The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Oct 2008
Case ReportsClocking delirium: the value of the Clock Drawing Test with case illustrations.
Screening for impaired cognition is very important in geriatric and palliative medicine. There are several validated screening tools for delirium; the Confusion Assessment Method, The Memorial Delirium Assessment Scale, and the Bedside Confusion Scale. ⋯ The Clock Drawing Test is quickly and easily performed by patients and can be kept in the patient's medical record for future reference. However, very few studies have used the Clock Drawing Test to assess delirium in cancer and even fewer have used the Clock Drawing Test to determine response to interventions for delirium.
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Am J Hosp Palliat Care · Oct 2008
The attitudes of physicians toward the new "Dying Patient Act" enacted in Israel.
This study aims to determine what clinicians know about Israel's new "Dying Patient Act" and its recommendations, to examine their attitudes and perceptions about it, and to assess their willingness to increase their involvement in advance care planning. In-depth face-to-face interviews with 10 stakeholders and specialists in the health care system, and 4 focus groups with family physicians and geriatricians working in the hospital system and the community, were conducted. ⋯ These barriers can be divided into three main categories: the medical system, the law itself, and the characteristics of the Israeli population. The results may help augment educational programs on related subjects and increase the use of advance care planning.
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Am J Hosp Palliat Care · Oct 2008
ReviewPalliative care in Japan: current status and a nationwide challenge to improve palliative care by the Cancer Control Act and the Outreach Palliative Care Trial of Integrated Regional Model (OPTIM) study.
Palliative care is an essential part of integrated cancer treatment. To improve palliative care throughout Japan, a nationwide demonstration project, the Outreach Palliative Care Trial of Integrated Regional Model (OPTIM) study, is ongoing. This article reviews the current status and the problems of palliative care in Japan and introduces the OPTIM study. ⋯ Primary end points are quality of care reported by patients as well as the bereaved family, number of patients who received specialized palliative care services, and place of death. The interventions are comprehensively designed to cover all areas identified by the national task force. The OPTIM study will contribute to improve patients' quality of life by proposing a regional palliative care model suitable for Japan.
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Am J Hosp Palliat Care · Aug 2008
Intravenous morphine can avoid distressing constipation associated with oral morphine: a retrospective analysis of our experience in 11 patients in the palliative care in-patient unit.
Morphine is the preferred strong opioid analgesic. Most of the adverse effects, such as daytime drowsiness, dizziness, mental clouding, and effects on cognitive and psychomotor function or nausea and vomiting, usually resolve with time. The main continuing adverse effect of morphine is constipation, and prophylactic use of laxative is almost always required. ⋯ This finding can be explained on the basis of differences in pharmacologic profiles, in affinity to opioid receptor, and a higher exposure of opioid-binding receptor in the GI tract after oral administration of morphine compared with intravenous morphine. This explanation was further affirmed as constipation and need for laxative was reported by 7 of the 11 patients when they were given the equi-analgesic oral doses of morphine. Thus, the route of administration seems to be responsible for the above finding; hence, further evaluation with prospective observation and data collection is being planned to look for external validity in a larger population catered by our palliative care unit.
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Am J Hosp Palliat Care · Aug 2008
Determinants of home death in palliative home care: using the interRAI palliative care to assess end-of-life care.
Many terminally ill patients are given the choice to die at home. This study identified determinants of home death among patients receiving palliative home care. Health information was collected using the interRAI palliative care assessment tool. ⋯ The patients' wish to die at home and the family's ability to cope were strong determinants of home death. This study suggests that the presence of a supportive family that is able to work with the health care team to implement a plan of care is important to the patients' ability to die at home. This study highlights the need to treat the patient and the caregiver(s) as a unit of care.