Tuesday 30 December 2008

International Journal of Palliative Nursing 2008 Vol 14 Part 11

Link to journal online
Palliative care in changing economic times
Ling , J .
Page: 523-525

I can not get a breath : experiences of living with advanced chronic obstructive disease
Hasson , F . ; Spence , A . ; Waldron , M et al
Page: 526-531

Norwegian nurses' thoughts and feelings regarding the ethics of palliative sedation
Gran , S . V . ; Miller , J
Page: 532-538

Spiritual care as a dimension of holistic care : a relational interpretation
Bush , T . ; Bruni , N
Page: 539-545

Patient perspective : what do palliative care patients think about their care ?
Conner , A . ; Allport , S . ; Dixon , J . ; Somerville , A . - M .
Page: 546-553

Involving and engaging patients in cancer and palliative care research : workshop presentation
Johnston , B . ; Forbat , L . ; Hubbard , G .
Page: 554-559

The impact of a modular HIV / AIDS palliative care education programme in rural Uganda
Downing , J . ; Kawuma , E
Page: 560-570

Progress in Palliative Care 2008 Vol 16 Part 5 / 6

Why should palliative care clinicians learn about heart failure ?
Goodlin , S . J .
Page: 215-219

Referral for palliative care in advanced heart failure
Albert , N . M .
Page: 220-228

Medical management of advanced heart failure
Rocchiccioli , P . ; McMurray , J
Page: 229-240

Palliative symptom management in patients with heart failure
Zambroski , C . H . ; Bekelman , D B .
Page: 241-249

The management of implantable cardiac devices at the end of life
Kirkpatrick , J . N . ; Knight , B P .
Page: 250-256

Spirituality and suffering of patients with heart failure
Westlake , C . ; Dyo , M . ; Vollman , M . ; Heywood , J . T .
Page: 257-266

Quantity and Level of Evidence of Palliative and Hospice Care Literature

Changes in the Quantity and Level of Evidence of Palliative and Hospice Care Literature : The Last Century
Jennifer Tieman
Journal of Clinical Oncology
Page: 5679 - 5683
VOL 26 ; PART 35 2008-December-10

Palliative care service provision for COPD patients

Palliative care service provision for COPD patients - results from the 2008 National COPD Audit
Buxton , K . L . ; Roberts , C . M ; Buckingham , R . J . ; Pursey , N . ; Stone , R . A .
Thorax
Page: S27
2008 ; VOL 63 ; SUPP / 7

Why Palliative Care Matters

Why Palliative Care Matters to patients and to your bottom line
Meier , D . E .
H and Hn ( Formerly : Hospitals and Health Networks ) EBSCO ( CINAHL with Full Text ) - via Athens
Page: 16-19
2008 VOL 82 ; PART 11

Nurses' knowledge of a palliative approach in residential aged care

A study of nurses' knowledge of a palliative approach in residential aged care facilities
Ronaldson , S . ; Hayes , L . ; Carey , M . ; Aggar , C .
International Journal of Older People Nursing ( Originally A Supplement To Journal of Clinical Nursing )
Page: 258-267
VOL 3 ; PART 4 Date: 2008/12/01

Developing leadership in rural interprofessional palliative care teams

Developing leadership in rural interprofessional palliative care teams
Hall , P . ; Weaver , L . ; Handfield - Jones , R . ; Bouvette , M .
Journal of Interprofessional Care
Page: 73-79
2008 ; VOL 22 ; SUPP / 1

Singapore Nursing Journal 2008 VOL 35 PART 4

Palliative Care Nursing Education In Singapore ( 1999 - 2008 )
Hong , P . W . ; O Connor , M . ; Leng , C . Y . ; Kannusamy , P .
EBSCO ( CINAHL with Full Text ) - via Athens
Page: 5-9

Palliative Care Nurses Chapter
EBSCO ( CINAHL with Full Text ) - via Athens
Page: 34-36

Archives of Pediatrics & Adolescent Medicine

Theme Issue on Palliative Care , Dying and Bereavement - call for papers
Page: 1188 - 1188
2008 VOL 162 ; PART 12 December
The Archives will publish a "rolling theme issue" this year on palliative care, dying, and bereavement. We are interested in original articles, narrative and systematic reviews, and commentaries that will add to the scientific knowledge about these topics. Such articles might include observational longitudinal studies such as the effects of loss of a family member on children and adolescents; clinical trials examining specific interventions or evaluating different systems of delivering palliative, hospice, or bereavement care; and ethical analyses regarding how we decide on and enact the goals and limits of medical therapy.

Monday 1 December 2008

Delivering Quality Palliative and End of Life Care Services for Children and Young People

I enclose an invitation to our forthcoming Westminster Briefing entitled "Delivering Quality Palliative and End of Life Care Services for Children and Young People" which will be hosted by The House Magazine on Wednesday, 25th February 2009 to be held in Westminster.
When people think of palliative and end of life care the common assumption is made that services are designed and oriented towards adults. However, according to The Association for Children with Life-Threatening or Terminal Conditions and their Families (ACT) at least 15,000 children require palliative care in the UK. Whilst it is acknowledged that some parallels can be drawn between the principles applying to end of life care services for adults and those for children and young people, there are also significant and unique differences. The children's palliative care strategy, Better Care: Better Lives , was launched to address these distinctive distinctions and improve outcomes and experiences for all children and young people with life-limiting and life-threatening conditions. While the death of any single person can be traumatic, a child's death remains emotionally difficult, unnatural and unexpected for families and healthcare providers alike.
Delegates at this Westminster Briefing will have the opportunity to consider the progress of the children's palliative and end of life care strategy and discuss what more needs to be done to ensure its aims are achieved. Participants will also examine case studies and examples of best practice concerning the delivery of children's palliative care and discuss how these successful models can be disseminated more widely.
Please click here for further details.


A Qualitative Report of Dual Palliative Care / Ethics Consultations

A Qualitative Report of Dual Palliative Care / Ethics Consultations : Intersecting Dilemmas and Paradigmatic Cases
Childers , J . W . ; Demme , R . ; Greenlaw , J . ; King , D . A . ; Quill , T .
Journal of Clinical Ethics
Page: 204-213
2008 ; VOL 19 ; PART 3

Setting up home - based palliative care

Setting up home - based palliative care in countries with limited resources : a model from Sarawak , Malaysia
B . C . R . Devi
Annals of Oncology
Page: 2061 - 2066
2008 ; VOL 19 ; PART 12 Date: 2008-December

ACP Releases Recommendations for Palliative Care at the End of Life

ACP Releases Recommendations for Palliative Care at the End of Life
American Family Physician
Page: 1093-1096
2008 ; VOL 78 ; PART 9

Journal of Advanced Nursing Vol 64 Issue 6 2008.

Next-of-kin caregivers in palliative home care – from control to loss of control
Berit Munck, Bengt Fridlund, Jan Mσrtensson
Pages: 578-586
http://www3.interscience.wiley.com/cgi-bin/abstract/121431365/ABSTRACT
Published Online: 7 Oct 2008

A study of nurses` knowledge of a palliative approach in residential aged care facilities

A study of nurses` knowledge of a palliative approach in residential aged care facilities
Ronaldson , Susan ; Hayes , Lillian ; Carey , Michele ; Aggar , Christina
International Journal of Older People Nursing
Page: 258-267
2008 ; VOL 3 ; PART 4 Date: 2008/12/01

Neurocritical Care 2008 Vol 9 Supplement

A Survey of Neuroscience ICU Nursing Attitudes Towards Palliative Care Consults
Warford , K .
Neurocritical Care
Page: 52 Vol/Issue: 2008 ; Volume 9 ; SUPP

The use of narcotics and benzodiazepines during palliative care in a neurological intensive care unit
Rives , J .
Neurocritical Care
Page: 54 Vol/Issue: 2008 ; Volume 9 ; SUPP

Cancer : Palliative Care in the Primary Care Setting

Cancer : Palliative Care in the Primary Care Setting
Geriatrics and Aging
Page: 506-508
2008 ; VOL 11 ; PART 9

