Journal of palliative medicine
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Pediatric palliative care is a distinct specialty that requires input from pediatric and palliative medicine specialists to provide comprehensive high-quality care. Consultations undertaken early in a child's illness trajectory, when end-of-life care is not anticipated to be required, enables relationships to be established and may enhance the quality of care provided. ⋯ We have provided the first published framework from expert consensus that defines the components and principles of an early pediatric palliative care consultation. This framework will provide guidance for clinical practice as well as being useful for education and research in this area.
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In hospitals, where care is focused on cure and life prolongation, impending death is often recognized too late. Physician awareness of impending death is a prerequisite for communication with patients and relatives about dying in hospital and providing care that adequately addresses patients' needs. ⋯ In two-thirds of deaths, hospital physicians had been aware of impending death of their dying patients. Physician awareness was related with more communication and more appropriate care in the last days of life.
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Observational Study
Convenient measurement of systolic pressure: the reliability and validity of manual radial pulse pressure measurement.
It is important to assess a patient's medical condition noninvasively, particularly in hospice care settings. ⋯ Manually measuring the radial pulse pressure is reliable and can be used to indicate a systolic blood pressure of 90 mm Hg or more.
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Methadone is a useful analgesic for neuropathic and nociceptive pain. However, there is little information about the use of methadone in the final days of life when a patient cannot swallow, discouraging its use by many palliative care physicians. ⋯ The cases reviewed suggest that methadone is well tolerated and effective when switched to the buccal route in patients at the end of life on a palliative care unit.