BMJ supportive & palliative care
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BMJ Support Palliat Care · Mar 2014
An analysis of knowledge and attitudes of hospice staff towards organ and tissue donation.
Only a minority of hospice patients eligible to donate tissue and organs choose to do so. Hospice care staff play a key role in discussions about donation, but their willingness to engage in these discussions and their understanding of issues around tissue and organ donation is poorly understood. ⋯ A reluctance to instigate discussions about organ and tissue donation may prevent palliative patients and their families being allowed the opportunity to donate. Suboptimal knowledge among hospice staff suggests the need for greater liaison between hospice staff, and the organ and tissue donation teams.
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BMJ Support Palliat Care · Mar 2014
The impact of a medical undergraduate student-selected module in palliative care.
The need for undergraduate medical education in palliative care is widely recognised. An optional student-selected module 'Fundamentals of Palliative Medicine' was introduced in 2011 and offered to third-year medical students. The overall objective of the module was to develop students' knowledge, attitudes and skills in palliative care. ⋯ The module was a popular choice with students, was well received, and appears to have had a significant educational impact in terms of changing students' attitudes and perceived knowledge and skills in palliative care.
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BMJ Support Palliat Care · Mar 2014
Issues for palliative medicine doctors surrounding the withdrawal of non-invasive ventilation at the request of a patient with motor neurone disease: a scoping study.
Non-invasive ventilation (NIV) is beneficial for respiratory failure in motor neurone disease (MND) but some patients may wish to stop the intervention. Guidance from the National Institute for Health and Care Excellence recommends that research is needed on NIV withdrawal. There is little in the literature focusing on the issues doctors face when withdrawing NIV in this group. ⋯ The withdrawal of NIV in patients with MND appears to pose considerable challenges to palliative medicine doctors; emotionally, practically and to a lesser extent ethically. Development of guidelines and a clear ethical statement of conduct may help but emotional issues appear more complex.
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BMJ Support Palliat Care · Mar 2014
Observational StudyTriggers in advanced neurological conditions: prediction and management of the terminal phase.
The challenge to provide a palliative care service for individuals with advanced neurological conditions is compounded by variability in disease trajectories and symptom profiles. The National End of Life Care Programme (2010) recommended seven 'triggers' for a palliative approach to care for patients with advanced neurological conditions. ⋯ Referral criteria based on the triggers can facilitate appropriate and timely patient access to palliative care. The components deduced through PCA have face validity; however larger studies prospectively validating the triggers are required. Closer scrutiny of the terminal phase is necessary to optimise management.
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BMJ Support Palliat Care · Mar 2014
Case ReportsA rare non-malignant cause of spinal cord compression in a young patient.
In the context of palliative medicine, spinal cord compression occurs in around 5% of patients with cancer. Ten per cent of patients with spinal metastases are affected; the commonest causes are breast, prostate, lung cancer and multiple myeloma. ⋯ Symptoms occur when the adipose tissue enlarges, encroaching on the spinal canal. In this case, the aetiology was long-term exogenous dexamethasone use.