A prospective study of unmet activity of daily living needs in palliative care inpatients

A prospective study of unmet activity of daily living needs in palliative care inpatients
Lalitha Jeyasingam ; Meera Agar ; Michael Soares ; John Plummer ; David Currow
Australian Occupational Therapy Journal
Page: 266-272
2008 ; VOL 55 ; PART 4 Date: December 2008

DNR Does Not Mean DNRx

DNR Does Not Mean DNRx : How Palliative Care Can Help Facilitate Communication about Goals of Care in Advanced Illness
Smith , C . B . ; Bunch , L
Mount Sinai Journal of Medicine
Page: 460-465 Vol/Issue: 2008 ; VOL 75 ; PART 5

BMC Palliative Care

www.biomedcentral.com/bmcpalliatcare/
General Practitioners' use and experiences of palliative care services: a survey in South East England.
Sabrina Bajwah, Irene J Higginson
BMC Palliative Care 2008, 7:18 (5 November 2008)
Provisional PDF http://www.biomedcentral.com/content/pdf/1472-684X-7-18.pdf

A randomized, double-blind comparison of OROS hydromorphone and controlled-release morphine for the control of chronic cancer pain
Magdi Hanna, John Thipphawong, 118 Study group
BMC Palliative Care 2008, 7:17 (31 October 2008)
Provisional PDF http://www.biomedcentral.com/content/pdf/1472-684X-7-17.pdf

Monday 17 November 2008

General Practitioners' use and experiences of palliative care services

General Practitioners' use and experiences of palliative care services : a survey in South East England
Sabrina Bajwah and Irene J Higginson
Bmc Palliative Care BioMed Central PDF Abstract
Page: 18 2008 Vol 7 Date: 2008-01-15

Why palliative care ?

Why palliative care ?
Richardson , A .
British Journal of General Practice [print copy in the Library]
Page: 809 2008 Vol 58 Part 556

International Journal of Palliative Nursing 2008 Vol 14 Part 10

Link to journal online
Attitudes to death and dying in China
Becker , R .
Page: 471 Vol/Issue: 2008 ; VOL 14 ; PART 10
The relevance of time in palliative nursing practice
Dalgaard , K . M . ; Delmar , C
Page: 472-477 Vol/Issue: 2008 ; VOL 14 ; PART 10
An inner struggle for hope : insights from the diaries of bereaved caregivers
Holtslander , L . ; Duggleby , W
Page: 478-484 Vol/Issue: 2008 ; VOL 14 ; PART 10
Artificial hydration : the role of the nurse in addressing patient and family needs
Schmidlin , E .
Page: 485-491 Vol/Issue: 2008 ; VOL 14 ; PART 10
Intuition in clinical decision - making : a psychological penumbra
Nyatanga , B . ; de Vocht , H
Page: 492-496 Vol/Issue: 2008 ; VOL 14 ; PART 10
Learn now ; live well : an educational programme for caregivers
White , K . ; D Abrew , N . ; Auret , K . ; Graham , N . ; Duggan , G .
Page: 497-501 Vol/Issue: 2008 ; VOL 14 ; PART 10
Development and evaluation of a Nursing Assistant Computerized Education Programme
Ersek , M . ; Wood , B . B
Page: 502-509 Vol/Issue: 2008 ; VOL 14 ; PART 10
Evaluating the care of patients with malignant spinal cord compression at a regional cancer centre
Warnock , C . ; Cafferty , C . ; Hodson , S . ; Kirkham , E . ; Osguthorpe , C . ; Siddall , J .
Page: 510-516 Vol/Issue: 2008 ; VOL 14 ; PART 10

Friday 14 November 2008

End of Life Care Strategy: quality markers consultation

End of Life Care Strategy: quality markers consultation
The DH has launched this consultation on quality markers for end of life care, as promised in the End of Life Care Strategy published in July. This document has been developed with help from the SHA Pathway Chairs for the NHS Next Stage Review, who identified the need for a national approach in order to raise the quality of care for people at the end of life. The document is aimed at commissioners, performance managers and providers of end of life care services, from the NHS, voluntary and independent sectors. (DH - publications)

Inoperable esophageal cancer and outcome of palliative care

Inoperable esophageal cancer and outcome of palliative care
Besharat S . ; Jabbari A . ; Semnani S . ; Keshtkar A . ; Marjani J .
World Journal of Gastroenterology
Page: 3725-3728 2008 Vol 14 Part 23

Palliative care

Palliative care
Annals of Oncology
Page: viii254-viii258
2008 VOL 19 SUPP / 8

Call for papers - paediatric care

Theme Issue on Palliative Care , Dying and Bereavement Call for papers
Archives of Pediatrics and Adolescent Medicine
Page: 1098
Vol 162 ; Part 11 Date: 2008-November
The Archives will publish a "rolling theme issue" this year on palliative care, dying, and bereavement. We are interested in original articles, narrative and systematic reviews, and commentaries that will add to the scientific knowledge about these topics. Such articles might include observational longitudinal studies such as the effects of loss of a family member on children and adolescents; clinical trials examining specific interventions or evaluating different systems of delivering palliative, hospice, or bereavement care; and ethical analyses regarding how we decide on and enact the goals and limits of medical therapy.
Our intent is to bring these issues to the forefront of pediatrics and adolescent medicine, just as they are in the minds of those children and families who are confronted with such loss. We hope the attention of the Archives will advance science and provide help to the physicians dealing with these issues on behalf of their patients and families.
This call for papers will be an ongoing one, and we intend to publish articles on this topic throughout the year as the manuscripts are submitted and accepted. For specific guidelines on manuscript preparation and submission, please consult the author instructions on our Web site at http://www.archpediatrics.com/. Authors should indicate in their cover letter that the manuscript is to be considered for this theme.

Palliative care A patient - centered approach

Palliative care A patient - centered approach
Glare , P . A .
Medical Journal of Australia , The
Page: 400 2008 Vol 189 Part 7

Changes in Physical Function After Palliative Surgery for Metastatic Spinal Tumor

Link to journal
Yamashita, Takayuki ; Aota, Yoichi ; Kushida, Kazuyoshi ; Murayama, Hitoshi et al
Changes in Physical Function After Palliative Surgery for Metastatic Spinal Tumor: Association of the Revised Tokuhashi Score With Neurologic Recovery
Spine. 33(21):2341-2346, October 1, 2008.
Abstract
Study Design. A retrospective study of patients undergoing palliative surgery for metastatic spinal tumors.Objective. To investigate short-term functional recovery and duration of improvement after palliative surgery, to correlate these outcomes with the revised Tokuhashi score, and to examine the relationship between function and neurologic deterioration.Summary of Background Data. The revised Tokuhashi score is a scoring system used to predict life expectancy for patients with metastatic spinal tumors. The relationship between the revised Tokuhashi score and physical functional improvement after palliative surgery has not been examined previously.Methods. The clinical charts of 86 patients were reviewed. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was used to assess physical function. Each score was documented before surgery and at every month after surgery. The duration of ECOG-PS improvement, defined as the period between surgery and deterioration to the preoperative ECOG-PS grade, was correlated with the revised Tokuhashi score.Results. The ECOG-PS grade improved in 44 (51.1%) patients at 1 month postoperative. When ECOG-PS improvement was found after surgery, it persisted above the preoperative level for an average of 9.3 months. At 1 month postoperative, patients scoring 0 to 8 on the total revised Tokuhashi score had significantly lower ECOG-PS improvement (26 of 55 patients) when compared to patients with higher scores (18 of 27 patients, P <>

Balancing Palliative and Restorative Care Delivery

A New Model for Long - Term Care : Balancing Palliative and Restorative Care Delivery
Thompson , S . ; Oliver , D . P
Journal of Housing for the Elderly 2008 Vol 22 Part 3
Page: 169-194

Pharmaceutical Journal articles

Palliative care should not be forgotten
Pharmaceutical Journal
Page: B40 2008 ; Vol 281 ; Part 7523 ; Supp


