Articles: palliative-care.
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Minerva anestesiologica · Dec 2010
Review Meta AnalysisPalliative care in Italy: problem areas emerging from the literature.
The aim of this study was to review the Italian literature regarding attitudes toward palliative care in cancer patients, as well as cultural, educational and organizational problems in Italy with respect to palliative care services. The Italian literature published in the last ten years on PUBMED was reviewed. Clinical trials were excluded from this analysis, as their focus was beyond the scope of this study. ⋯ An appropriate place to die was often not guaranteed and was dependent on the availability of local resources. However, the most striking finding was that there were geographical differences in the distribution of palliative care resources. The development of a range of palliative care programs integrating primary territorial care and specialized palliative services may constitute the ideal synthesis to respond to patients' needs.
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Palliative medicine · Dec 2010
Review Meta AnalysisThe understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research.
Spirituality and spiritual care are gaining increasing attention but their potential contribution to palliative care remains unclear. The aim of this study was to synthesize qualitative literature on spirituality and spiritual care at the end of life using a systematic ('meta-study') review. Eleven patient articles and eight with healthcare providers were included, incorporating data from 178 patients and 116 healthcare providers, mainly from elderly White and Judaeo-Christian origin patients with cancer. ⋯ Relationships formed an integral part of spirituality as they were a spiritual need, caused spiritual distress when broken and were the way spiritual care was given. Barriers to spiritual care include lack of time, personal, cultural or institutional factors, and professional educational needs. By addressing these, we may make an important contribution to the improvement of patient care towards the end of life.
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J Pain Palliat Care Pharmacother · Sep 2010
Meta AnalysisEfficacy of the sustained-release hydromorphone in neuropathic pain management: pooled analysis of three open-label studies.
This pooled analysis was designed to determine whether the analgesic response to treatment with OROS hydromorphone, as measured by the "pain on average" scale of the Brief Pain Inventory (BPI), was different in patients with neuropathic pain compared to those with nociceptive pain, after adjusting for differences in baseline characteristics. Three open-label studies on patients with neuropathic and nociceptive malignant and nonmalignant chronic pain were analyzed. A mixed model for repeated measures linear regression analysis was used to compare the effect of OROS hydromorphone on patients with neuropathic and nociceptive pain, adjusting for potentially confounding factors. ⋯ For some outcome variables, treatment was more effective for patients with neuropathic pain. The treatment was generally well tolerated. This pooled analysis shows that treatment with OROS hydromorphone had similar efficacy for neuropathic and nociceptive pain.
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Palliative medicine · Jun 2010
Review Meta AnalysisPrimary thromboprophylaxis in the palliative care setting: a qualitative systematic review.
Symptomatic venous thromboembolism (VTE) occurs in 15% of patients with advanced malignancy. Primary thromboprophylaxis using low-molecular-weight heparin (LMWH) is supported by Level 1A evidence but is under-utilized in the palliative setting. A systematic search was performed of Medline, Cochrane Library, EMBASE, AMED, and Web of Science for papers published between 1960 and January 2010 using search terms: 'palliative', 'thromboprophylaxis', 'thromboembolism', 'heparin', and 'advanced cancer'. ⋯ Reluctance to prescribe LMWH is based on physicians' concerns regarding negative impact on quality of life, and lack of evidence specific to the palliative care setting. In conclusion, LMWH prophylaxis should be implemented in patients with a previously good performance status who have a transiently increased risk of VTE and no contraindications. Further research is required using outcome measures specific to palliative care.
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Cochrane Db Syst Rev · May 2010
Review Meta AnalysisChemotherapy and supportive care versus supportive care alone for advanced non-small cell lung cancer.
Since our individual patient data (IPD) meta-analysis of supportive care and chemotherapy for non-small cell lung cancer (NSCLC), published in 1995, many trials have been completed. We have carried out an updated IPD meta-analysis to assess newer regimens and determine conclusively the effect of chemotherapy. ⋯ All trials were of good methodological quality with no risk of bias. This meta-analysis of chemotherapy in the supportive care setting demonstrates that chemotherapy improves overall survival in all patients with advanced NSCLC. Patients who are fit enough and wish to receive it should be offered chemotherapy.