The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Jan 2000
Developing a physicians' palliative care pain hotline in Maryland.
Physicians have had relatively little formal training in pain management and palliative care. For this reason, a telephone consultation service was offered, the physicians' palliative care pain hotline, that would allow physicians to call a toll-free number and, within 15 minutes, speak to a board-certified physician in hospice and palliative medicine. ⋯ This article describes the process involved in creating such a pain hotline and reports on some data collected on its use in the first 10 months. This report should help others who have an interest in establishing a similar program.
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Am J Hosp Palliat Care · Jan 2000
ReviewTizanidine in the management of spasticity and musculoskeletal complaints in the palliative care population.
Spasticity and other muscle symptoms in the palliative care patient can contribute to suffering, significantly detracting from overall quality of life. Current therapy primarily includes use of centrally acting muscle relaxants, which are beneficial in treating some symptoms, but frequently have extensive side effects, such as sedation and muscle weakness. ⋯ When taken at night, patients report improvement in getting to sleep and little drowsiness or "hangover sensation" upon waking. Tizanidine is potentially helpful to many palliative care patients with chronic muscle pain and sleep disturbances.
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Hospice caregivers are often targets of appropriate or displaced anger from the patients and family members that they try to help. Although anger is often an essential part of the grieving process, it may be difficult to endure. Caregivers must therefore understand the causes and signs of anger in themselves, patients, and family members, and find strategies to reduce the anger. A therapeutic response to anger will better facilitate the grief process as well as the effectiveness and well-being of the hospice caregiver.
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Efforts to introduce hospice and palliative care into American prisons have become fairly widespread, in response to the sharp increase in inmate deaths. The primary impetus originally came from the alarming number of AIDS deaths among prisoners. The new combination therapies have proved very successful in treating AIDS, but are very costly, and many problems must be overcome to ensure their effectiveness in correctional settings. ⋯ Continual nudging and nurturing by local and state hospice professionals is required in order to bring about this change in the first place and to sustain it through time. Prison hospice workers need not only initial training, but also ongoing education and personal contact with experienced hospice professionals. While the interest of the big national organizations is necessary, the real action happens when local hospices work with nearby prisons to attend to the needs of dying inmates.