BMJ supportive & palliative care
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BMJ Support Palliat Care · Dec 2012
Randomized Controlled TrialLack of association between genetic variability and multiple pain-related outcomes in a large cohort of patients with advanced cancer: the European Pharmacogenetic Opioid Study (EPOS).
This study examined whether the choice of pain-related outcome to represent opioid efficacy influenced findings in a genetic association study. Data from the European Pharmacogenetic Opioid Study, which used opioid dose as the outcome, were analysed in respect of six alternative outcomes: average pain intensity, pain right now, worst pain intensity, pain at its least, pain relief and pain interference. ⋯ None of the outcomes were associated with variation in the selected SNPs, as previously shown for opioid dose. Thus, we observed that findings related to associations between genetic variability and opioid efficacy were consistent for several alternative outcomes.
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BMJ Support Palliat Care · Dec 2012
ReviewGuideline for the management of terminal haemorrhage in palliative care patients with advanced cancer discharged home for end-of-life care.
Terminal haemorrhage is a rare and distressing emergency in palliative oncology. We present an algorithm for the management of terminal haemorrhage in patients likely to receive end-of-life care at home, based on a literature review of the management of terminal haemorrhage for patients with advanced cancer, where a DNAR (do not attempt resuscitation) order is in place and the patient wishes to die at home. ⋯ Terminal haemorrhage is a rare yet highly feared complication of advanced cancer, for which there is a limited evidence base to guide management. The suggested three-step approach to managing this situation gives professionals a logical framework within which to work.
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BMJ Support Palliat Care · Dec 2012
Multicenter Study Observational StudyStructure, organisation and clinical outcomes in cancer patients of hospital support teams in Spain.
To describe the structure, characteristics of patients and basic clinical outcomes in cancer patients receiving care from palliative care hospital support teams (HSTs) in Spain. ⋯ Palliative intervention of HSTs is characterised by being adjusted to patient needs and short duration. Their care was focused on the preterminal phase of cancer patients of moderate-high complexity.
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BMJ Support Palliat Care · Dec 2012
Measuring patients' experiences with palliative care: the Consumer Quality Index Palliative Care.
The Consumer Quality Index Palliative Care (CQ-index PC) is a structured questionnaire for measuring the quality of palliative care from the perspective of care users. CQ-indices assess which care aspects need quality improvement by relating answers about actual care experiences to answers about the importance of certain aspects of care. ⋯ The CQ-index PC provides opportunities for care organisations to assess which care aspects have the highest priority for quality improvement within their organisation. Further research is needed to assess whether the instrument has enough discriminative power to assess differences between organisations.
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BMJ Support Palliat Care · Dec 2012
Hospice inpatients' views on physical examination by medical students: is it acceptable?
Hospices are increasingly involved in medical student teaching, which the patients generally enjoy. No studies have specifically investigated how hospice patients view the prospect of physical examination by students. Previous evidence involves patients who have already seen students, while the views of other patients are unknown. This study aimed to provide an initial understanding of the views of a diverse group of hospice inpatients on the acceptability and perceived importance of students physically examining them. ⋯ Hospice inpatients generally wish to be involved in medical student teaching, but many are concerned about being physically examined, and some feel a sense of obligation to participate. There are implications for hospices that teach students. Further research is necessary to investigate the frequency and severity of these concerns.