Articles: palliative-care.
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There has been a dramatic shift of the human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) epidemic into poor, marginalized, and minority communities in the US. At the same time, the availability of new highly active antiretroviral treatments has made it possible for a large number of individuals to live for a much longer time with their disease. A net result is that the US is faced with an increasing number of people who are living with HIV/AIDS and are dependent on publicly supported health care services. ⋯ In addition to supporting traditional hospice care, HRSA's HIV/AIDS Bureau has begun a series of initiatives that apply a broader concept of palliative care to its HIV programs in hospital- and community-based settings. Our interest is not to substitute palliation for access to new HIV therapies, such as highly active antiretroviral treatments, but to ensure that our health delivery systems attend to the alleviation of symptoms and suffering along with the provision of antiretroviral and other necessary treatments. HRSA's HIV/AIDS Bureau is organizing a broader provision of palliative care for its clients and actively contributing to improving care for the disenfranchised internationally.
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Efficient, comprehensive documentation is a vital element of all healthcare provision. It not only provides a record of care, but should reflect the quality of that care, enable continuity of care between practitioners and reinforce care standards. ⋯ This article describes the formulation of an integrated system of documentation which aims to address the failings of documentation procedures in one hospice/palliative care unit. The resulting system seeks to embody the rationale of palliative care within a dynamic, patient-centred approach to nursing documentation.
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The complex needs of palliative care patients require an informed, expert, and swift response from out-of-hours general medical services, particularly if hospital admission is to be avoided. Few general practitioners (GPs) reported routinely handing over information on their palliative care patients, particularly to GP co-operatives. ⋯ Most responders wanted 24-hour availability of specialist palliative care. This indicates a need to develop and evaluate out-of-hours palliative care procedures and protocols, particularly for GP co-operatives, and to improve inter-agency collaboration.
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J Paediatr Child Health · Jun 2000
A 7-year review of deaths on the general paediatric wards at John Hunter Children's Hospital, 1991-97.
To study the palliative management of children dying on the wards of a tertiary referral centre. In particular to identify areas of difficulty and discuss ways in which these can be improved. ⋯ The majority of terminally ill children were managed well with intravenous narcotics and adjuvant medications. There may be scope for such children to be managed successfully at home with appropriate support for the general practitioner by paediatric and palliative care specialists. Some cases in which palliation is difficult do remain in hospital and additional measures need to be employed to ensure a symptom free death for these children.
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This study aims at describing the experience of the patients and their family when they are faced with an interdisciplinary team in palliative care. Are the patients and their family aware of the interdisciplinarity within the team and does this organization meet their expectations? We also went deeper into some themes, i.e. pain treatment, notion of safety and the position of the patients and of his relatives as object or subject of the care. We chose the qualitative approach to answer this question. ⋯ At home, the interdisciplinarity is not yet perceived by the subjects and it is striking to see the relatives who wish to "take a break" in their accompaniment of the sick person, even if they feel very guilty and are not very well considered by the care takers. We also noted all what was expressed around the death and the death accompaniment, which raises questions on the role of the team, the limits of this accompaniment and the training of the care takers for this accompaniment. To conclude, this study allowed us to describe an experience rather precisely; we could thus stress the perception by the patients and the families of a team, what, we think, can help the latter in their daily practice but also in a deepened reflection on the interdisciplinarity conditions and the implementation of real team projects, involving the patient and his family.