UniChem Convention Palliative Care Pharmacists Network
Pharmaceutical Journal
Page: 451-451 2008 Vol 281 Part 7525

Journal of Hospice and Palliative Nursing Vol 10 Part 5 2008

I'll Always Want More : Complex Issues in HIV Palliative Care
Morgan , B . D . ; Kochan , K . A
Page: 265-271
What Are the Potential Factors That Sustain Registered Nurses Who Provide Home - Based Palliative and End - of - Life Care ?
Penz , K .
Page: 295-303
Modes of Participation in the Implementation of an Integrated Palliative Care Network : Viewpoints of the Stakeholders Involved
Morin , D . ; Saint - Laurent , L ; Bresse , M . - P . ; Fillion , L . ; Dallaire , C .
Page: 313-324
Palliative care and the trauma patient.
Cooper Z
page: 262-4

Pain management in palliative care oncology patients

Pain management in palliative care oncology patients
Gavrin , Jonathan ; McMenamin , Erin
Current Pain and Headache Reports
Page: 257-261 Vol 12 ; Part 4 Date: 2008/08/01

Promoting patient - centredness in undergraduate palliative care education

Really good stuff : Promoting patient - centredness in undergraduate palliative care education
Linklater , Gordon T
Medical Education Page: 1126-1127 2008 ; Vol 42 Part 11 Date November 2008

Monday 27 October 2008

Palliative care for people with dementia

Palliative care for people with dementia
Willis , S . ; Makaza , M
Mental Health Practice Page: 26-29 2008 Vol 12 Part 2

Perception of Palliative Care and Euthanasia

Perception of Palliative Care and Euthanasia Among Recently Graduated and Experienced Nurses
Tomasz Brzostek
Nursing Ethics
Page: 761 - 776 VOL 15 PART 6 2008-November

Evaluating education in palliative care with link nurses in nursing homes

Evaluating education in palliative care with link nurses in nursing homes
Waldron , M . ; Hasson , F . I . ; Kernohan , W . G . ; Whittaker , E . ; McClaughlin , D .
British Journal of Nursing
Page: 1078-1083 2008 ; VOL 17 ; PART 17


Valuing local diversity in palliative care : translating the concept
Quinn , S . ; Hickey , D
British Journal of Nursing
Page: 1084-1087 2008 ; VOL 17 ; PART 17

Promoting patient - centredness in undergraduate palliative care education

Promoting patient - centredness in undergraduate palliative care education
Gordon T Linklater
Medical Education Vol 42 ; Part 11 Date: November 2008
Page: 1126-1127

Progress in palliative care Vol 16 Part 4 2008

Gatekeeping from palliative care research trials
White , C . ; Hardy , J
Page: 167-172

Online resources in palliative care
Rosielle , D . A .
Page: 173-178

Tuesday 21 October 2008

International Journal of Palliative Nursing 2008 Vol 14 Part 9

Link to journal online

Diversity and dilemmas in palliative care nursing
Costello , J .
Page: 419

Pathways in end - of - life care for older people : care managers' reasoning
Osterlind , J . ; Hansebo , G . ; Lantz , G . ; Ternestedt , B . - M .
Page: 420-425

Perceptions of the use of a remote monitoring system in patients receiving palliative care at home
McCall , K . ; Keen , J . ; Farrer , K . ; Maguire , R . et al
Page: 426-431

Nurses' decision - making in pressure care management in the last 48 hours of life
Searle , C . ; McInerney , F
Page: 432-438

Health - promoting conversations about hope and suffering with couples in palliative care
Benzein , E . G . ; Saveman , B . - I .
Page: 439-447

The concept of spirituality in palliative care : an alternative view
Paley , J .
Page: 448-453

Renal failure and specialist palliative care : an assessment of current referral practice
McKeown , A . ; Agar , R . ; Gambles , M . ; Ellershaw , J . E . ; Hugel , H .
Page: 454-458

The conception of the Nankya model of palliative care development in Africa
Downing , J .
Page: 459-466

Differences in home-based palliative care service utilisation

Journal of Clinical Nursing
Volume 17, Issue 11c, 2008.
Pages: 429-435
Differences in home-based palliative care service utilisation of people with cancer and non-cancer conditions
Debbie Kralik, Barbara Anderson

Palliative care link nurse role in nursing homes

Journal of Advanced Nursing
Volume 64, Issue 3, 2008
Pages: 233-242
The palliative care link nurse role in nursing homes: barriers and facilitators
Felicity Hasson, W. George Kernohan, Mary Waldron, Evelyn Whittaker, Dorry mclaughlin

Palliative Care Files : Management of hope

Palliative Care Files : Management of hope
Woelk , C . J .
Canadian Family Physician 2008 Vol 54 Sep
Page: 1243-1244

Theme Issue on Palliative Care , Dying & Bereavement

Theme Issue on Palliative Care , Dying , and Bereavement
Archives of Pediatrics and Adolescent Medicine
Page: 968 - 968 Vol 162 ; Part 10 2008-October

Caregivers' active role in palliative home care

Caregivers' active role in palliative home care - to encourage or to dissuade ? A qualitative descriptive study
Anna Weibull ; Frede Olesen and Mette Asbjoern Neergaard
Bmc Palliative Care Page: 15 2008 ; Vol 7 Date: 2008-01-15
BioMed Central PDF Abstract
Page: 15 2008 ; Vol 7 Date: 2008-01-15

Cardiology : palliative care

Cardiology : palliative care
Nazarko , L .
Nursing and Residential Care EBSCO ( CINAHL with Full Text ) - via Athens Full Text
Page: 494-497
2008 ; VOL 10 ; PART 10

Rethinking palliative care . A social role valorisation approach

Rethinking palliative care . A social role valorisation approach
Rosenberg , John
Mortality 2008 Vol 13 Part 4 2008/11/01
Page: 366-367

Dying with dignity

Dying with dignity
Nursing Standard EBSCO ( CINAHL with Full Text ) - via Athens 2008 VOL 23 PART 2
Page: 26-27

End-of-Life Services for Pediatric Oncology Patients

Availability and Use of Palliative Care and End-of-Life Services for Pediatric Oncology Patients
Donna L . Johnston
Journal of Clinical Oncology 2008 Vol 26 ; Part 28 October-1
Page: 4646 - 4650

Finding the Right Words

Finding the Right Words : Using the Terms Allow Natural Death ( AND ) and Do Not Resuscitate ( DNR ) in Pediatric Palliative Care
Journal for Healthcare Quality 2008 Vol 30 ; Part 5
Page: 55-63

Illegal practice by prescribers

Illegal practice by prescribers in palliative care to be ignored
The Pharmaceutical Journal
Page: 291 2008 VOL 281 PART 7519

BMJ 2008 Vol 337 Oct 10

Sickle cell disease - palliative care [letter]
Cate Seton - Jones
Page: a1876 - a1876

Tuesday 30 September 2008

Is the qualitative research interview an acceptable medium for research with palliative care patients and carers ?

