Articles: palliative-care.
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To determine why and how sedatives and analgesics are ordered and administered during the withholding and withdrawal of life support from critically ill patients. ⋯ Large doses of sedatives and analgesics were ordered primarily to relieve pain and suffering during the withholding and withdrawal of life support, and death was not hastened by drug administration.
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We report the work of two community teams who care for people with AIDS/HIV related illness, the characteristics of patients referred, and the impact of the teams on four aspects of quality of life. Data was collected on 140 patients (85 St. Mary's Home Support Team, 55 Bloomsbury Community Care Team) who were referred to and remained in the care of these teams until death. ⋯ Patient anxiety, also a commonly severe problem at referral, improved significantly throughout care. Pain control was less commonly severe at referral and improved significantly throughout care. Practical aid, in contrast, was rarely a severe problem at any stage of care.
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Half of the patients with advanced cancer suffer from shortness of breath. This may be due to the cancer itself, result from its treatment or arise from concurrent conditions. ⋯ Treatment should be directed toward altering the underlying pathological process as far as possible (e.g. tumour reduction or pleural puncture). The relieve of symptoms by reassuring presence and morphine application are the mainstay, when it is not possible to reverse the cause of dyspnea, and can also successfully complement specific therapy.
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Dyspnea can be defined as an unusual perception of respiration and/or urge to breath more than usual. Up to 70% of all tumour patients suffer at one time from this complaint, and often only an incomplete palliation is achieved. Dyspnea in the tumour patient is often associated with anxiety, which leads itself to a further exacerbation of dyspnea (through increased respiratory work and dead-space ventilation). ⋯ Therapeutic measures include bronchoscopic suction of retained secretions and physical measures to reduce secretions. Supplemental oxygen is indicated in hypoxemic patients and in those who derive benefit of it. The nonspecific drug therapy with benzodiazepines and/or opiates remains clinically useful, although its efficacy is questioned by some controlled studies.