Palliative medicine
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Palliative medicine · Oct 2011
Association between symptoms and their severity with survival time in hospitalized patients with far advanced cancer.
To assess the significance of symptoms and their severity for predicting survival of hospitalized patients with far advanced cancer. ⋯ Fatigue, lack of appetite, feeling sad, and shortness of breath could be predictive factors for survival time of hospitalized patients with far advanced cancer. The more severe these symptoms are, the shorter will be survival time.
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Primary thromboprophylaxis (PTP) is a Department of Health priority in England. The NICE guidelines agree that PTP is inappropriate in the dying patient, but should be considered for those with reversible pathology. In the light of continued variation and uncertainty in UK hospice practice, we assessed PTP prescribing in three hospices. ⋯ Patients receiving PTP increased slightly from 1% to 3.6% and documentation of PTP decisions increased from 5% to 81%. Whilst the PBCN VTE tool is a useful tool to tailor an approach for this complex patient group, many questions remain. Clinical trials that include patients with advanced disease with relevant outcome measures are needed to help inform the clinicians who care for them.
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Palliative medicine · Oct 2011
Choosing the unit of measurement counts: the use of oral morphine equivalents in studies of opioid consumption is a useful addition to defined daily doses.
Defined daily dose (DDD) is the most common measurement unit used in drug consumption studies. The DDD for opioids may not reflect their relative clinical potencies. The aim of this study was to explore whether opioid consumption data may be interpreted differently when adding oral morphine equivalent (OMEQ) dose as a measurement unit compared with using DDD. ⋯ OMEQ reflects clinical dosing better than DDD, and can give additional insight into opioid consumption when combined with DDD. Using OMEQ can also lead to different conclusions in opioid consumption studies compared with using DDD alone.
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Palliative medicine · Oct 2011
The use of crisis medication in the management of terminal haemorrhage due to incurable cancer: a qualitative study.
Terminal haemorrhage is a rare but devastating event that may occur in certain advanced cancers. The focus of management involves administration of 'crisis medicine' with the intention of relieving patient distress through sedative doses of anxiolytics or opioids. This practice, whilst widely accepted, is based on limited evidence and has never been formally evaluated. ⋯ Anticipatory prescribing of crisis medication rarely benefits the patient and may unintentionally detract from nursing care. Guidelines on the management of terminal haemorrhage should reconsider the emphasis on crisis medication and focus on non-pharmacological approaches to this invariably fatal event.
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Palliative medicine · Oct 2011
'A bridge to the hospice': the impact of a Community Volunteer Programme in Uganda.
In Africa, the need for palliative care provision is escalating with an increasing number of people living with HIV/AIDS, coupled with rising cancer and AIDS-related cancer diagnoses. In Uganda there is a shortage of doctors, particularly in rural areas. To address this Hospice Africa Uganda developed a Community Volunteer Programme to train volunteers to help by providing support to patients in their own homes. ⋯ The results reported the value of the Community Volunteer Programme, including the impact on patients and families, and how the CVWs acted as a 'bridge to the hospice' in identifying patients. Developing financial challenges that are emerging which could potentially impact on the programme were reported. The Community Volunteer Programme appears to be having a positive impact on patients, families and the hospice team, and is a model worthy of consideration by other developing countries to allow the expansion of palliative care.