Is the qualitative research interview an acceptable medium for research with palliative care patients and carers ?
Marjolein Gysels ; Cathy Shipman and Irene J Higginson
Bmc Medical Ethics PDF Abstract
Page: 7 2008 ; VOL 9 Date: 2008-01-24

Palliative and end - of - life care for patients with severe COPD

Palliative and end - of - life care for patients with severe COPD
Curtis , J . R .
European Respiratory Journal 2008 ; VOL 32 ; PART 3
Page: 796-803

Improving palliative care in Africa

Improving palliative care in Africa
Richard A Powell
BMJ Vol/Issue: 2008 ; VOL 337 ; PART sep23_2
a1566 - a1566

Bad Image of Morphine

Majority of People Have a Bad Image of Morphine Palliative Care Survey
Pharma
Page: 18 Vol/Issue: 2008 ; PART 2101

Caregivers active role in palliative home care

Caregivers active role in palliative home care to encourage or to dissuade A qualitative descriptive study
Anna Weibull ; Frede Olesen and Mette Asbjoern Neergaard
BMC Palliative Care
PDF Abstract
Page: 15 Vol/Issue: 2008 ; VOL 7 Date: 2008-01-15

Palliative care

Palliative care
Annals of Oncology VOL 19 ; PART suppl_8 Date: 2008-September
Page: viii254 - viii258

Ultrasonography ... for Ganglion Impar Neurolysis in Perianal Cancer Pain

Link to journal
Gupta, Deepak; Jain, Roopesh; Mishra, Seema; Kumar, Santosh et al
Ultrasonography Reinvents the Originally Described Technique for Ganglion Impar Neurolysis in Perianal Cancer Pain
Anesthesia & Analgesia. 107(4):1390-1392, October 2008.
Abstract
Visceral pain in the perineal area associated with malignancies may be effectively treated with neurolysis of the ganglion impar. Since the first description of the technique of accessing the ganglion impar through anococcygeal ligament, many techniques for ganglion impar block have been described. We present a patient diagnosed with carcinoma of the anal canal who was successfully given ultrasound-guided ganglion impar block using a Chiba needle inserted through the anococcygeal ligament. In summary, ultrasound-guided ganglion impar neurolysis is a fast, safe, and cost-effective method, which can be used as a first-line pain relief intervention for good quality of life in patients with perianal cancers.

Spiritual Issues as an Essential Element of Quality Palliative Care

Spiritual Issues as an Essential Element of Quality Palliative Care : A Commentary Puchalski , C . M .
Journal of Clinical Ethics
Page: 160-162 Vol/Issue: 2008 ; VOL 19 ; PART 2

Cost Savings Associated With US Hospital Palliative Care

Cost Savings Associated With US Hospital Palliative Care Consultation Programs
R . Sean Morrison
Archives of internal medicine VOL 168 ; PART 16 Date: 2008-September-8
Page: 1783 - 1790

Scottish palliative care needs better access

Scottish palliative care needs better access
Pharmaceutical Journal 2008 ; VOL 281 ; PART 7516
Free Medical Journals . com
Page: 207

International Journal of Palliative Nursing Vol.14 No.8 2008

Link to journal online
Meeting the spiritual needs of palliative care patients
Smyth , D .
Page: 367

Active carers : living with COPD in the family
Spence , A . ; Hasson , F . ; Waldron , M . ; Kernohan , G . et al
Page: 368-373

Staff opinions of a good death in long - term care
Gibson , M . C . ; Gutmanis , I . ; Clarke , H . ; Wiltshire , D .
Page: 374-381

Addressing the needs of patients with advanced non - malignant disease in a hospice day care setting
Cochrane , E . ; Colville , E . ; Conway , R .
Page: 382-389

Lay caregivers' perspectives on the use of subcutaneous medications in patients at home
Israel , F . ; Reymond , L . ; Slade , G . ; Menadue , S . ; Charles , M . A .
Page: 390-395

Catching the concept of spiritual care : implementing an education programme
Hickey , D . ; Doyle , C . ; Quinn , S . ; O Driscoll , P . et al
Page: 396-401

The use of biographies and stories in paediatric palliative care
McNeilly , P . ; Read , S . ; Price , J .
Page: 402-407

Theories of hope : are they relevant to palliative care nurses ?
Penz , K .
Page: 408-412

Wednesday 17 September 2008

Reactions of primary caregivers of frail older people and people with cancer in the palliative phase living at home

Pages: 576-585
Reactions of primary caregivers of frail older people and people with cancer in the palliative phase living at home
Ellen Karine Grov, Marthe Lyngσs Eklund
Journal of Advanced Nursing Vol 63 No 6
ABSTRACT
Aim. This paper is a report of a study conducted to (1) compare means of the single items and the dimensions of the Caregiver Reaction Assessment among caregivers of frail older people and caregivers of cancer patients in the palliative phase; (2) examine gender differences for the scoring parameters in the Caregiver Reaction Assessment within each group and (3) examine the demographic variables' association with the caregiver groups' scores for the dimensions of the Caregiver Reaction Assessment.
Background. Limited research has focused on the caregiver situation in the home-care setting among primary caregivers of frail older people, and caregivers of patients with cancer in the palliative phase.
Methods. A convenience sample of 224 caregivers of frail older people, and 85 caregivers of patients with cancer in the palliative phase was recruited between 2002 and 2005. We used the Caregiver Reaction Assessment to collect the data.
Results. The mean scores for the Caregiver Reaction Assessment dimensions showed statistically significant differences between the two groups of caregivers for the factors self-esteem, family support, finances and health. For caregivers of frail older people, we found statistically significant associations between several demographic variables and the Caregiver Reaction Assessment dimensions. For caregivers of patients with cancer in the palliative phase, age was the only demographic variable that was statistically significantly associated with the dimensions.
Conclusion. Healthcare personnel should pay attention to how relatives experience their caregiver situation, and the Caregiver Reaction Assessment could be a valuable tool for gathering systematic data on this.

A retrospective audit exploring the use of relaxation as an intervention in oncology and palliative care

A retrospective audit exploring the use of relaxation as an intervention in oncology and palliative care
MILLER , J . ; HOPKINSON , C .
European Journal of Cancer Care VOL 17 ; PART 5 (September 2008)
p. 488-491

BMJ 2008 ; VOL 337 ; PART Aug 26

Palliative care in Scotland is too focused on cancer, says national report
Adrian O`Dowd
2008 ; VOL 337 ; PART aug26_1
Page: a1428 - a1428

Wednesday 27 August 2008

BMJ Learning modules on palliative care

Here are the most popular modules on palliative care for you to complete.
You can gain a special certificate to those of you who complete them all.
The role of opioids in cancer pain: an up to date guide
Breaking bad news to patients and relatives
Patients with recurrences of cancer: a guide to diagnosis and management
Drug treatment of nausea and vomiting related to cancer

Emergency calls and need for emergency care in patients looked after by a palliative care team

Emergency calls and need for emergency care in patients looked after by a palliative care team: Retrospective interview study with bereaved relatives
Christoph H . R . Wiese ; Andrea Vossen - Wellmann ; Hannah C . Morgenthal et al
2008 ; VOL 7 (2008-01-15)
Bmc Palliative Care From BioMed Central [PDF]
Page: 11

Seven Years and 50 Courses Later : End -of - Life Nursing Education

Seven Years and 50 Courses Later : End - of - Life Nursing Education Consortium Continues Commitment to Provide Excellent Palliative Care Education
Malloy , P . ; Virani , R . ; Kelly , K . ; Harrington - Jacobs , H . ; Ferrell , B
Journal of Hospice and Palliative Nursing 2008 ; VOL 10 ; PART 4
Page: 233-239

Alternative and Complementary Medicine Internet Resources for Palliative Care

Alternative and Complementary Medicine Internet Resources for Palliative Care
Hartmann , R . J
Journal of Consumer Health on the Internet 2008 ; VOL 12 ; PART 2
Page: 163-168

Palliative Care for Nursing Home Residents With Dementia at End of Life

Meaning and Practice of Palliative Care for Nursing Home Residents With Dementia at End of Life
Powers , Bethel ; Watson , Nancy
2008 ; VOL 23 ; PART 4 (2008/08/01)
American Journal of Alzheimer's Disease and Other Dementias
Page: 319-325

Journal of Clinical Oncology VOL 26 ; PART 23 (2008-August-10)

Is It Feasible and Desirable to Collect Voluntarily Quality and Outcome Data Nationally in Palliative Oncology Care ?
David C . Currow
Page: 3853 - 3859

Symptom Assessment in Palliative Care : A Need for International Collaboration
Stein Kaasa
Page: 3867 - 3873

Improving district nurses` confidence and knowledge in the principles and practice of palliative care

Improving district nurses` confidence and knowledge in the principles and practice of palliative care
Shipman , Cathy ; Burt , Jenni ; Ream , Emma ; Beynon , Teresa et al
Journal of Advanced Nursing 2008 ; VOL 63 ; PART 5 (2008/09/01)
Page: 494-505

