The American journal of hospice & palliative care
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Palliative care began in the UK hospice movement in the late 1960s and has rapidly developed in many countries since. In some, it has become a fully recognized specialty with comprehensive training programs and recognized expertise in areas such as pain and symptom control. ⋯ This article considers some of the conceptual, practical, and administrative challenges that have been faced in an effort to establish palliative medicine as a discrete field of specialized practice from a US perspective. We also comment on current issues in regard to education and research, and development of comprehensive palliative care programs in the United States.
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Am J Hosp Palliat Care · Feb 2011
ReviewMethylnaltrexone: treatment for opioid-induced constipation.
Opioids have become the gold standard for treatment of severe pain in advanced disease, but adverse effects can affect the quality of life. Opioid-induced bowel dysfunction can lead to refractory constipation. Methylnaltrexone bromide is a peripherally acting mu antagonist and is indicated for the treatment of opioid-induced constipation in patients with advanced illness, when response to standard laxative therapy has been inefficacious. This pharmacology update will review the etiology, pathophysiology, and treatment of opioid-induced constipation, focused on methylnaltrexone as a novel treatment for refractory cases.
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Am J Hosp Palliat Care · Feb 2011
ReviewReview article: terminal delirium in geriatric patients with cancer at end of life.
Terminal delirium is a common symptom that is frequently underdiagnosed in geriatric patients with cancer at end of life and is a major cause of distress for the patient as well as their family. This article explores the hyperactive and hypoactive delirium subtypes as well as the pathophysiology of terminal delirium and the theory of acetylcholine deficiency and dopamine excess. ⋯ The use of the Confusion Assessment Method (CAM) is discussed as a means of delirium diagnosis and the Memorial Delirium Assessment scale (MDAS) is presented as a tool to measure its severity. Lastly, nonpharmacologic and pharmacologic treatment measures are reviewed and an algorithm is presented to assist the clinician in the identification and management of terminal delirium.
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to evaluate satisfaction with inpatient hospice goals at the end of life and to determine steps for program improvement. ⋯ clarification and focus on goals of care improves satisfaction with end-of-life care.
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Am J Hosp Palliat Care · Feb 2011
End-of-life experiences: reaching out for compassion, communication, and connection-meaning of deathbed visions and coincidences.
A recent study shows that the greatest fear for many Britons is to die alone. More than half the complaints received by the UK National Health Service (NHS) concern end-of-life care, with an emphasis on spiritual matters. ⋯ They lack the confidence and/or training to recognize or discuss spiritual aspects of death and dying or to affirm the spiritual needs of the dying person. Our end-of-life experience (ELE) research suggests that deathbed visions (DVs) and deathbed coincidences (DCs) are not uncommon, and that the dying process appears to involve an instinctive need for spiritual connection and meaning, requiring compassionate understanding and respect from those who provide end-of-life care.