Current opinion in supportive and palliative care
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As quality in end-of-life care for the seriously ill and dying patient and his relatives is the central aim of palliative care, the development of clinically relevant quality indicators is essential. To get an insight into the most recent advances concerning quality indicators in end-of-life care, a literature review has been performed. ⋯ In most domains of care the existing indicators have to be specified methodologically. Missing domains mainly concerned with spiritual, religious, existential and cultural aspects have to be focused on to develop meaningful indicators. Additionally the initiatives working on national levels have to collaborate to bring together all their valuable information. Above that the patients and families insight, on what they perceive as quality, should be listened to more intensely.
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Curr Opin Support Palliat Care · Jun 2010
ReviewThe management of painful crisis in sickle cell disease.
Until recently management of sickle pain was the province of haematologists. However, a recent National Confidential Enquiry into Patient Outcome and Death report highlighted problems with the management of pain and opioid analgesia in this group and suggested a multiagency approach similar to that used in palliative care. ⋯ In this review we will give a brief overview of the disease and its pathogenesis before examining the epidemiology, management of pain in sickle cell disease. We will also review recent evidence regarding quality of life and discuss the role of opioid hyperalgesia in sickle cell disease.
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Curr Opin Support Palliat Care · Jun 2010
Editorial ReviewThe dyspnea target: can we zero in on opioid responsiveness in advanced chronic obstructive pulmonary disease?
Despite recognition that opioids alleviate dyspnea in chronic obstructive pulmonary disease, many clinicians remain reluctant to use them outside of the final days of life. This article defines the term 'opioid responsiveness' as it pertains to dyspnea, and poses that it may be possible to predict more accurately the patients with chronic obstructive pulmonary disease and refractory dyspnea who might benefit from opioid treatment for either short-term use during episodes of dyspnea crisis or for long-term use for chronic dyspnea on minimal exertion. ⋯ The 'dyspnea target' or similar conceptual models that attempt to predict how specific aspects of dyspnea may affect response to treatments offer clinicians the potential to more effectively target interventions. The model is presented in its theoretical stage in order to stimulate further discussion and research in an area of current interest.
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Curr Opin Support Palliat Care · Jun 2010
ReviewManagement of dyspnea in interstitial lung disease.
Dyspnea is the most common symptom in interstitial lung disease, yet little is known about its management. This review summarizes the available evidence for the treatment of dyspnea in interstitial lung disease. ⋯ Studies support pulmonary rehabilitation as an effective treatment for dyspnea in interstitial lung disease and pulmonary rehabilitation should be considered in all dyspneic patients. Several investigational agents have been developed and evaluated for potential use in fibrotic interstitial lung disease; however, these agents have not been shown to improve dyspnea.
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Curr Opin Support Palliat Care · Jun 2010
ReviewManagement of dyspnea in advanced pulmonary arterial hypertension.
Pulmonary hypertension leads to progressive increase in pulmonary vascular resistance, heart failure, and death. Pulmonary arterial hypertension (PAH) is a subset of pulmonary hypertension affecting small pulmonary arteries and not associated with underlying heart or lung disease. Dyspnea and exercise intolerance are hallmarks of PAH and are used to monitor disease progression. This review focuses on recent advances in the pathophysiology and treatment of dyspnea in PAH. ⋯ Establishing the cause and clinical severity of pulmonary hypertension is critical for management. The pathophysiology of dyspnea in PAH is complex and related to pulmonary vascular resistance. Although disease-specific treatments are now available, a cure for PAH remains elusive and trials of combination treatments to improve symptoms and outcomes are ongoing.