Palliative medicine
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A review of the research in the area of staff stress in hospice/palliative care since the start of the modern hospice movement shows that, while high stress was identified as a problem in the early days of the movement, later studies have shown that stress and burnout in palliative care are by no means universal. Staff stress and burnout in hospice/palliative care has been demonstrated to be less than in professionals in many other settings. However, other studies have noted suicidal ideation, increased alcohol and drug usage, anxiety, depression, and difficulty in dealing with issues of death and dying. ⋯ Staff in hospice/palliative care have been found to have increased stress when mechanisms such as social support, involvement in work and decision-making, and a realistic work-load are not available. The stress that exists in palliative care is due in large measure to organizational and societal issues, although personal variables were also found to have an influence. Suggestions are given for the direction of future research in the field.
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Prognosis in severe chronic obstructive pulmonary disease is poor, and it is increasingly accepted that such patients need good palliative care. This paper reviews the medical management of chronic obstructive pulmonary disease, and also discusses the place of long-term oxygen therapy. ⋯ The drug treatment of dyspnoea has been disappointing, but close attention to psychosocial aspects can improve mobility and control. The place of palliation in a number of other chronic lung conditions is also mentioned.
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Palliative medicine · Jan 1995
The need for inpatient palliative care facilities for noncancer patients in the Thames Valley.
Inpatient facilities in palliative care units are generally considered to be mainly for cancer patients. We present and discuss the results of a survey that attempted to estimate the number of noncancer patients requiring inpatient palliative care. Questionnaires sent to all general practices in the Thames Valley area asked about the diagnosis and the number of bed-days that would have been required for each noncancer patient in the practice dying in the last year or still in their care. ⋯ For the Thames Valley area this would amount to at least 66,000 bed-days per year for noncancer patients, compared with the current provision, mainly for cancer patients, of about 40,000 bed-days per year. The diagnoses involved and the reasons why our figures may overestimate need, are discussed. There can be no doubt that, if the need is to be met, current facilities will be inadequate and additional beds and services will be required.