Journal of palliative medicine
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To determine how palliative and end-of-life care can best be incorporated into the training of pediatric residents. ⋯ For palliative care principles to be better incorporated into pediatric practice, they must be incorporated into residency education, optimally through informal teaching and during rounds. Finding ways to teach residents palliative medicine during clinical "teachable moments" and standardizing didactic curricula should become a priority in palliative and end-of-life care education.
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The sublingual administration of opioid analgesics has been a mainstay in the pain management of homebound dying hospice patients who are no longer able to swallow. It is also a potentially useful route of administration in other situations in which the oral route is not available and other routes are impractical or inappropriate. Potential advantages of the sublingual route include rapid analgesic onset and avoidance of hepatic first-pass metabolism. ⋯ Other opioids have been less studied. Available data suggests limited sublingual availability of hydrophilic opioids (e.g., morphine, oxycodone, and hydromorphone) and superior absorption of the lipophilic opioids (e.g., methadone and the fentanils). Buprenorphine, a potent, lipophilic, partial mu-opioid receptor agonist, appears promising but awaits further study.
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Although palliative care services are becoming increasingly prevalent in acute care hospitals only a minority of patients who die in hospital or in the community have seen palliative care teams. There are large numbers of patients who might benefit from palliative care who are not receiving it. That said, identification of patients who are eligible for these services, and of those who would most benefit is problematic. ⋯ Institutions that are planning to develop new services, or expand their current services will require some method/tool to assess specific population needs at their site. The Hamilton Chart Audit (H-CAT) was developed at our institution to help identify potential palliative care needs of patients and their families. We report on development of the tool and use of the tool for a retrospective audit of 222 patients who died at our institution.
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Comparative Study
Length of survival of patients with cancer in hospice: a retrospective analysis of patients treated at a major cancer center versus other practice settings.
This is a retrospective study of the length of survival (LOS) in hospice of patients with cancer treated at a major cancer center compared to other treatment sites. Of 670 patients, the 185 (28%) treated at a major cancer center had unique characteristics, including higher median Palliative Performance Score (PPS) at the time of hospice enrollment (45 versus 40, p = 0.009), and longer median LOS in hospice (35 versus 21 days, p = 0.02: log rank test). ⋯ After adjusting survival for PPS with a Cox proportional hazard model, the hazard ratio for PPS remained statistically significant (95% confidence interval [CI]: 0.95-0.97] while that for the treatment site was not (95% CI: 0.73-1.04]. The performance status, and not the treatment site, was the dominant predictor of the LOS of patients with cancer in hospice.