Journal of pain and symptom management
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Lorazepam (Ativan(®)), diphenhydramine (Benadryl(®)), haloperidol (Haldol(®)) (ABH) topical gel is currently widely used for nausea in hospice because of perceived efficacy and low cost and has been suggested for cancer chemotherapy. However, there are no studies of absorption, a prerequisite for effectiveness. We completed this study to establish whether ABH gel drugs are absorbed, as a prerequisite to effectiveness. ⋯ As commonly used, none of the lorazepam, haloperidol, or diphenhydramine in ABH gel is absorbed in sufficient quantities to be effective in the treatment of nausea and vomiting. Diphenhydramine is erratically absorbed at subtherapeutic levels. The efficacy of ABH gel should be confirmed in randomized trials before its use is recommended.
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J Pain Symptom Manage · May 2012
Consensus recommendations from the strategic planning summit for pain and palliative care pharmacy practice.
Pain and symptoms related to palliative care (pain and palliative care [PPC]) are often undertreated. This is largely owing to the complexity in the provision of care and the potential discrepancy in education among the various health care professionals required to deliver care. Pharmacists are frequently involved in the care of PPC patients, although pharmacy education currently does not offer or require a strong curriculum commitment to this area of practice. ⋯ Six working groups were charged with objectives to address barriers and opportunities in the areas of student and professional assessment, model curricula, postgraduate training, professional education, and credentialing. Consensus was reached among the working groups and presented to the Summit Advisory Board for adoption. These recommendations will provide guidance on improving the care provided to PPC patients by pharmacists through integrating education at all points along the professional education continuum.
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J Pain Symptom Manage · May 2012
In a language spoken and unspoken: nurturing our practice as humanistic clinicians.
The health care industry and health care practitioners face significant challenges related to increasing demand for services and decreasing availability of resources. This article offers brief descriptions of four actions that health care leaders, administrators, and clinical staff of all disciplines can implement and/or advocate for to promote continuing quality of biopsychosocial/spiritual care for those we serve. The first action addresses how we, as health care practitioners, improve delivery of care through continuous improvement methodology; the second, how we enhance the training of our future workforce by increasing in-home training opportunities; the third, how we cost-effectively broaden our understanding of the human experience through the inclusion of humanities in our training and workplace; and the fourth, how we increase our self-awareness to improve our ability to practice as humanistic clinicians.
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J Pain Symptom Manage · May 2012
Changes in the prescription of psychotropic drugs in the palliative care of advanced cancer patients over a seven-year period.
Psychiatric disorders are frequently underdiagnosed and undertreated in advanced cancer patients. ⋯ Between 2002 and 2009, there was a significant increase in the use of psychotropic drugs and a change in the profile of drugs prescribed.
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J Pain Symptom Manage · May 2012
Development of a rural palliative care program in the Calgary Zone of Alberta Health Services.
Specialized rural models of palliative care are greatly needed to address the challenges rural communities face in providing palliative care services and to ensure that their unique strengths and needs are considered. In late 2005, a Rural Palliative Care Program was developed to support primary care providers in delivering palliative care to patients in rural communities outside of Calgary, Alberta, Canada. The program was grounded in the needs of individual communities, incorporated integral roles for local champions, and adopted pre-existing, accepted rural structures and processes. ⋯ The following actions were taken to address the top six priorities: 1) more accessible palliative care education opportunities with a rural focus were provided to health care professionals; 2) linkages with rural and urban resources were strengthened and access to specialists and procedures was improved; 3) strategies were implemented to improve psychosocial support for patients and families; 4) resources were developed to facilitate rural home deaths; 5) opportunities were expanded for education and utilization of volunteers; and 6) a mobile specialist consultation team was developed to support rural health care professionals and their patients in their rural communities. In its first four years, the team consulted on 640 patients, nearly three-quarters of whom died in their rural communities. Rather than imposing an urban outreach strategy, the development of a rural-based program through respectful engagement of local providers has proven to be crucial to the success of this rural palliative care program.