Journal of palliative medicine
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Working in hospice care is a highly challenging yet rewarding profession. However, the challenges of working with dying patients and their families can overwhelm even the most highly dedicated professional, leading to burnout, compassion fatigue, anxiety, and depression. ⋯ Poor mental health places staff at risk for burnout and likely contributes to staff leaving hospice care; this is a critical issue as the profession attempts to attract new staff to meet the expanding demands for hospice care.
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Research into acute hospital admissions (AHAs) of hospice patients is relatively underdeveloped. The goal of this study, based on the electronic health records (EHR) of a large Midwestern hospice service over a 3-year period, was to identify characteristics of new hospice patients that are associated with an increased risk of later AHAs. ⋯ The future agenda for research on AHA of hospice patients should include studies of large and undifferentiated hospice populations like our own, but designed to capture data on socioeconomic status (SES), religion, race/ethnicity, the details of supportive care in place, and a look at specific factors surrounding individual AHAs.
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Complex interventions are common in palliative and end-of-life care. Mixed methods approaches sit well within the multiphase model of complex intervention development and evaluation. Generic mixed methods guidance is useful but additional challenges in the research design and operationalization within palliative and end-of-life care may have an impact on the use of mixed methods. ⋯ There is a need for further discussion of these recommendations and their contribution to methodology. The recommendations should be considered when designing and operationalizing mixed methods studies of complex interventions in palliative care, and because they may have wider relevance, should be considered for other applications.
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Case Reports
Use of intravenous acetaminophen (paracetamol) in a pediatric patient at the end of life: case report.
For the better part of 100 years, acetaminophen (or paracetamol as it is known outside of the United States) has been a common first-line analgesic in pediatrics and is typically well tolerated with minimal side effects. Its use as an anti-pyretic is also well-documented and thus it is used broadly for symptom control in the general pediatric population. ⋯ Here, we describe a case using intravenous acetaminophen in a pediatric patient at the end of life.
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In 2011 the Palliative Care Funding Review highlighted concerns about the funding, provision, and quality of care at the end of life. Two years on, an independent review of the Liverpool Care Pathway--prompted by a storm of negative media coverage--has raised concerns around a lack of funding, availability of support for the dying and their relatives, and patient centered care. There are recommendations to increase funding through a national tariff for palliative care services, address inconsistencies, and replace the Liverpool Care Pathway with individual end-of-life care plans. ⋯ While there is a need for increased funding in the short term (highlighted in recent reviews), increasing funding to services that have little evidence base appears to be an irresponsible long-term strategy. Hence there should also be increased investment in research and increased emphasis in particular on developing economic tools to evaluate services.