BMJ supportive & palliative care
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BMJ Support Palliat Care · Jun 2012
Review Meta AnalysisVarious formulations of oral transmucosal fentanyl for breakthrough cancer pain: an indirect mixed treatment comparison meta-analysis.
To compare the efficacy of fentanyl effervescent buccal tablet (FBT), sublingual oral transmucosal fentanyl citrate (ODT) and compressed lozenge oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough cancer pain (BTcP). ⋯ FBT may have some efficacy advantages over ODT and OTFC and all oral fentanyl preparations appear superior to MSIR in the treatment of BTcP.
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BMJ Support Palliat Care · Jun 2012
Barriers to providing end-of-life care for people with dementia: a whole-system qualitative study.
People with dementia may experience poor quality end-of-life care. The complex health and social care system may not meet their needs. The authors' objectives were to identify perceived and real barriers that prevent people with dementia and their carers receiving end-of-life care of acceptable quality. ⋯ Qualitative methods of service evaluation facilitated a broader and deeper understanding of a range of perspectives, which, with other components of rapid participatory appraisal, generated potential solutions to improve care.
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Implantable cardioverter defibrillators (ICDs) reduce mortality in selected patients with chronic heart failure but prognostic benefit is likely to attenuate with progression to end-stage heart failure. The incidence of multiple futile ICD shocks before death is uncertain. ⋯ Patient and carer opinions about end-stage heart failure and ICD deactivation may not meet professional expectations. Future research should focus on these opinions and examine interventions that bridge the gap between best practice and the reality of current clinical practice.
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BMJ Support Palliat Care · Jun 2012
Introducing the Palliative Performance Scale to clinicians: the Grampian experience.
The Palliative Performance Scale (PPS) was introduced across NHS Grampian. Our aim was to determine how practical and useful the PPS was for clinicians looking after palliative patients in a variety of settings. ⋯ Clinicians found the PPS to be a quick, useful way of assessing and reviewing functional changes in palliative patients. However, it may not identify the subtle changes in individuals with advanced dementia. The survival figures confirm that caution is needed in generalising survival data across different settings and populations. Further work is needed to examine changing functional status in patients with non-malignant diseases or dementia/frailty.
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BMJ Support Palliat Care · Jun 2012
'They patiently heard what we had to say... this felt different to me': the palliative care needs and care experiences of advanced cancer patients and their families in Bangladesh.
In 2008, 70% of cancer deaths occurred in low- and middle-income countries. This study aimed to describe the needs and experiences of patients and families who received palliative care in Bangladesh, and those of the providing clinicians, in order to inform fledgling service development. ⋯ To alleviate the distress to cancer patients and their families, it is essential for oncologists to receive adequate training in palliative care, especially in communication, holistic assessment and information giving. To meet the massive challenge in a country like Bangladesh, palliative care should be mainstreamed into the existing healthcare system for a feasible and sustainable public health approach.