Articles: palliative-care.
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Jt Comm J Qual Improv · Oct 1996
Cancer pain management: pilot implementation of the AHCPR guideline in Utah.
Using the Agency for Health Care Policy and Research's (AHCPR's) 1994 Clinical Practice Guideline for Management of Cancer Pain, HealthInsight, the peer review organization for Utah and Nevada, organized a cooperative project with physicians and nurses from seven acute care hospitals in Utah. The project's purpose was to adapt the guideline into action plans for participating hospitals and provide the tools necessary to address six "core" guidelines-to assess and relieve pain, educate the patient/family and health care workers, measure patient satisfaction, and provide a continuum of care postdischarge. GUIDELINE DEVELOPMENT: The guidelines were further adapted to meet the needs of the individual hospitals and were implemented in January 1995. Baseline data was collected on 10 patient records per hospital. ⋯ The project team continues to monitor progress in guideline implementation. Surveys demonstrate that, at the time of diagnosis, up to 45% of cancer patients experience moderate to severe pain; 65%-90% experience severe pain when cancer reaches the advanced stages. Unrelieved cancer pain can cause intense suffering, diminished activity, loss of appetite, and loss of sleep.
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J Pain Symptom Manage · Sep 1996
Clinical TrialAttenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone.
We have observed among patients of the Southern Community Hospice Programme that up to 25% experience acute delirium when treated with morphine and improve when the opioid is changed to oxycodone or fentanyl. This study aimed to confirm by a prospective trial that oxycodone produces less delirium than morphine in such patients. Oxycodone was administered by a continuous subcutaneous infusion, as this allowed more flexible and reliable dosing, and patients were monitored for any adverse reactions to the drug. ⋯ These results show that oxycodone administered by the subcutaneous route can provide effective analgesia without significant side effects in patients with morphine-induced delirium. This treatment allows patients to remain more comfortable and lucid in their final days. A small proportion of patients who do not metabolize oxycodone effectively may not receive this benefit.
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Br. J. Cancer Suppl. · Sep 1996
Opening doors: improving access to hospice and specialist palliative care services by members of the black and minority ethnic communities. Commentary on palliative care.
To put Council's project on improving access to hospice and specialist palliative care services by members of the black and minority ethnic communities into context, palliative care will be defined, and the scope of palliative care services currently available in the UK outlined. Palliative care is the active total care of patients whose disease no longer responds to curative treatment. ⋯ Council's project on improving access was supported by Cancer Relief Macmillan Fund and Help the Hospices as well as receiving a grant from the NHS Ethnic Minorities Unit. The report describes how the specialist palliative care services are currently provided in three areas with high minority ethnic populations and contains a series of recommendations around ethnic monitoring, equal opportunities strategies, staff training, communications and the provision of a more culturally sensitive service provision.
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J Pain Symptom Manage · Aug 1996
Catalonia WHO Demonstration Project on Palliative Care Implementation 1990-1995: results in 1995.
A global, comprehensive, publicly planned and financed program to implement palliative care was designed by the Department of Health of Catalonia (6 million inhabitants. Planned in collaboration with the cancer unit of the WHO in 1989, the program was implemented in 1990-1995. It included specific services, measures general resources, education and training, organizational and educational standards, opioid availability, legislation and evaluation. ⋯ Palliative care implementation has demonstrated efficacy in the care of the patients and families, efficiency in the provision of care, and cost-benefit in the regional global approach. It adds qualitative and organizational values to the health-care system. Its implementation must be prioritized and planned by the health administration, not only to improve the quality of care for advanced and terminal patients, but also to improve the global efficiency and appropriate use of resources in the public health system.