The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Jun 2006
Comparative StudyA cost comparison of hospice care in amyotrophic lateral sclerosis and lung cancer.
The authors compare the cost of hospice care provided to 25 amyotrophic lateral sclerosis (ALS) patients and 159 lung cancer patients by the Wissahickon Hospice of the University of Pennsylvania. The mean length of stay was 86.7 days for ALS patients and 35.0 days for patients with lung cancer (P = .011). ⋯ The longer length of stay (LOS) accounts for this difference. Longer LOS can be accomplished by close clinical monitoring of ALS patients for the development of life threatening respiratory and/or nutritional compromise and by liberalizing the present hospice admission guidelines.
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Am J Hosp Palliat Care · Jun 2006
Comparative StudyTeaching end-of-life issues in US medical schools: 1975 to 2005.
This study examined medical school offerings on end-of-life issues between 1975 and 2005. Seven national surveys of US medical schools were conducted in 1975, 1980, 1985, 1990, 1995, 2000, and 2005 (response rates in percentages of 95, 96, 90, 90, 93, 92, and 81, respectively). Results revealed that between 1975 and 2005, the overall offerings in death and dying increased so that 100% of US medical schools, beginning in 2000, offered something on death and dying. ⋯ Palliative care is offered in 94% of US medical schools, to some extent, and about a fourth of the schools offer students an opportunity to have a continuing relationship for several weeks with a terminally ill patient. Numerous end-of-life topics are currently covered in the curriculum. This increased attention to end-of-life issues in medical schools should enhance each medical student's relationship with terminally ill patients and their families.
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Am J Hosp Palliat Care · Jun 2006
The adverse effects of morphine: a prospective survey of common symptoms during repeated dosing for chronic cancer pain.
Little information is available about the incidence, prevalence, or severity of morphine side effects during repeated individualized dosing for chronic cancer pain, although it has been widely used in this way for more than 30 years. The authors' aim was to describe the prevalence of symptoms possibly attributable to morphine side effects in a convenience sample of patients with pain due to advanced cancer. They used a prospective survey of inpatients and outpatients on regularly dosed morphine, with a questionnaire administered weekly for 4 weeks. ⋯ Constipation, dysphoria, myoclonus, nausea, and sedation were more likely to be severe following dose increases. In conclusion, although constipation, nausea, and sedation are well described as side effects of morphine administration, others such as dry mouth and myoclonus appear to be underestimated. Validated patient-based measures of opioid side effects are needed.
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Am J Hosp Palliat Care · Jun 2006
Case ReportsHome pediatric compassionate extubation: bridging intensive and palliative care.
Compassionate home extubation for pediatric patients is a topic that seldom appears in the literature and is of unknown clinical importance. However, standards in pediatric intensive care unit (PICU) and among pediatric critical care physicians regarding end-of-life decisions are changing, including where and when patient extubation occurs. The authors' hospice recently consulted on an infant with spinal muscular atrophy in the PICU requiring mechanical ventilation, for whom further life-sustaining care was deemed futile. ⋯ The infant died quietly about 20 minutes later. This case prompted the authors to review the current state of published articles covering this topic, suggest a protocol for implementing home extubation, realize imposed barriers, and discuss potential solutions. A well-developed plan for home extubation procedures may improve interactions with PICU and hospice services and at the same time provide additional choices for parents and patients wishing to maximize end-of-life quality outside the hospital setting.
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Depression and other mood disorders occur in approximately 25 percent of terminal patients. Untreated, depression and mood disorders can have a significantly negative impact on patients and families. Screening for depression can be done as easily as asking one question: "are you depressed?" A positive response to this question can be followed with one of the more extensive screening tools. ⋯ These can be identified by also using one of the validated screening tools. Use of the antidepressant medications for treating depression and, in some cases, anxiety disorders has not been well studied in hospice and palliative care. Some of the antidepressants can also serve as adjuvant therapy in pain management.