J Palliat Care
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To assess the necessity and feasibility of introducing a home-based palliative care program for children admitted to our neurosurgical unit and diagnosed as being terminally ill, we conducted an analysis of all such patients admitted to our unit over an 18-month period. Of a total of 30 patients, 22 (73.4%) had central nervous system tumors, 6 (20.0%) had myelomeningocele/hydrocephalus, and 2 (6.6%) had arteriovenous malformations. The mean duration +/- SEM of hospitalized days prior to death and the proportion of time spent hospitalized during the terminal phase of illness were 28.8 +/- 4.77 and 0.327 respectively, for the 23 patients who died and on whom adequate data were available. ⋯ The most troublesome symptoms in this subgroup were feeding difficulties, gastrointestinal symptoms, breathing difficulty, and seizures. These symptoms were managed either by (a) medications administered orally or by feeding tube or rectally, or by (b) noninvasive procedures carried out by a nurse under the direction of the admitting neurosurgeon. This study suggests that prolonged hospitalization for children diagnosed as being terminally ill can be avoided by introducing a home-based palliative program with involvement from a nurse and a physician familiar with drug therapy for terminally ill children.
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Perinatal loss and grief have been recognized as a special form of loss in the last ten years. Perinatal death includes miscarriage, therapeutic abortion, stillbirth, and infant death shortly after birth. Acknowledgement of the death and support to mourn their loss by significant others promotes resolution of this bereavement. ⋯ A multidisciplinary Perinatal Support Service is in place at Women's College Hospital to provide grief counselling to the mother and her family who have experienced a stillbirth or neonatal loss. The service has a direct link to the community through the Public Health Nurse on the obstetrical service. A review of three years reveals a high rate of referral by the attending physician and obstetrical nurse.