Journal of palliative medicine
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To report on implementation of a Veterans Affairs (VA) network-wide, standardized, high-quality palliative care (PC) program using a Web-based PC Report Card for performance monitoring and improvement. ⋯ All the sites established PC teams and the number of consultations showed a sustained increase over baseline in 2002. All sites improved on the key process measures captured by the Report Card.
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We report here our retrospective observations on the use of recombinant human hyaluronidase (rHuPH20) for the facilitation of subcutaneous hydration and drug infusion. Thirty-two patients were treated with rHuPH20 in a hospice setting over a 6-month period. Of these, 26 received this agent to enhance hypodermoclysis with standard hydration fluids for symptom control of delirium, myoclonus and mild to moderate dehydration. ⋯ There were no significant adverse events. Induration at the infusion site occurred in 1 patient receiving hydration and higher than expected serum lidocaine concentration was observed in another patient. Based on our positive initial experience with recombinant human hyaluronidase, there is interest in expanding its use in our facility in both the inpatient and outpatient settings.
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Good communication is a fundamental skill for all palliative care clinicians. Patients present with varied desires, beliefs, and cultural practices, and navigating these issues presents clinicians with unique challenges. ⋯ In addition, it reviews the literature regarding cultural aspects of care for terminally ill patients and their families and offers strategies for engaging them. Through good communication practices, clinicians can help to avoid conflict and understand patients' desires for end of life care.