Articles: palliative-care.
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Review
General anaesthesia in end-of-life care: extending the indications for anaesthesia beyond surgery.
In this article, we describe an extension of general anaesthesia - beyond facilitating surgery - to the relief of suffering during dying. Some refractory symptoms at the end of life (pain, delirium, distress, dyspnoea) might be managed by analgesia, but in high doses, adverse effects (e.g. respiratory depression) can hasten death. Sedation may be needed for agitation or distress and can be administered as continuous deep sedation (also referred to as terminal or palliative sedation) generally using benzodiazepines. ⋯ To be a valid option, general anaesthesia in end-of-life care will require a clear multidisciplinary framework and consensus practice guidelines. We see these as an impending development for which the specialty should prepare. General anaesthesia in end-of-life care raises an important debate about the possible role of anaesthesia in the relief of suffering beyond the context of surgical/diagnostic interventions.
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J Pain Symptom Manage · Oct 2021
Meta AnalysisAssociation of Palliative Care Intervention with Health Care Use, Symptom Burden and Advance Care Planning in Adults with Heart Failure and Other Noncancer Chronic Illness.
Palliative care (PC) improves outcomes in noncancer illness. We hypothesized the benefit is driven by studies of heart failure (HF) patients exclusively versus studies of other noncancer illnesses. ⋯ PC is particularly effective at reducing potentially unwanted hospital admissions for patients with HF compared to other noncancer illnesses. Our findings should further encourage efforts to increase PC access to HF patients.
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J Pain Symptom Manage · Oct 2021
A National Survey of Challenges Faced by Hospices during the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death.
No national data exist on hospice medication shortages, the frequency that opioid medications go missing, and drug disposal practices. ⋯ Hospices face numerous challenges during the national opioid crisis. Interventions are needed to ensure access to needed treatments, mitigation of diversion, and safe medication disposal.
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J Pain Symptom Manage · Oct 2021
Randomized Controlled TrialTRAINING STAFF IN LONG-TERM CARE FACILITIES - EFFECTS ON RESIDENTS' SYMPTOMS, PSYCHOLOGICAL WELL-BEING, AND PROXY SATISFACTION.
Long-term care facility (LTCF) residents have unmet needs in end-of-life and symptom care. ⋯ Our rigorous randomized controlled trial on palliative care training intervention demonstrated mild effects on residents' symptoms and no robust effects on psychological well-being or on proxies' satisfaction with care.
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1Cystic fibrosis (CF) is an autosomal recessive genetic condition with multisystemic disease manifestations, the most prominent of which occur in the respiratory system. Despite significant developments in disease understanding and therapeutics, each contributing to improved lung function and survival in patients with CF, several pulmonary complications, including pneumothorax, massive hemoptysis, and respiratory failure, continue to occur. In this review, we briefly describe each of these complications and their management and discuss how they impact the care and disease trajectory of individuals in whom they occur. Finally, we discuss the evolving role that palliative care and CF transmembrane conductance regular modulator therapies play in the natural disease course and care of patients with CF.