Journal of palliative medicine
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Although intravenous midazolam and flunitrazepam are frequently administered for primary insomnia in Japan, there is no empirical study on their efficacy and safety. ⋯ Intravenous midazolam and flunitrazepam appeared to be almost equal about efficacy and safety for primary insomnia, but flunitrazepam is less expensive and shows lower risk of tolerance development. A future prospective comparison study is necessary.
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Previous studies of end-of-life experience have been conducted primarily in urban medical centers and mostly focused on preferences for rather than experience of care. ⋯ Opportunities exist in community health care settings to improve quality of life for people approaching life's end. Clinicians, patients, and patients' families can contribute by engaging in open and ongoing communication about preferences for care, symptoms and their management, activities designed to enrich patients' personal experiences, as well as having patient care coordination and continuity of care on nights and weekends.
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Comparative Study
Differences in hospice care between home and institutional settings.
To compare hospice care delivered at home with hospice care delivered in institutional settings, such as the nursing home. ⋯ These national data point to significant differences across hospice settings and a growing need to analyze their implications. Yet, these data also leave many questions about hospice use across settings unanswered, including whether agency costs differ in institutional compared to home settings. As policymakers seek to assess the quality and appropriateness of hospice utilization and the methods used for its payment, further empirical work is needed, including how the growing use of hospice outside the home affects options for reform.
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Given the volume and cost of inpatient care during the last year of life, there is a critical need to identify patterns of dying as a means of planning end-of-life care services, especially for the growing number of older persons who receive services from the Veterans Health Administration (VHA). ⋯ As a recognized leader in end-of-life care, the VHA can play a unique role in the development of specific interventions that address the diverse needs of persons with different dying trajectories identified through this research.