Journal of palliative medicine
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Although differences in physician practices of artificial hydration therapy for terminally ill patients with cancer can cause unnecessary suffering from overhyrdration or underhydration of patients, no clinical guideline is available in Japan. This paper illustrates a summary of a nationwide project to construct a clinical guideline for artificial hydration therapy. ⋯ The Japanese Society of Palliative Medicine constructed a clinical guideline for artificial hydration therapy for terminally ill patients with cancer, using evidence-based and formal consensus-building methods. The clinical efficacy of this guideline should be tested in the future.
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Conventional analgesic treatment involves the use of oral and transdermal formulations of drugs that require repetitive administration for sustained pain relief to be achieved. Along with the potential of analgesia, the risk of ongoing side effects consequent on the use of these analgesics also exists and this may have a detrimental effect on the patient's quality of life. In contrast, an intriguing body of evidence suggests that short-term administration of intravenous lidocaine may produce pain relief that far exceeds both the duration of infusion and the half-life of the drug. When pain relief is produced, concomitant analgesic medication can be reduced, side effects from pain relieving medication minimized with a potential for very real improvement in the quality of life of the patient. ⋯ While this form of therapy is not commonplace in the terminally ill patient, it could be argued that its use has much merit in that field and should be considered.
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By the year 2020, chronic obstructive pulmonary disease (COPD) will be the third leading cause of death globally. While there have been consistent calls for increased palliative care involvement in the care of patients with advanced COPD, these calls should be based on empirical evidence that such an approach improves the symptom burden and poor quality of life associated with advanced COPD. Rather than reviewing the traditional treatments of airflow obstruction and palliative measures familiar to the palliative care community, we will focus on some novel approaches to the management of patients with advanced COPD from the perspective of clinicians involved in end of life care provision and research. By combining the clinical and research skills of pulmonologists and palliative medicine specialists we can advance the care of patients with this progressive and incurable disease.
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Caring for a terminally ill family member can be extremely stressful, and stress is known to have a negative influence on aspects of cognition. In contrast to the well-known physical and mental health risks associated with caregiving, little is known about its impact on cognitive functioning. ⋯ In addition to the well-documented physical and mental health risks associated with caregiving, this study adds to a small body of literature demonstrating impaired cognitive functioning among family members providing end-of-life care. Secondary findings of both improvement and deterioration of cognition post caregiving provide tentative support for the possibility of reversing certain cognitive deficits by reducing caregiver stress.