Journal of palliative medicine
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Comparative Study
Acceptability and preferences of six different routes of drug application for acute breathlessness: a comparison study between the United Kingdom and Germany.
Opioids are the drugs of choice for management of breathlessness in advanced disease, but acute episodic breathlessness remains difficult to manage. New routes of opioid applications with quicker onset of action seem attractive for the management of episodic breathlessness. ⋯ Inhaled was the most accepted and preferred route of application, but no route seemed to be acceptable to all patients. Therefore, individual patient preferences should be explored before drug prescription to enhance compliance and convenience.
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The experiences of people with pain under palliative care is not well documented longitudinally. This work aims to describe the prevalence, intensity, progression, and associations of self-reported pain scores of people under a community palliative care service, by retrospectively examining how routinely collected pain scores changed over time. ⋯ Even in the context of expert delivery of palliative care where pain is most likely to be optimally managed, pain continues to be a problem. Work such as this suggests that the different mechanisms that contribute to pain may influence patients' experiences even when analgesia is optimized in a specialist setting. Particular attention is needed in the future to explore the relationship between severe pain and mobility.
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Communicating with patients about goals of care is an important skill for internal medicine residents. However, many trainees are not competent to perform a code status discussion (CSD). A multimodality intervention improved skills in a group of first-year residents in 2011. How long these acquired CSD skills are retained is unknown. ⋯ CSD skills taught in a rigorous curriculum are retained at one-year follow-up. Residents in the control group did not acquire new CSD skills despite an additional year of training and clinical experience. Further study is needed to link improved CSD skills to better patient care quality.
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Unmet spiritual needs have been associated with decreased patient ratings of quality of care, satisfaction, and quality of life. Few instruments exist to measure spiritual needs particularly among non-English speaking patients in the U.S. ⋯ The Chinese SNAP is an internally consistent and reliable instrument for measuring spiritual needs. The apparent lack of correlation between the SNAP score and the question on unmet spiritual needs may suggest that the SNAP captures patient needs considered by Westerners to be spiritual but that Chinese patients might not readily describe as spiritual.