Journal of palliative medicine
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Comparative Study
Specialized home palliative care for adults and children: differences and similarities.
To compare the provision of specialized home palliative care (SHPC) by the adult and pediatric SHPC teams at the Munich University Hospital. ⋯ Our results show important differences in several clinically relevant parameters between adults and children receiving SHPC. This should assist in the development of age-group specific SHPC concepts that effectively address the specific needs of each patient population.
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Randomized Controlled Trial
Effect of intrathecal dexmedetomidine on spinal morphine analgesia in patients with refractory cancer pain.
Systemic administration of dexmedetomidine has been shown to reduce opioid consumption and improve analgesia satisfaction. The purpose of this study was to investigate the effect of intrathecal dexmedetomidine on spinal morphine analgesia in patients with refractory cancer pain. ⋯ Intrathecal administration of dexmedetomidine and morphine reduced the morphine consumption in patients with refractory cancer pain. There were no serious side effects.
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Informal caregivers play a critical role in the provision of care to hospice patients. The care they provide often impacts their physical and psychological well-being. ⋯ Beyond satisfaction with hospice services, the direct impact of standard hospice care on caregivers remains uncertain. Caregiver intervention studies have demonstrated promising outcomes signifying a need for additional investigations into hospice-specific interventions that improve caregiver outcomes. Additional research and resources are needed to assist hospice caregivers, with the ultimate goal of minimizing their psychiatric and physical morbidity and enhancing their caregiving and subsequent bereavement processes.
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Do-not-resuscitate (DNR) orders prevent medically futile attempts at resuscitation but are not always instituted in hospitalized patients with advanced cancer. One explanation for this underuse is the perception that DNR orders are inevitably associated with withdrawal of all medical interventions and inpatient death. ⋯ Most medical interventions were continued with high frequency in adult oncology inpatients after placement of DNR orders. A majority of patients survived hospitalization and remained alive at 30 days after DNR orders were documented. This study offers some reassurance that DNR orders do not inevitably lead to cessation of appropriate medical treatment.
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Malignant pleural effusion can be treated successfully by video-assisted thoracic surgery (VATS) talc pleurodesis. This procedure can also be performed using local anesthesia on nonintubated patients. ⋯ Nonintubated VATS talc pleurodesis can achieve similar results in pleural effusion to the same operation performed under general anesthesia but with earlier improvement of some quality-of-life domains as well as better mortality, morbidity, hospital stay, and costs.