleep disturbance. Many treatments have been proposed for intractable hiccups, but there is little consensus regarding treatment in the medical literature. ⋯ Gabapentin is a promising medication for the treatment of intractable hiccups for its safety, lack of serious side effects, and rapid onset of action. Further research is indicated to determine whether gabapentin is consistently effective.