Journal of palliative medicine
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Comparative Study
Acceptability and preferences of six different routes of drug application for acute breathlessness: a comparison study between the United Kingdom and Germany.
Opioids are the drugs of choice for management of breathlessness in advanced disease, but acute episodic breathlessness remains difficult to manage. New routes of opioid applications with quicker onset of action seem attractive for the management of episodic breathlessness. ⋯ Inhaled was the most accepted and preferred route of application, but no route seemed to be acceptable to all patients. Therefore, individual patient preferences should be explored before drug prescription to enhance compliance and convenience.
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Communicating with patients about goals of care is an important skill for internal medicine residents. However, many trainees are not competent to perform a code status discussion (CSD). A multimodality intervention improved skills in a group of first-year residents in 2011. How long these acquired CSD skills are retained is unknown. ⋯ CSD skills taught in a rigorous curriculum are retained at one-year follow-up. Residents in the control group did not acquire new CSD skills despite an additional year of training and clinical experience. Further study is needed to link improved CSD skills to better patient care quality.
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Infant mortality is a persistent problem in the United States, and yet, hospice care is rarely provided for infants at the end of life. ⋯ Hospices may need to explore ways to direct resources toward assisting hospice staff members in gaining pediatric experience.