Articles: palliative-care.
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In the United States, the majority of deaths occur in the hospital but the dying process there is at best unsatisfactory and more likely inadequate for both patients and caregivers. The development of hospital-based palliative care programs (HBPCPs) can vastly improve inpatient end-of-life care. This study is the first to examine the prevalence and characteristics of HBPCPs in the United States, thus providing a snapshot of the characteristics of these HBPCPs. ⋯ They tend to be based in oncology, general medicine, and geriatrics. We also assessed reasons for consultation, patient characteristics, and future development needs. These findings can help guide future funding, educational, and programming efforts in hospital-based palliative care.
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The Pan American Health Organization (PAHO) is engaged in field demonstration projects in Latin America and the Caribbean to expand the availability and effectiveness of palliative care services. Workshops and calls for proposals address the multiple causes of inadequate palliative care services that are typical for countries in the developing world. These include regulatory barriers and drug interdiction policies that interfere with the medical use of opioids, lack of education among health professionals, and insufficient palliative care infrastructure.
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At Children's Hospital of Wisconsin there is a pediatric palliative care consultation service that serves a diverse patient population, including infants. However, the value of a palliative care consultation for infants has not been well evaluated. We performed a retrospective, case series, descriptive chart review of infants in our neonatal intensive care unit (NICU) who received palliative care consults between January 1996 and June 1998. ⋯ Recommendations that the palliative care staff made fell into four categories: advance directive planning, the optimal environment for supporting neonatal death, comfort and medical care, and psychosocial support. This series is a description of what a palliative care service can offer for terminally ill infants in an NICU. We speculate that such consults can more consistently and comprehensively provide appropriate end-of-life care for these patients and their families.
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Octreotide is an extremely useful compound for palliative care physicians. It appears to be active in a number of different pain states and may be given by the spinal and intraventricular route. Its actions in reducing gut motility and secretions make it a valuable adjunct in the management of inoperable bowel obstruction. ⋯ Its ability to reduce gut secretions has led to its use in the treatment of fistulae. It has also been proposed as a useful drug in the management of cachexia and ascites. Most of the existing evidence is based on small numbers of case reports and further larger trials are necessary.
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Surg. Oncol. Clin. N. Am. · Jan 2001
ReviewPharmacologic management of pain: the surgeon's responsibility.
Historically, surgeons have had to witness their patients' pain probably longer than any specialty within medicine. Pain relief in palliative care forms the cornerstone of a comprehensive pattern of care that encompasses the physical, psychologic, social, and spiritual aspects of suffering. In a society that lives by mottoes, such as "no pain, no gain," and "just say no to drugs," pervasive subconscious barriers to effective pain relief exist. In being responsible for effective pain management to the patient, the surgeon must first set aside his or her own beliefs and attitudes regarding pain and its control and be open to change.