International Journal of Palliative Nursing 2008 ; VOL 14 ; PART 7

Link to journal online
Cultural competence: a noble idea in a changing world
Author(s): Nyatanga , B
ISSUE: 2008 ; VOL 14 ; PART 7
Page: 315
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Anticipatory mourning: processes of expected loss in palliative care
Clukey , L
Page: 316-325
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Getting it right under pressure: action research and reflection in palliative nursing
Taylor , B . ; Bewley , J . ; Bulmer , B . ; Fayers , L . ; Hickey , A . et al
Page: 326-333
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Open all hours: a qualitative exploration of open visiting in a hospice
Cooper , L . ; Gray , H . ; Adam , J . ; Brown , D . ; McLaughlin , P . ; Watson , J
Page: 334-341
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`A voyage of grief and beauty': supporting a dying family member with an intellectual disability
Marlow , S . ; Martin , M .
Page: 342-349
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Palliative care nurse consultants in Melbourne: a snapshot of their clinical role
Author(s): O Connor , M . ; Peters , L . ; Walsh , K .
Page: 350-355
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Exploring the concepts behind truth-telling in palliative care
Shaw , S
Page: 356-360

Integrating Palliative Care in Severe Chronic Obstructive Lung Disease

Integrating Palliative Care in Severe Chronic Obstructive Lung Disease
Hardin , Kimberly ; Meyers , Frederick ; Louie , Samuel
2008 ; VOL 5 ; PART 4 (2008/08/01)
Copd : Journal of Chronic Obstructive Pulmonary Disease
Page: 207-220

Progress in Palliative Care 2008 ; VOL 16 ; PART 3

Accuracy of clinical prediction of survival in a palliative care unit
Lam , P . T
Page: 113-118

Assessment of palliative care needs for people living with HIV / AIDS in Rwanda
Uwimana , J . ; Struthers , P .
Page: 119-128

Theme Issue on Palliative Care, Dying, and Bereavement

Theme Issue on Palliative Care, Dying, and Bereavement
VOL 162 ; PART 8 (2008-August)
Archives of Pediatrics and Adolescent Medicine
Page: 768 - 768
Call for Papers: Palliative Care, Dying, and Bereavement
Frederick P . Rivara
VOL 162 ; PART 8 (2008-August) :
Archives of Pediatrics and Adolescent Medicine
Page: 789 - 789

Ethical dilemmas in palliative care in traditional developing societies

Ethical dilemmas in palliative care in traditional developing societies, with special reference to the Indian setting
S K Chaturvedi
VOL 34 ; PART 8 (2008-August)
Journal of Medical Ethics Page: 611 - 615

Preschool As Palliative Care

Preschool As Palliative Care
Mary Elizabeth Ross
Journal of Clinical Oncology VOL 26 ; PART 22 (2008-August-1)
Page: 3797 - 3799

Integrating Palliative Medicine into the Care of Persons with Advanced Dementia

Integrating Palliative Medicine into the Care of Persons with Advanced Dementia : Identifying Appropriate Medication Use
Holly M . Holmes ; Greg A . Sachs ; Joseph W . Shega et al
ISSUE: 2008 ; VOL 56 ; PART 7 (July 2008)
Journal of the American Geriatrics Society 2008 ; VOL 56 ; PART 7 (July 2008)
Page: 1306-1311

BMJ 2008 ; VOL 337 ; 29 July

Life saving treatment for a "palliative care" patient
Jane Gibbins
Journal Title:Access
Page: a428 - a428

Tuesday 26 August 2008

Manual acupuncture as an adjunctive treatment of nausea

Manual acupuncture as an adjunctive treatment of nausea in patients with cancer in palliative care--a prospective, observational pilot study.
Full text available at Ebsco CINAHL Athens
Acupuncture in medicine : journal of the British Medical Acupuncture Society, Mar 2008, vol. 26, no. 1
p. 27-32
Nystrom-Elisabeth, Ridderstrom-Gunilla, Leffler-Ann-Sofie.
Abstract
BACKGROUND: Good clinical evidence has been reported for the effect of PC6 acupuncture in preventing or attenuating postoperative and pregnancy related nausea. Our primary aim was to examine whether PC6 acupuncture during a period of chemotherapy could complement pharmacological treatment of nausea in cancer patients in the palliative stage of their disease. METHOD: We conducted a prospective observational pilot study to measure changes in nausea, and also explored the relationship between nausea, pain and constipation. Twelve patients suffering from nausea and four nausea free patients participated in the study. The nausea free patients were included because they had been troubled by nausea in a previous course of chemotherapy, despite medication with antiemetic drugs, and were about to start a new course of treatment. The patients rated their intensity of nausea, pain and constipation on a numerical rating scale before each of 10 treatment sessions with PC6 acupuncture over the course of three weeks, and at two follow ups during the following week. RESULTS: Fifteen patients completed the study. Compared to before treatment, the patients scored a significantly reduced intensity of nausea before the last treatment session (P<0.01) and at the first follow up (P<0.05). Three out of four nausea free patients were still nausea free before the last treatment session with acupuncture. No relationship could be found between nausea, pain and constipation before, during or after the treatment period had finished. CONCLUSION: The study demonstrated that acupuncture treatment in cancer patients can be associated with a significantly reduced intensity of nausea during a period of chemotherapy in their final phase of life.

A grounded theory guided approach to palliative care systems design

A grounded theory guided approach to palliative care systems design.
International journal of medical informatics, Jun 2007 (epub: 07 Jul 2006), vol. 76 Suppl 1
p. S141-8
Kuziemsky-Craig-E, Downing-G-Michael, Black-Fraser-M, Lau-Francis.
Abstract
As healthcare looks for new and innovative ways to deliver more services with less resources we are increasingly turning to informatics based solutions. However, the means by which information systems (IS) are both designed and implemented will impact how successful the system will be at enhancing care delivery. We believe a key component to successful IS design is the methodological rigor by which design requirements are gleaned and applied. This paper describes our use of a grounded theory (GT) guided methodology for designing an ontology of palliative care severe pain management. In this paper we illustrate how the methodological rigor of GT was applied to three palliative information sources to allow us to gain an understanding of how severe pain is managed. We then illustrate how that understanding was formalized into an ontology and applied to IS design of a computer based tool to enhance education around palliative care severe pain management.

End-stage nursing home residents with dementia

End-stage nursing home residents with dementia: recognizing the need for palliative care.
Journal of the American Medical Directors Association, May 2008 vol. 9 no. 4
p. 281-3
Cornali-Cristina, Bianchetti-Angelo, Trabucchi-Marco.

Journal of Medical Ethics Apr 2008 vol. 34 no. 4

Ethical issues arising from the requirement to sign a consent form in palliative care.
p. 279-80,
Plu-I, Purssell-Francois-I, Moutel-G, Ellien-F, Herve-C.
Abstract
French healthcare networks aim to help healthcare workers to take care of patients by improving cooperation, coordination and the continuity of care. When applied to palliative care in the home, they facilitate overall care including medical, social and psychological aspects. French legislation in 2002 required that an information document explaining the functioning of the network should be given to patients when they enter a healthcare network. The law requires that this document be signed. Ethical issues arise from this legislation with regard to the validity of the signature of dying patients. Signature of the consent form by a guardian or trustee, a designated person--the Person of Trust--transforms the doctor-patient relationship into a triangular doctor-patient-third-party relationship.

In quest of justice? Clinical prioritisation in healthcare for the aged.
p. 230-5
Pedersen-R, Nortvedt-P, Nordhaug-M, Sletteboe-A, Groethe-K-H et al
Abstract
BACKGROUND: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians' consideration in daily clinical prioritisation in healthcare services for the aged is scarce. OBJECTIVES: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients. DESIGN: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style. PARTICIPANTS: 20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway. RESULTS AND INTERPRETATIONS: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients' needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations. CONCLUSION: The interviews in this study indicate that considerations of justice and patients' perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients.

