The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Nov 2011
ReviewExploring uncertainty in advance care planning in African Americans: does low health literacy influence decision making preference at end of life.
African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. ⋯ Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans.
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Am J Hosp Palliat Care · Nov 2011
Development and validation of a modified version of the Edmonton Symptom Assessment Scale in a Flemish palliative care population.
Palliative cancer patients are faced with multiple symptoms that threaten their quality of life. To manage these symptoms, a reliable and valid way of registration is crucial. In this study, the Edmonton Symptom Assessment Scale (ESAS) has been translated, modified, and tested on content, face, criterion, construct validity, and internal consistency for patients admitted to Flemish palliative care units. ⋯ The second sample checked the face validity and consisted of 4 patients, 5 family members, and 5 nurses. The last sample involved 23 patients admitted to 3 Flemish palliative care units. Heedful of the "new-wave" vision on validity, the translated and altered ESAS seemed a suitable instrument for the symptom assessment of patients with cancer admitted to a palliative care unit.
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Patients receiving palliative care often possess multiple risk factors and predisposing conditions for delirium. The impact of delirium on patient care in this population may also be far-reaching: affecting not only quality of remaining life but the dying process experienced by patients, caregivers, and the medical team as well. ⋯ This article summarizes the multifactorial nature, numerous predisposing medical risk factors, neuropsychiatric adverse effects of palliative medications, pharmacokinetic changes, and challenges complicating delirium assessment and provides a systematic framework for assessment. The benefits, risks, and patient-specific considerations for treatment selection are also discussed.
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Malignancies are becoming increasingly common, especially as the population ages, and patients with cancer are likely to represent an increasing proportion of ICU populations. Advances in oncological and supportive care have led to improved prognosis and extension of survival time in patients with cancer. The National Institute Cancer located in Mexico City has an oncological ICU with 6 beds. ⋯ The course of organ dysfunction over first days of life-sustaining treatment before admission to ICU could be useful for physicians who treat critically ill cancer patients to detect patients who should be admitted to ICU to try to avoid the progression to multiple organ dysfunction. On the other hand, admission to the ICU should be offered to patients with newly diagnosed cancer and acute life-threatening cancer related events. The critical care of patients with cancer contribute and support to continue the fight against cancer.
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Am J Hosp Palliat Care · Nov 2011
Case ReportsSevere diarrhea following neurolytic coeliac plexus block: case report and literature review.
Diarrhea is one of the commonest complication following coeliac plexus ablative procedures. It is believed to occur due to inadvertent chemical sympathectomy by the block. For the majority of patients, complications are temporary and self limited. ⋯ We would like to present a case of severe diarrhea following a neurolytic coeliac plexus block using alcohol 50% in a patient with cancer pancreas. Patient achieved a significant reduction in her pain scores but developed severe diarrhea and dehydration. Diarrhea was refractory to medical treatment and patient died few weeks later.