Journal of palliative medicine
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In reviewing the literature, there are few articles describing the role of the speech-language pathologist in hospice. Communication impairments can impact upon the hospice team's ability to provide symptom control and supportive psychosocial care, and diminish the patient's ability to guide the decision making process and maintain social closeness with family. ⋯ Four primary roles of the speech-language pathologist in hospice can be described. (1) To provide consultation to patients, families, and members of the hospice team in the areas of communication, cognition, and swallowing function; (2) To develop strategies in the area of communication skills in order to support the patient's role in decision making, to maintain social closeness, and to assist the client in fulfillment of end-of-life goals; (3) To assist in optimizing function related to dysphagia symptoms in order to improve patient comfort and eating satisfaction, and promote positive feeding interactions for family members and (4) To communicate with members of the interdisciplinary hospice team, to provide and receive input related to overall patient care. Further development of the speech-language pathologist as a participating member of the hospice interdisciplinary team would support the overall goal of providing quality care for patients and families served by hospice.
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Parenteral lidocaine has been reported to relieve neuropathic pain and/or pain refractory to opioid therapy. ⋯ Parenteral lidocaine appears to be rapidly effective for opioid refractory pain and is well tolerated. A randomized controlled trial is needed to confirm these impressive but preliminary uncontrolled results.
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Palliative medicine is assuming an increasingly important role in patient care. Yet, most physicians did not learn this during their formal training. The Education for Physicians in End-of-life Care (EPEC) Project aims to increase physician knowledge in palliative care by disseminating the EPEC Curriculum through a train-the-trainer approach. An assessment of its use to help the project reach its targets was performed. ⋯ There is evidence that physicians selected to be EPEC Trainers judge the EPEC Curriculum to be high in quality, respected, and most importantly, usable. They use the EPEC Curriculum as part of a train-the-trainer dissemination strategy. The interpretation of this enthusiastic assessment is tempered by the study's limitations including respondent bias and possible acquiescence. Nevertheless, it appears that the EPEC Curriculum has set a standard of knowledge in the field and is an example of disseminating new information to physicians in practice. We conclude that the EPEC Curriculum is an effective vehicle to transmit palliative care information to physicians in practice.
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In the general intensive care setting, decisions to withdraw life support when patients deteriorate despite aggressive treatment are estimated to occur in 10% of all patients and in 40% of the patients who die. Acute renal failure (ARF) severe enough to necessitate renal replacement therapy (RRT) is associated with in-hospital mortality approximating 50%. Yet the impact of severe ARF on decisions to withdraw treatment has not been previously described. In chronic renal failure patients, voluntary withdrawal from maintenance dialysis occurs in 10%-20% of patients when increasing complications and poor quality of life ensue, and knowing these data facilitates discussions with patients and families. Having similar data for complicated ARF would facilitate decision making for families and caregivers when these difficult situations arise. ⋯ Severe ARF reflects the severity of underlying illness, impacts overall survival, and is associated with more frequent withdrawal from aggressive treatment. High severity of illness and prolonged intensive care without improvement beyond 2 weeks presage decisions to withdraw treatment and signal patients and caregivers that death is imminent and that further aggressive care should be reconsidered or limited.
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Comparative Study
Physicians' perceptions of procedural pain and discomfort.
Previous studies have demonstrated that patients with end-stage dementia receive a high rate of painful and uncomfortable procedures. This study was undertaken to determine whether this finding might be related to physicians' misperceptions about the burden of common hospital experiences and procedures. ⋯ Physicians have an accurate perception of pain and discomfort associated with common hospital procedures. Further investigation should scrutinize in greater detail the ubiquity and depth of physician knowledge about the issue of procedural burden and should focus on methods and interventions that would allow physicians to consciously weigh the benefits and burdens of routine interventions in the care of persons with serious and life-threatening illness.