End-of-life care for COPD patients

End-of-life care for COPD patients.
Primary care respiratory journal : journal of the General Practice Airways Group, Mar 2008, vol. 17, no. 1
p. 46-50
Dean-Mervyn-M.
Abstract
Patients with chronic obstructive pulmonary disease (COPD) receive poor end-of-life (EoL) care, in part because their disease course is not predictable. If the family physician would not be surprised at the patient's death within a year, then EoL issues should be raised for discussion. Embarking on such a discussion has the potential to enhance the patient's quality of life and EoL care, thereby avoiding unnecessary treatments or interventions. An Advance Health Care Directive can be useful. Appropriately-used systemic (not nebulised) opioids are safe and effective for managing dyspnoea. The family physician is in an excellent position to provide comprehensive EoL care for COPD patients.

Palliative and end of life needs in dialysis patients

Palliative and end of life needs in dialysis patients.
Seminars in dialysis, Mar-Apr 2008, vol. 21, no. 2, p. 196, ISSN: 0894-0959.
Murtagh-F-E-M, Noble-H, Murphy-E.
Comment, Letter.
Comment
Comment on: Semin Dial. 2008 May-Jun; 21(3):206-9.

Parents' perspective - end-of-life decisions for children

Parents' perspective on symptoms, quality of life, characteristics of death and end-of-life decisions for children dying from cancer.
Klinische Paediatrie, May-Jun 2008, vol. 220, no. 3
p. 166-74
Hechler-T, Blankenburg-M, Friedrichsdorf-S-J, Garske-D, Huebner-B, Menke-A et al
Abstract
BACKGROUND: In the present study, we investigated the situation of children who had succumbed to their malignancy in Germany as perceived by their parents. Specifically, we were interested in bereaved parents' perspective on five essential areas: 1) symptoms and quality of life, 2) characteristics of the child's death, 3) anticipation of their child's death and care delivery, 4) end-of-life decisions and 5) impact of the child's death on the parents and perceived social support by the health care team. MATERIALS AND METHODS: We contacted all existing departments for paediatric oncology in the German federal state of Nordrhein Westfalen and asked them to contact all parents for participation in our study who had lost their child to cancer in 1999 and 2000. Upon agreement, we interviewed the parents utilising a validated semi-structured interview on distressing symptoms and quality of life of their children during the end-of-life care period. RESULTS: Six of the 19 departments agreed to participate. Parents of 48 children (31 boys, 17 girls) were interviewed. The main distressing symptoms were fatigue, pain, loss of appetite, and dyspnoea according to the parents. While parents perceived pain and constipation to have been treated successfully, loss of appetite and anxiety were not treated effectively. 75% of the children died due to a progression of their malignancy. Of these, 50% obtained cancer-directed therapy at the end of life, which was negatively rated by the parents in hindsight. 48% of the children died at home even though 88% of the parents chose 'at home' as the most appropriate locale of death in hindsight. Parents anticipated their child's death on average 9 weeks prior to the child's death. 41% of the parents provided palliative home care for their child and the majority (88%) rated the quality of care as good or very good. 64% discussed end-of-life decisions with the health care team, 36% did not have a discussion. Parents were clearly affected by their child's death. However, 15% of the parents were not contacted by the health care team following the child's death. CONCLUSIONS: The present study demonstrated that psychological symptoms (e.g. anxiety) are frequent symptoms in the end-of-life care period and cause severe suffering in the children. Questions in terms of benefits and costs of cancer-directed therapy in the end-of-life care period need to be addressed in future prospective studies. Parents' perspective on their child's death and related end-of-life decisions highlighted the importance of communication between parents and the health care team. Future studies need to investigate potential barriers in the communication between parents and the team to optimise end-of-life decisions and hence, reduce parents' long- term distress. In line with the previous, the present data demonstrated that there is still a lack of routine contact from the health care team following the child's death despite existing guidelines. Research is therefore needed into the implementation of guidelines for routine contact into clinical practice following a child's death.
Language English.

Hospital deaths of people aged 90 and over: end-of-life palliative care management.

Hospital deaths of people aged 90 and over: end-of-life palliative care management.
Gerontology, 2008 (epub: 30 May 2008), vol. 54, no. 3,
p. 148-52
Formiga-Francesc, Lopez-Soto-Alfons, Navarro-Margarita et al
Abstract
BACKGROUND: In developed countries, hospital deaths at very advanced age are increasingly common.Few studies have addressed end-of-life care in very elderly patients with non-cancer chronic diseases. OBJECTIVE: To evaluate the circumstances related to end-stage death of non-cancer nonagenarians in an acute care hospital. The results were compared with those from a sample of younger patients. METHODS: We conducted a prospective assessment in two teaching hospitals of the written instructions for the following actions: do not resuscitate (DNR) orders, the graduation of therapeutic decisions, information provided to relatives about prognosis, total withdrawal of normal drug therapy and provision of palliative care. RESULTS: 80 patients over 89 years of age with end-stage congestive heart failure (57.5%) or dementia (42.5%) were included. The control group comprised 52 younger patients (65-74 years). DNR orders were specified in 56% of cases, graduation of therapeutic decisions in 35%, and knowledge of relatives regarding the prognosis in 61%. Drug therapy was withdrawn in 66% of cases and terminal palliative care was initiated in 69%. In the nonagenarians who died, we detected a predominance of females (p = 0.001), a higher percentage of DNR orders (p = 0.02) and a higher percentage of graduation of therapeutic measures (p = 0.02) in comparison with younger patients. CONCLUSION: Our results indicate that there are marked differences according the palliative care provided to oldest-old patients with end-stage non-cancer chronic diseases admitted to an acute care hospital. In any case, care should be improved for both age groups.

Palliative treatment for elderly patients with colon cancer

Palliative treatment for elderly patients with colon cancer in ten Italian medical oncology units.
Anticancer research, May-Jun 2008, vol. 28, no. 3B,
p. 1813-20
Pasetto-Lara-Maria, Falci-Cristina, Rizzo-Elisa, De-Salvo-Gian-Luca, Gasparini-Giampietro et al
Abstract
BACKGROUND: Palliative chemotherapy significantly reduces mortality in patients with stage IV colon cancer, but is less prescribed with rising age. In this paper, we highlight the pattern of palliative treatment and possible effects on survival among elderly patients. PATIENTS AND METHODS: From January to December 2004, 78 files on the management of stage IV colorectal cancer (CRC) patients over 70 years, collected from 10 Italian Centres, were retrospectively examined. Determinants of receipt of palliative chemotherapy and their relation to toxicity and survival were considered. RESULTS: The proportion of elderly patients receiving first-line palliative chemotherapy was 98.7% and it was evaluated according to age, gender, educational level and comorbidities; patients receiving second-line therapy comprised 47.4%, those receiving third-line therapy 14.1% and those treated with a fourth-line therapy totalled 2.6%. Forty-one percent of patients received best supportive care (BSC) alone. CONCLUSION: In Italy, a proportion of elderly patients with metastatic chemonaive CRC are usually treated with a tolerability and overall survival similar to those for the younger population. Among progressive patients after second-line therapy, 45.8% usually undergo third line therapy; the remaining 54.2% undergo BSC.

