Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Jun 2013
ReviewModels of delivering palliative and end-of-life care in the UK.
The development of palliative and end-of-life care in the UK has been shaped by history and circumstances within and outside palliative care itself. The main focus of this review is to describe adult palliative care services in England, although much of the historical developments apply across the whole of the UK, and some of the later developments affect children's services as well. ⋯ Although there is comprehensive coverage of palliative care obtainable across the UK and good access to medication and equipment, there remains a lot of inequity to challenge and address, including those relating to geography, diagnosis, age and ethnicity.
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Curr Opin Support Palliat Care · Jun 2013
ReviewModels of delivering palliative and end-of-life care in sub-Saharan Africa: a narrative review of the evidence.
This narrative review examines evidence for models of palliative and end-of-life (eol) care delivery in sub-Saharan Africa (SSA) since 2010. It highlights recent developments, on-going challenges and innovative approaches used to address obstacles to increased access to care. ⋯ Although community and HBC programs remain primary models of palliative and eol care delivery in SSA, there is an urgent need to develop a public health approach that integrates care into national health systems to increase accessibility.
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Curr Opin Support Palliat Care · Jun 2013
ReviewPharmacological treatment of constipation in palliative care.
The prevalence of constipation in palliative care patients varies. There is uncertainty about the choice from varying recommendations for pharmacological management of constipation and a varying clinical practice in palliative care settings. The purpose of the review was to evaluate the current recommendations of therapy guidelines and to determine the effectiveness and safety of laxative administration for the management of constipation in palliative care patients. ⋯ There are limited data available on the conventional pharmacological treatment of constipation in palliative care patients due to insufficient randomized controlled trials. However, subcutaneously administered methylnaltrexone was found to be effective in aiding of laxation and well tolerated with limited or transient side effects in palliative care patients.
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Cancer pain management is in continuous innovation and new data are available that could change the therapeutical approach and guidelines. ⋯ The findings reported in this review provide new ideas to be developed in further studies to confirm or not confirm some suggestive data.
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Curr Opin Support Palliat Care · Jun 2013
ReviewManagement of neuropathic pain in children with cancer.
Many children with cancer suffer from neuropathic pain. However, there are no published pediatric randomized controlled trials (RCTs), nor agreed upon pediatric treatment recommendations. Pediatric neuropathic pain in patients with malignancies is often underassessed and undertreated with ineffective therapies. ⋯ A combination of integrative, rehabilitative, and supportive therapies with pharmacotherapy, including first line medications such as NSAIDs, opioids, low-dose tricyclics, and gabapentinoids, appear to be successful treatment strategies. There is a dearth of evidence regarding the management of neuropathic pain in children with cancer; studies, especially RCTs, are desperately needed.