Journal of palliative medicine
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Comparative Study
Patterns of complementary and alternative medicine use among Turkish cancer patients.
The aim of this study was to determine the tendency to use complementary/alternative medicine (CAM) by patients with cancer in Turkey, and to compare sociodemographic and medical characteristics, perceptions, and quality of life of users and nonusers of CAM. ⋯ This study showed that CAM use is widespread among Turkish cancer patients and CAM use does not improve QLQ scores. Physicians should be aware of high CAM utilization rate in patients with cancer and should better understand the factors directing the patients to such treatments.
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Advance care planning is widely considered important for good treatment decision making. Patient values have been proposed as superior to standard living wills as guides to end-of-life (EOL) care decisions on behalf of decisionally incapacitated patients. Little research has examined whether values outperform living wills as predictors of treatment preferences. ⋯ Providing better guidance than a living will in determining a patient's EOL treatment preferences are (1) knowledge about a patient's religiosity, (2) patient's wishes for longevity, and (3) patient's wishes for following family preferences. Wishes for dignity and pain management and reluctance to burden others do not offer better guidance than a living will.
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Although the provision of hospice emergency kits (HEKs) by home hospice agencies is thought to be widespread, little is known about their use, safety, and impact. ⋯ HEKs have value as a means to alleviate many symptoms that emerge predictably in home hospice patients and may avoid unwanted hospitalizations and ED visits.
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We report the process of creating a new palliative care service at a large, urban children's hospital. Our aim was to provide a detailed guide to developing an inpatient consultation service, along with reporting on the challenges, lessons, and evaluation. ⋯ The pilot phase of service delivery laid the groundwork for a more effective service by creating documentation templates and identifying relevant data to track growth and outcomes. It also allowed time to establish a clear delineation of team members and distinction of roles. The survey of referring physicians proved a useful evaluation starting point, but conclusions could not be generalized because of the low response rate. It may be necessary to reconsider the survey technique and to expand the sample to include patients and families. Future research is needed to measure the financial benefits of a well-staffed inpatient pediatric palliative care service.
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Case Reports
Treatment with gabapentin associated with resolution of apnea in two infants with neurologic impairment.
Infants with neurologic impairment (NI) as a result of injury to the central nervous system have a significant rate of pain. Problems associated with pain in children with NI include increased tone. This secondary hypertonia may contribute to apnea as a result of alterations in airway tone and chest wall movement. Infants are at greatest risk given their smaller airways, lower functional residual capacity, and the high rate of unrecognized pain at this age. ⋯ Infants with NI and apnea should have careful pain assessment and treatment, when considering other causes and interventions for apnea.