Indian Journal of Palliative Care 2008 Vol 14 Part 1

The palliative care needs of patients with stage 3 and 4 HIV infection
Jameson
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 1-6

Parental concerns in children requiring palliative care
Dighe ; Jadhav ; Muckaden ; Sovani
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 16-22

Adverse psychosocial consequences: Compassion fatigue, burnout and vicarious traumatization: Are nurses who provide palliative and hematological cancer care vulnerable&# x003F ;
Sabo
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 23-29

Keeping hospice palliative care volunteers on board: Dealing with issues of volunteer attrition, stress, and retention
Claxton - Oldfield ; Claxton - Oldfield
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 30-37

Emotion management in childrens palliative care nursing
Maunder
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 45-50

Showing the way forward: Pain and Palliative Care Policy of the Government of Kerala
Paleri
Indian Journal of Palliative Care From EBSCO ( CINAHL with Full Text ) - via Athens
Page: 51-54

Canadian Nursing Home 2008 ; VOL 19 ; PART 2

Using active rehabilitation to decrease risk of pneumonia in palliative end-of-life ALS and dementia care-a case study Aggressive nutritional and swallowing interventions can be employed for palliative end-of-life neurological conditions-even in the nursing home
Cleary , S . ; Kizar , S . ; Kalra , S . ; Johnston , W .
Canadian Nursing Home From EBSCO ( CINAHL with Full Text ) - via Athens [Full Text]
Page: 4-10

Establishing palliative care support programs for LTC staff This article addresses the importance of establishing a system of care within LTC homes that supports staff confronted with palliative/end-of-life care on a regular basis
Lusk , C
Canadian Nursing Home From EBSCO ( CINAHL with Full Text ) - via Athens [Full Text]
Page: 11-16

Cancer and disability benefits

Cancer and disability benefits: a synthesis of qualitative findings on advice and support.
Psycho-oncology, May 2008, vol. 17, no. 5,
p. 421-9, 40 refs
Wilson-Kate, Amir-Ziv.
Abstract
Following the Supportive and Palliative Care Guidance, a call was made for a meta-ethnography on social support services for people affected by cancer. We responded by focusing on the topic of financial advice and support. After a scoping exercise revealed little qualitative evidence, we adopted the chief aim of identifying issues for research. Over 50 keywords relating to patient finances, cancer and qualitative research were entered into electronic search databases and combined. Because of the nature of the literature found, we synthesized primary data into themes and discussion, rather than second-order constructs into third-order constructs, as is common in meta-ethnography. Most of the literature found serves pragmatic, campaigning and/or service-development objectives. Also, most relates to disability benefits rather than insurance, tax and other issues. Five themes emerged: patients' struggles to obtain financial advice and benefits; tests/rules for disability benefits; issues relating to 'Special Rules'; intervention by benefit advisers; and intervention by health/social-care professionals. Struggles with the benefit system emerged as the fundamental theme.We conclude that patients need sensitive, proactive services to assist with benefit claims, and a benefit system that seems supportive rather than obstructive. Numerous under-researched topics were identified, including the need for general financial advice, help for carers, and cultural issues.

Airway management in anaplastic thyroid carcinoma

Airway management in anaplastic thyroid carcinoma.
Full text available at OVID for NHS
The Laryngoscope, {Laryngoscope}, Jul 2008, vol. 118, no. 7,
p. 1195-8
Shaha-Ashok-R.
Abstract
OBJECTIVES/HYPOTHESIS: In patients who present with advanced anaplastic thyroid cancer, airway management is difficult because of bilateral vocal cord paralysis or tracheal invasion by the tumor. Airway management can be extremely complex in these patients. STUDY DESIGN: This is the author's 25 year experience with 30 patients who presented with anaplastic thyroid cancer and acute airway problems. METHODS: The patients' airway issues developed soon after presentation or a few months after treatment. Ten patients presented with initial symptoms of acute airway distress. All of these patients were treated with tracheostomy or cricothyrotomy. RESULTS: The 10 patients who presented with initial symptoms of acute airway distress died within 4 months. Eight of the remaining 20 patients developed bilateral vocal cord paralysis. Airway management for these patients depended on the extent of distant disease and the family's understanding of the advanced nature of the disease and the palliative efforts. The remaining patients had a palliative and supportive approach. CONCLUSIONS: Airway management was the most critical issue in patients who presented with anaplastic thyroid cancer and initial airway distress. Cricothyrotomy was helpful in avoiding acute airway catastrophe. It is important to distinguish between poorly differentiated and anaplastic thyroid cancer and lymphoma for appropriate airway management.

Communication model for encouraging optimal care at the end of life for hospitalized patients

A communication model for encouraging optimal care at the end of life for hospitalized patients.
QJM : monthly journal of the Association of Physicians, Dec 2007, vol. 100, no. 12
p. 791-7
Workman-S.
Abstract
Multiple studies have demonstrated that treatment at or near the end of life is rarely optimal. Unwanted death-prolonging treatments are frequently provided and open communication about death and dying is often lacking. Early effective communication about goals, prognosis and options would improve patient care at or near the end of life by enhancing choice and facilitating palliative care. A five-step sequential approach to communicating with patients at risk of dying in hospital about treatment goals and outcomes (and/or their family members) is presented. The five steps are founded upon the recognition that trials of life-sustaining treatments are also, by definition, trials of palliative care. A narrative review of currently available qualitative and quantitative research is used to support the recommendations.
Journal-Article, Review.

Current opinion in oncology Jul 2008 vol. 20 no. 4

Delirium in cancer patients: a focus on treatment-induced psychopathology.
p. 360-6, 66 refs
Agar-Meera, Lawlor-Peter.
Abstract
PURPOSE OF REVIEW: Delirium is a neuropsychiatric syndrome that occurs frequently in cancer patients, especially in those with advanced disease. Recognition and effective management of delirium is particularly important in supportive and palliative care, especially in view of the projected increase in the elderly population and the consequent potential for the number of patients both diagnosed and living longer with cancer to increase substantively. RECENT FINDINGS: Studies of delirium in a variety of settings have generated new insights into phenomenology, assessment tools, the psychomotor subtypes, potential patho-physiological markers, pathogenesis, reversibility, and the role of sedation in symptom control. SUMMARY: Validated tools exist to assist in the assessment of delirium. Although our understanding of the pathogenesis of delirium has improved somewhat, there remains a compelling need to further elucidate the underlying pathophysiology, especially in relation to opioids and the other psychoactive medications that are used in supportive care. Further trials are needed, especially in patients with advanced disease to determine predictive models of reversibility, preventive strategies, outcomes, and to assess the role of antipsychotic and other medications in symptomatic management.

Depression and cancer: recent data on clinical issues, research challenges and treatment approaches.
p. 353-9
Reich-Michel
Abstract
PURPOSE OF REVIEW: Clinical guidelines for depression screening, assessment and management in the oncologic field and palliative care are becoming paramount in routine cancer care. This psychiatric comorbidity has several impacts on quality of life, anticancer treatment compliance, hospital stay duration, health-care costs, morbidity and possibly mortality even if discordant reports exist. RECENT FINDINGS: Recent development of brain imaging techniques (MRI, positron emission tomography), neurobiological and genetic tools allow new understanding of the pathophysiology process of depressive disorders in cancer populations besides the usual endocrinologic and psychoneuroimmunologic hypothesis. Broader indications besides depressive or anxiety disorders appear or must be investigated for the new generation of antidepressants (selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, noradrenergic specific serotonergic antidepressants) in oncology, such as hot flashes, neuropathic pain, fatigue, anorexia/cachexia. Psychosocial interventions seem to have a slight impact on well- being, quality of life and depressive symptomatology but not on survival. SUMMARY: The present article reviews recent literature on depression and cancer and highlights practical assessment and detection of depression, biological and physiopathological correlates and its pharmacologic and psychosocial treatment. Implementation of these several techniques must be supported by ongoing research about the complex relation between depressive disorders and generally mental health and oncology.

Journal of pain and symptom management, May 2008, vol. 35, no. 5

Factors correlated with fatigue in terminally ill cancer patients: a longitudinal study.
Okuyama-Toru, Akechi-Tatsuo, Shima-Yasuo, Sugahara-Yuriko et al
Abstract
Fatigue is among the most distressing symptoms experienced by terminally ill cancer patients. It is necessary to clarify factors correlated with fatigue to develop effective management strategies. A consecutive sample of cancer patients newly registered in the Palliative Care Unit (PCU) was assessed on three occasions: at the second visit to the outpatient clinic of the PCU (Time 1), three weeks after the Time 1 session over the telephone (Time 2), and at admission to the PCU (Time 3). The patients' fatigue and a broad range of biopsychosocial factors were assessed using the validated questionnaires, structured interviews, and medical record reviews at Time 1 and Time 3. Fatigue was the only factor assessed at Time 2. Two hundred patients participated in the Time 1 session, and 129 and 73 were followed at Time 2 and Time 3, respectively. Greater fatigue at Time 1 was significantly correlated with psychological distress, lower Karnofsky Performance Status score, dyspnea, and appetite loss (adjusted coefficients of determination (R(2))=0.49). Greater fatigue at Time 2 was significantly correlated with psychological distress, lower Karnofsky Performance Status and fatigue at Time 1 (adjusted R (2)=0.51). Greater fatigue at Time 3 was significantly correlated with changes for the worse in psychological distress, Karnofsky Performance Status, and dyspnea severity during the period between Time 1 and Time 3, after adjusting for Time 1 fatigue (adjusted R(2) =0.54). The results indicate that fatigue in terminally ill cancer patients is determined by both physical and psychological factors. It may be important to include psychological intervention in the multidimensional management of fatigue in this population, in addition to physical and nursing interventions.

