Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Jun 2011
ReviewAssessing the role of hydration in delirium at the end of life.
Delirium is the most frequent neuropsychiatric disorder that affects the advanced cancer population who are receiving palliative care. There is limited evidence and much debate about the role of hydration in delirium management at the end of life. The purpose of this article is to review the literature on delirium management with regards to pharmacological management and hydration. ⋯ More work is required to assess the role of hydration in delirium at the end of life. Given the lack of evidence-based research on hydration, more randomized clinical trials are needed to elucidate the effects of hydration as a delirium intervention.
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To examine recent and current evidence available to guide the management of chronic pain in primary care. ⋯ Most chronic pain presents and is managed in primary care; yet, most evidence for its management is difficult to apply in the primary care setting. Despite growing evidence for the management of chronic pain generally, management in primary care must be largely guided by consensus, experience, and judicious extrapolation from research in other contexts or conditions. A need for increased and on-going education and resources is apparent, as is the need for more research based in primary care.
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Curr Opin Support Palliat Care · Jun 2011
ReviewManagement of dyspnea within a rapid learning healthcare model.
This review addresses a distressing symptom experienced by many palliative care patients, for which available interventions have been only partially effective. A new model of healthcare delivery and research - rapid learning healthcare - provides a potential framework for improving clinical care for and outcomes of dyspnea. This review places dyspnea management in palliative care within the new systems approach offered by rapid learning healthcare. ⋯ A rapid learning model could improve comprehensive assessment, timeliness of intervention, accrual of data to support best practice, and tailoring of care to patients' needs as their disease and experiences change over time. Data collected in the process of routine care in a rapid learning model can simultaneously function as clinical information and a resource for research on patient-centered experiences and outcomes.
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To present an overview of insights into brain mechanisms of pain perception and analgesia based on human brain imaging. ⋯ Neuroimaging of pain and plasticity can provide a framework to understand the basic mechanisms of pain regarding function, gray and white matter structure and connectivity. This information may also guide future clinical practice. For instance, the time-course of disease-driven brain plasticity and capacity for reversibility may help decide the optimal time frame for chronic pain treatment. Furthermore, findings from functional and structural connectivity studies may indicate potential side effects of targeting specific brain areas in treating chronic pain. Lastly, the correlation between individual factors and functional/structural MRI data may direct individualized treatment plans.
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Breathlessness remains a frequent and burdensome symptom for individuals with life-limiting symptoms in both malignant and nonmalignant settings. As oxygen therapy is frequently given as part of the management of breathlessness and is associated with costs, treatment burden and potential dangers, it is timely to review the efficacy and appropriateness of palliative oxygen therapy. ⋯ On the basis of the findings of this review, the routine use of palliative oxygen therapy without detailed assessment of pathogenesis and reversibility of symptoms cannot be justified. Promoting self-management strategies, such as cool airflow across the face, exercise and psychological support for patients and carers, should be considered before defaulting to oxygen therapy. If palliative oxygen therapy is considered for individuals with transient or mild hypoxaemia, a therapeutic trial should be conducted with clinical review after 3 days to assess the net clinical benefit and patient preference.