The American journal of hospice & palliative care
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Malignancies are becoming increasingly common, especially as the population ages, and patients with cancer are likely to represent an increasing proportion of ICU populations. Advances in oncological and supportive care have led to improved prognosis and extension of survival time in patients with cancer. The National Institute Cancer located in Mexico City has an oncological ICU with 6 beds. ⋯ The course of organ dysfunction over first days of life-sustaining treatment before admission to ICU could be useful for physicians who treat critically ill cancer patients to detect patients who should be admitted to ICU to try to avoid the progression to multiple organ dysfunction. On the other hand, admission to the ICU should be offered to patients with newly diagnosed cancer and acute life-threatening cancer related events. The critical care of patients with cancer contribute and support to continue the fight against cancer.
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Am J Hosp Palliat Care · Nov 2011
Case ReportsSevere diarrhea following neurolytic coeliac plexus block: case report and literature review.
Diarrhea is one of the commonest complication following coeliac plexus ablative procedures. It is believed to occur due to inadvertent chemical sympathectomy by the block. For the majority of patients, complications are temporary and self limited. ⋯ We would like to present a case of severe diarrhea following a neurolytic coeliac plexus block using alcohol 50% in a patient with cancer pancreas. Patient achieved a significant reduction in her pain scores but developed severe diarrhea and dehydration. Diarrhea was refractory to medical treatment and patient died few weeks later.
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Am J Hosp Palliat Care · Nov 2011
Advance directives in home health and hospice agencies: United States, 2007.
This report provides nationally representative data on policies, storage, and implementation of advance directives (ADs) in home health and hospice (HHH) agencies in the United States using the National Home and Hospice Care Survey. Federally mandated ADs policies were followed in >93% of all agencies. ⋯ Nearly all agencies informed staff about the AD, but only 77% and 72% of home health agencies informed the attending physician and next-of-kin, respectively. Home health and hospice agencies are nearly universally compliant with ADs policies that are required in order to receive Medicare and Medicaid payments, but have much lower rates of adoption of ADs policies beyond federally mandated minimums.
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Am J Hosp Palliat Care · Sep 2011
ReviewCross-cultural communication and use of the family meeting in palliative care.
Terminally-ill patients and their families often report poor communication and limited understanding of the patient's diagnosis, prognosis, and treatment plan; these deficits can be exacerbated by cross-cultural issues. Although family meetings are frequently recommended to facilitate provider-family communication, a more structured, evidence-based approach to their use may improve outcomes. Drawing on research and guidelines from critical care, palliative care, and cross-cultural communication, we propose a framework for conducting family meetings with consideration for cross-cultural issues.
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Am J Hosp Palliat Care · Sep 2011
Caregiver evaluation in hospice: application of a semi-structured interview.
In this study we report the results of construction and administration of a semi-structured interview for the evaluation of caregivers in hospice. The results presented here are related to interviews (n = 25) that were administered at Rimini Hospice. ⋯ As concerning the care burden, greater distress was detected in areas relating to the change in the rhythm of life (38%) and in social network (26%); whereas, as concerning the psychological burden, a greater distress was detected in the area related to the caregiver role (51%). In conclusion, a singular element identified as a source of distress in, our study, is that of social network.