J Palliat Care
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Letter Case Reports
Intrathecal administration of drinking water and morphine.
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Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and disability worldwide. For many patients, maximal therapy for COPD produces only modest relief of disabling symptoms and these symptoms result in a significantly reduced quality of life. Despite the high morbidity and mortality, patients with COPD do not receive adequate palliative care. ⋯ Understanding the barriers to this communication may be an important step to improving communication about EOL care and improving patient-centred outcomes. Two areas that may influence the quality of care received by patients with COPD are also highlighted: 1) the role of depression, a common problem in patients with COPD, in physician-patient communication; and 2) the role of advance care planning in this communication. Further research is needed to develop and test interventions that can enhance patient-physician communication about palliative and EOL care for patients with COPD, and we describe our perspective on a research agenda in each area.
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End-of-life sedation remains a controversial and ill-defined clinical practice; its applications vary considerably. With this in mind, a study was conducted using a 2 x 2 experimental design. The variables experimented with were prognosis (short- or long-term) and type of suffering (physical or existential). ⋯ Thus, when a patient was suffering physically, the respondents were significantly in favour of sedation, whereas they were not in favour of this practice if the suffering was existential. Lastly, it is clear that health professionals are uncomfortable when confronted with their patients' existential suffering. This is an issue worth exploring in future studies.
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Ventricular assist devices (VAD) are mechanical pumps implanted into patients with advanced heart failure who are at risk of imminent death. VADs are a treatment and not a cure, and mortality on device support remains high. Recognizing the dire nature of the decisions for patients and families and the associated high mortality rates, we actively included processes for device withdrawal as part of our program mandate. ⋯ Establishing a process for device withdrawal has been a key factor in the success of our VAD program. This process relies heavily on pre-implantation preparation, a strategy for resolving disagreements, and a process for withdrawing device support.
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Biography Historical Article
In memory of...snapshots of Cicely: reflections at the end of an era.