Journal of palliative medicine
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Access to palliative care has been advocated as a human right by international associations, based on the right to the highest attainable standard of physical and mental health. It has been argued that failure to provide palliative care for patients facing severe pain could constitute cruel, inhuman, or degrading treatment. Yet the governments of many countries throughout the world have still not acknowledged a human right to access palliative care for all those who need it. The European Association for Palliative Care (EAPC), the International Association for Hospice and Palliative Care (IAHPC), and Human Rights Watch (HRW) discussed this at the EAPC congress in 2011 and formulated the Lisbon Challenge: Governments must: (1) put in place health policies that address the needs of patients with life-limiting or terminal illnesses; (2) ensure access to essential medicines, including controlled medications, to all who need them; (3) ensure that health care workers receive adequate training on palliative care and pain management at undergraduate levels; and (4) facilitate and promote the implementation of palliative care services as part of available health services.
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Previous research has reported improved pain after adding methadone to another opioid, but did not quantify this benefit using a validated outcome measure. ⋯ The addition of methadone was associated with improved pain control for patients with moderate to severe pain on another opioid and appears to offer a safe, well-tolerated and practical alternative in this situation.
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Randomized Controlled Trial Comparative Study
Repeat dose opioids may be effective for breathlessness in chronic heart failure if given for long enough.
The longer-term effects of opioids for breathlessness are not known in people with chronic heart failure (CHF). ⋯ Opioids given for 3 months were well tolerated and safe. Opioid-related improvement in breathlessness in people with CHF might not be seen until longer-term administration. We cannot conclude from these data that they are effective and a longer-term RCT is needed.
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Review Historical Article
Palliative medicine physician education in the United States: a historical review.
In this review we discuss the history of Hospice and Palliative Medicine (HPM) physician education in the United States over the last 20 years, as there has been dramatic growth in our specialty during this time. A Medline literature search was completed and we surveyed leaders in the field of HPM education regarding their experiences in promoting palliative medicine education. ⋯ A survey tool was designed and emailed to 18 educators across the country and follow-up phone interviews were done to further explore specific questions. The survey and interviews sought information about major palliative care education milestones, instrumental projects, and barriers to further development of palliative medicine education.
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It is unclear if physiologic measures are useful for assessing dyspnea. We examined the association among the subjective rating of dyspnea according to patients with advanced cancer, caregivers and nurses, and various physiologic measures. ⋯ Patients' level of dyspnea was weakly associated with physiologic measures. Caregivers' perception may be a useful surrogate for dyspnea assessment.