Journal of palliative medicine
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The length of hospice stay, as an indicator of timing of hospice referral, is an important outcome to examine in end-of-life care because it is relevant to the quality and cost efficiency of end-of-life care that patients receive. Although the majority receives nonmedical care from informal caregivers, many elderly hospice users rely on paid caregivers or staff of residential facilities. ⋯ Our findings suggest that ethnic differences in length of stay should be discussed in terms of type of caregiver, not just type of setting, since patients in residential facilities can have informal primary caregivers who are vigilant advocates for their dying relatives. We discuss possible reasons for the influence of having formal caregivers on length of stay of minority elders.
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The field of hospice and palliative medicine has grown to include more than 50 fellowship training programs. In 2007 hospice and palliative medicine received American Board of Medical Specialties (ABMS) recognition as a subspecialty of medicine. Palliative medicine fellowships will begin formal accreditation under the American Council of Graduate Medical Education (ACGME) in 2008. ⋯ Through carefully designed collaborative partnerships with community organizations three draft ACGME requirements for accreditation were met. It is anticipated that the program will receive full accreditation through the ACGME in 2008.
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Review Meta Analysis Comparative Study
Adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison to long-acting morphine: a meta-analysis and systematic review of the literature.
To assess the adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison with slow release oral morphine. ⋯ Although no difference in the overall adverse effect profile exists between transdermal opiates and slow release oral morphine, the difference in some adverse effects (mainly constipation) seems to favor transdermal opiates in the preference of patients with moderate-severe cancer pain.
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Multicenter Study
Do-not-resuscitate orders and/or hospice care, psychological health, and quality of life among children/adolescents with acquired immune deficiency syndrome.
The frequency of do-not-resuscitate (DNR) orders and hospice enrollment in children/adolescents living with acquired immune deficiency syndrome (AIDS) and followed in Pediatric AIDS Clinical Trials Group (PACTG) Study 219C was examined, and evaluated for any association with racial disparities or enhanced quality of life (QOL), particularly psychological adjustment. ⋯ Children who died of AIDS rarely had DNR/hospice enrollment. National guidelines recommend that quality palliative care be integrated routinely with HIV care. Further research is needed to explore the barriers to palliative care and advance care planning in this population.
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To determine what questions family caregivers want to discuss with health care providers (HCPs) in order to prepare for the death of a loved one. ⋯ Family caregivers of patients with terminal illness need more than prognostic information in order to prepare for the death. HCPs should be aware that caregivers may not ask important questions and that unanswered questions may contribute to caregiver distress. Awareness of caregivers' questions can help HCPs improve the care provided to caregivers by better preparing them for the death of their loved one.