The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Feb 2009
Effectiveness of an integrated ward-based program in preparing medical students to care for patients at the end of life.
Integrating end-of-life care training into the clinical years of medical school has been promoted to enhance education in this area. To assess the effectiveness of an end-of-life care exercise integrated into clinical clerkships, we compared the level of preparedness in end-of-life care reported by students who did or did not complete the exercise. ⋯ Among 5 domains of skills examined, significant differences were seen in interviewing/communicating (3.7 vs 3.5; P = .05) and management of common symptoms (3.3 vs 3.0; P < .01). We conclude that a ward-based integrated end-of-life care exercise may improve graduating students' self-reported preparedness to care for patients at the end of life.
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Neuropathic pain is common in the palliative care population; unless adequately treated, the pain can lead to chronic anxiety, depression, and social impairment. Many treatments have been proposed for neuropathic pain; however, it remains underdiagnosed, under-treated, and often requires long-term therapy with risk of adverse effects. Memantine (Namenda), an N-Methyl, D-aspartate receptor inhibitor currently marketed for the treatment of dementia, has been proposed as a medication for the treatment of neuropathic pain for its mechanism, safety, lack of serious adverse effects, and relatively rapid onset of action. However, clinical trials have not been promising so far and its routine use in neuropathic pain is not currently recommended.
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Am J Hosp Palliat Care · Feb 2009
Pilot testing of a question prompt sheet to encourage family caregivers of cancer patients and physicians to discuss end-of-life issues.
Family members of patients with advanced illness have many questions. Unfortunately, several barriers prevent caregivers from discussing their questions with the physicians caring for the patient. ⋯ Our results demonstrated that caregivers wanted to discuss a variety of questions, primarily questions about medications, symptoms, support services, and what to expect. All caregivers thought that the question prompt sheet was easy to understand and felt comfortable completing it in clinic and the majority reported that the question prompt sheets made it easier for them to ask questions.
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We studied the prevalence of specific barriers that prevent indigent homebound older adults from obtaining advance directives and tested the effectiveness of clinical reminders for lowering the number of clients without advance directives. Case managers interviewed 1569 clients to determine whether they had an advance directive. All 530 clients without advance directives were contacted 3 months later to determine if advance directives had been obtained. ⋯ About 57.8% of the barriers identified may reflect reluctance on the part of clients to address their own mortality. Reminders by the case managers were ineffective at lowering the number of homebound older adults without advance directives. Further studies are needed to identify and design strategies for convincing this population of homebound elderly to establish advance directives.
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Am J Hosp Palliat Care · Feb 2009
Hospitalization pattern in a hospital-based palliative care program: an example from Saudi Arabia.
The few palliative care programs available to date in Saudi Arabia are largely hospital-based. Subacute palliative care models have not been developed yet. This retrospective review was conducted to assess the patterns and outcomes of hospital-based palliative care unit admissions in the absence of subacute palliative care models. ⋯ The majority (86%) of patients died in-hospital. These results suggest that end-of-life quality indicators are unlikely to improve depending on hospital-based palliative care models only. To improve palliative care services in Saudi Arabia, other subacute models may need to be considered.