Journal of palliative medicine
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To research the children's palliative care (CPC) educational needs of health professionals in Uganda. METHODOLOGY DESIGN AND SETTING: Mixed quantitative and qualitative survey set in three hospice sites in Uganda. ⋯ There is educational need for all CPC subject areas across the board, but communication with children is the most pressing. There are disparities between recognized learning needs (technical skills predominating) and unrecognized learning needs (interpersonal and intrapersonals skills predominating). While the broad subject areas for CPC may be similar in resource-rich and resource-poor settings, educational resources developed for the specific context of African and other resource poor settings are required.
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Data collection and analysis are vital for strategic planning, quality improvement, and demonstration of palliative care program impact to hospital administrators, private funders and policymakers. Since 2000, the Center to Advance Palliative Care (CAPC) has provided technical assistance to hospitals, health systems and hospices working to start, sustain, and grow nonhospice palliative care programs. CAPC convened a consensus panel in 2008 to develop recommendations for specific clinical and customer metrics that programs should track. ⋯ Clinical metrics include: daily assessment of physical/psychological/spiritual symptoms by a symptom assessment tool; establishment of patient-centered goals of care; support to patient/family caregivers; and management of transitions across care sites. For customer metrics, consensus was reached on two domains that should be tracked to assess satisfaction: patient/family satisfaction, and referring clinician satisfaction. In an effort to ensure access to reliably high-quality palliative care data throughout the nation, hospital palliative care programs are encouraged to collect and report outcomes for each of the metric domains described here.
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While research has established that pediatric pain is undertreated, it is unclear who should have primary responsibility for its management. This study asks pediatricians who they believe should treat pain and how pain should be assessed and managed. ⋯ Our findings illustrate that pediatricians' theoretical approaches to chronic pain management are more collaborative than independent. Future research must test if pediatricians could benefit from supplemental pain education, increased emphasis on clinical guidance, and an increased awareness of hospice to be included in the pain management team for children.
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To describe the postresuscitative hospital course of emergency department patients who initially survive nontraumatic out-of-hospital cardiac arrests (OOHCA) but die in the hospital. ⋯ In this urban setting, approximately three of four OOHCA patients who are initially resuscitated do not survive to hospital discharge. This short in-hospital course post-CPR is often marked by pain and ends with the withdrawal of life support. This information may be an important component of advance planning discussions and may assist patients as they weigh the pros and cons associated with resuscitation preferences.
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We undertook a systematic review of published evidence of the effectiveness of propofol for terminal sedation. INCLUSIONS: Prospective or retrospective trials (controlled or uncontrolled) or case series of propofol for sedation in advanced incurable disease in either generalist setting or specialist palliative care units. ⋯ Four articles--all case series or case reports--reporting generally favorable reports of the use of propofol as sedation for intractable symptoms in the last days of life especially when one or more other drugs have failed. Since these four articles are essentially hypothesis-generating, the article also discusses the possibility of the design of a clinical trial to compare propofol with other drugs used in this situation.