Potential drug interactions in cancer patients receiving supportive care exclusively.
p. 535-43
Riechelmann-Rachel-P, Zimmermann-Camilla, Chin-Sheray-N, Wang-Lisa et al
Abstract
Cancer patients at the end of life often take many medications and are at risk for drug interactions. The purpose of this study was to describe the epidemiology of potential drug interactions in cancer patients receiving supportive care exclusively. We retrospectively reviewed the charts of consecutive adult cancer outpatients attending palliative care clinics at the Princess Margaret Hospital, Toronto, Canada. Drugs were screened for interactions by the Drug Interaction Facts software, which classifies interactions by levels of severity (major, moderate, and minor) and scientific evidence (1-5, with 1=the strongest level of evidence). Among 372 eligible patients, 250 potential drug interactions were identified in 115 patients (31%, 95% confidence interval 26%-36%). The most common involved warfarin and phenytoin. Most interactions were classified as being of moderate severity (59%) and 42% of them were supported by Levels 1-3 of evidence. In multivariable analysis, increasing age (P<0.001), presence of comorbidity (P=0.001), cancer type (brain tumors, P<0.001), and increasing number of drugs (P<0.001) were associated with risk of drug interactions. Potential drug interactions are common in palliative care and mostly involve warfarin and anticonvulsants. Older patients, those with comorbid conditions, brain tumor patients, and those taking many medications are at greater risk of drug interactions.

Mapping levels of palliative care development: a global view.
p. 469-85
Wright-Michael, Wood-Justin, Lynch-Thomas, Clark-David.
Abstract
Palliative care is coming to be regarded as a human right. Yet globally, palliative care development appears patchy and comparative data about the distribution of services are generally unavailable. Our purpose is to categorize hospice-palliative care development, country by country, throughout the world, and then depict this development in a series of world and regional maps. We adopt a multimethod approach, which involves the synthesis of evidence from published and grey literature, regional experts, and a task force of the European Association of Palliative Care. Development is categorized using a four-part typology constructed during a previous review of palliative care in Africa. The four categories are (1) no identified hospice-palliative care activity, (2) capacity building activity but no service, (3) localized palliative care provision, and (4) countries where palliative care activities are approaching integration with mainstream service providers. We found palliative care services in 115/234 countries. Total countries in each category are as follows: (1) no identified activity 78 (33%), (2) capacity building 41 (18%), (3) localized provision 80 (34%), and (4) approaching integration 35 (15%). The ratio of services to population among Group 4 countries ranges from 1:43,000 (in the UK) to 1:4.28 million (in Kenya); among Group 3 countries it ranges from 1:14,000 (in Gibraltar) to 1:158 million (in Pakistan). The typology differentiates levels of palliative care development across the four hemispheres and in rich and poor settings. Although half of the world's countries have a palliative care service, far more are needed before such services are generally accessible worldwide.

Nerve blocks in palliative care.

Nerve blocks in palliative care.
British journal of anaesthesia, Jul 2008 (epub: 20 May 2008), vol. 101, no. 1,
p. 95-100
Chambers-W-A.
Abstract
Although between 85% and 90% of patients with advanced cancer can have their pain well controlled with the use of analgesic drugs and adjuvants, there are some patients who will benefit from an interventional procedure. This includes a variety of nerve blocks and also some neurosurgical procedures. Approximately 8-10% of patients may benefit from a peripheral nerve block and around 2% from a central neuraxial block. The most common indication is because opioid dose escalation is limited by signs of opioid toxicity but some patients will benefit from one component of their pain being relieved by a simple peripheral block. Most patients about to undergo these procedures are already taking high doses of opiods and obtaining valid consent may pose problems. The use of peripheral nerve blocks, epidural and intrathecal infusions, and plexus blocks is discussed.

Awake palliative thoracic surgery

Awake palliative thoracic surgery in a high-risk patient: one-lung, non-invasive ventilation combined with epidural blockade.
Anaesthesia, Jul 2008 (epub: 12 Feb 2008), vol. 63, no. 7
p. 761-3
Guarracino-F, Gemignani-R, Pratesi-G, Melfi-F, Ambrosino-N.
Abstract
We report the case of a terminally ill cancer patient with recurrent pericardial and bilateral pleural effusions who was scheduled for video-assisted thoracoscopic surgery. The operation was performed with the patient awake under epidural anaesthesia. The patient's cough reflex in response to lung manipulation was successfully minimised by the inhalation of aerosolised lidocaine. Video-assisted thoracic surgery requires the exclusion of a lung from ventilation. In order to support one-lung spontaneous ventilation in this high- risk patient, we successfully used non-invasive bilevel positive airway pressure ventilation via a facemask. Based on this preliminary experience, we think that critically ill patients scheduled for palliative surgery can be successfully managed with the combination of minimally invasive surgical techniques and neuraxial block with non-invasive lung ventilation.

Views of nurse prescribing among Macmillan nurses

Exploring the views of nurse prescribing among Macmillan nurses.
Full text available at Ebsco CINAHL Athens
British journal of community nursing, Apr 2008, vol. 13, no. 4, p. 171-2, 174-7
Ryan-Woolley-Bernadette, McHugh-Gretl, Luker-Karen.
Abstract
Nurse prescribing is a key government initiative which aims to enhance patient care. The aim of this study was to investigate the prescribing practice of specialist nurses working in cancer and palliative care and to explore the benefits of and barriers to uptake of nurse prescribing training. A national postal survey of 2252 Macmillan nurses was undertaken using a structured questionnaire with open-ended questions. Data were analyzed using thematic content analysis for 1575 respondents (70% response rate). Only 13% (203) had undergone prescribing training and of these 105 provided responses to the open questions concerning training and of the 87% (1372) who had not undergone the training, 423 provided details on barriers to nurse prescribing training. The data presented in this paper draw from this data. The findings indicate that those who prescribed gave the prospect of improving care as the main reason for undertaking nurse prescribing training. The main reasons why these specialist nurses did not undertake training were: resource issues particularly with respect to backfill while training, lack of medical support and mentorship, concerns about the relevance of prescribing as a nursing role and prioritizing other courses. If nurse prescribing is to be more widely available for cancer and palliative care patients it is important in both primary and secondary care to address the resource and support issues.

BMC health services research

A method to determine spatial access to specialized palliative care services using GIS.
BMC health services research, 2008 (epub), vol. 8, p. 140
Cinnamon-Jonathan, Schuurman-Nadine, Crooks-Valorie-A.
Abstract
BACKGROUND: Providing palliative care is a growing priority for health service administrators worldwide as the populations of many nations continue to age rapidly. In many countries, palliative care services are presently inadequate and this problem will be exacerbated in the coming years. The provision of palliative care, moreover, has been piecemeal in many jurisdictions and there is little distinction made at present between levels of service provision. There is a pressing need to determine which populations do not enjoy access to specialized palliative care services in particular. METHODS: Catchments around existing specialized palliative care services in the Canadian province of British Columbia were calculated based on real road travel time. Census block face population counts were linked to postal codes associated with road segments in order to determine the percentage of the total population more than one hour road travel time from specialized palliative care. RESULTS: Whilst 81% of the province's population resides within one hour from at least one specialized palliative care service, spatial access varies greatly by regional health authority. