The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Jun 2008
The Japan HOspice and Palliative Care Evaluation study (J-HOPE study): study design and characteristics of participating institutions.
This article describes the study design and background data of participating institutions in the Japan HOspice and Palliative care Evaluation (J-HOPE) study. The J-HOPE study is a large nationwide survey about the dying experience of cancer patients. The primary aim of this article is to describe the design of the J-HOPE study for the bereaved family members of Japanese inpatient palliative care units and home hospices. ⋯ The questionnaires were sent to 7955 bereaved family members of the Japanese inpatient palliative care units and 447 of the home hospices. The authors describe the structure of the Japanese inpatient palliative care units and home hospices, including type of staff, architectural structure, number of patients, and death. In addition, the authors describe available treatments at the Japanese inpatient palliative care units and home hospices.
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Am J Hosp Palliat Care · Jun 2008
Case ReportsManagement of pericatheter cerebrospinal fluid leak after intrathecal implantation of a drug delivery system.
Persistent cerebrospinal fluid leak is a known complication of intrathecal pump system insertion for drug delivery. Various treatment modalities, such as an epidural blood patch, use of glue, removal of catheter, and surgical closure of dura and subdural blood patch, have been reported previously. ⋯ This was complicated by a persistent cerebrospinal fluid leak that was successfully managed by purse-string sutures over the dura around the catheter, without removing the intrathecal implant. The cause of the cerebrospinal fluid leak and different treatment approaches are discussed.
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Am J Hosp Palliat Care · Jun 2008
The hospital-survival and prognostic factors of patients with solid tumors admitted to an ICU.
The decision to admit a patient with cancer to the intensive care unit (ICU) is complex. There are limited data as to the outcome and prognostic factors of patients with solid tumors admitted to the ICU. A retrospective chart review was undertaken to evaluate this issue. ⋯ A total of 79 (54%) patients survived to hospital discharge, with 50 (34%) patients being discharged to home. Metastatic disease and the requirement for vasopressor agents were independent predictors of poor outcome. The relatively high survival rate of this cohort of patients should prompt a reevaluation of the ICU admission criteria for patients with solid tumors who become critically ill.
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Am J Hosp Palliat Care · Jun 2008
Resolving end-of-life ethical concerns: important palliative care practice development issues for acute medicine in Australia.
Historically palliative care research has focused on issues associated within the hospice and palliative care system. The findings presented in this manuscript reverse this assumption to argue that significant palliative care issues can only be understood if the focus is on the acute care system. ⋯ In short, understanding the ethical decision making of acute care professionals in relation to end-of-life care can illuminate many important palliative care practice development issues. The findings indicate that all professional groups in this study of an acute medical ward find end-of-life issues the most challenging of all the ethical challenges.
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Methadone hydrochloride is an old drug that has been in vogue off and on. It has complex pharmacodynamics and can be potentially fatal in inexperienced settings. ⋯ It is critical when using the drug to monitor for signs and symptoms of toxicity so that overdosing or toxicity can be identified in a timely manner. This review discusses these important topics so that methadone can be used safely and effectively.