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
Provision of palliative care for life-limiting disease in a low income country national hospital setting: how much is needed?
This study aimed to measure the magnitude of palliative care needs among hospital inpatients. Objectives were to: (1) determine the point prevalence of inpatients with active life-limiting disease and (2) describe multidimensional need for palliative care among these patients. ⋯ The prevalence of active life-limiting disease reported here (46%) is greater than in comparable European studies (5-23%).This reflects the sub-Saharan increased disease prevalence, presentation at a later stage and limited access to curative therapies. There is need for symptom control, food, financial assistance and spiritual support. Service development should be tailored to meet these needs.
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Most terminally ill patients and relatives prefer care and death to occur at home. However, in many cases patients die in hospital and the question arises whether social inequity in palliative care exists. The aim of this study was to analyse associations between dying at home and demographic and socioeconomic characteristics adjusted for healthcare utilisation among Danish cancer patients. ⋯ The found socioeconomic differences in whether death occurred at home or at institutions indicate that age, income and social class must be taken into account when palliative care services engage in fulfilling preferences of dying at home. This may lead to more equality in the possibility of dying at home, despite differences in socioeconomic level.
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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.