The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Sep 2011
A spider in the web: role of the palliative care nurse specialist in Uganda--an ethnographic field study.
Palliative care is not a priority in developing countries. Hospice Africa Uganda (HAU), where nurses complete a course in clinical palliative care, is considered a model for other African countries. ⋯ The role of the palliative care nurse specialist is multifaceted. Beyond prescribing drugs, their role is to deliver holistic care. They encounter numerous challenges in their work, but they also have the possibility to improve the quality of the patient's life.
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Am J Hosp Palliat Care · Sep 2011
How they cope: a qualitative study of the coping skills of hospice volunteers.
The purpose of this phenomenological study was to examine the coping techniques utilized by hospice volunteers. Individual semi-structured interviews were conducted with 15 hospice volunteers who had at least 1 year of experience, working as a hospice volunteer with direct patient care. ⋯ The most significant coping mechanism utilized for the volunteer was talking with the volunteer coordinator. Implications for hospice volunteer coordinators are also discussed.
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Am J Hosp Palliat Care · Sep 2011
Trends in hospice utilization across age among the veteran population.
Hospice is a major expansion area within the Veterans Health Administration (VHA). The objective of this retrospective study was to explore trends in hospice utilization among older veterans receiving services at the end of life over a 4-year (2006-2009) time period. ⋯ More funds were spent on younger veterans, with an average of $1.5 million spent on veterans aged 55 to 64 and less than $400,000 spent on veterans aged 85 and older. Findings highlight the growing need and demand for hospice within the VHA to provide end-of-life services.
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The objective of this study was to examine US medical school offerings on end-of-life issues between 1975 and 2010. Data were obtained from a mailed survey to the US medical schools in 1975, 1980, 1985, 1990, 1995, 2000, 2005, and 2010. Survey response rates for the 8 points in time (in percentages) were 95, 96, 90, 90, 93, 92, 81, and 79, respectively. ⋯ Palliative care is offered to some extent in 99% of US medical schools today. Numerous end-of-life topics are currently covered in the curriculum. Increased attention to end-of-life issues in medical schools should enhance medical students' relationship with terminally ill patients and their families.
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Am J Hosp Palliat Care · Aug 2011
Review Comparative StudyOpioid and adjuvant analgesics: compared and contrasted.
An adjuvant (or co-analgesic) is a drug that in its pharmacological characteristic is not necessarily primarily identified as an analgesic in nature but that has been found in clinical practice to have either an independent analgesic effect or additive analgesic properties when used with opioids. The therapeutic role of adjuvant analgesics (AAs) is to increase the therapeutic index of opioids by a dose-sparing effect, add a unique analgesic action in opioid-resistant pain, or reduce opioid side effects. A notable difference between opioids and AAs is that unlike opioids some AAs are associated with permanent organ toxicity, for example, nonsteroidal anti-inflammatory drugs (NSAIDs) and renal failure. ⋯ No apparent tolerance to analgesia develops with AAs. Abrupt discontinuation of an opioid after chronic repeated use for more than a few days will cause a withdrawal syndrome of variable severity. Adjuvant analgesics are an essential tool in cancer pain.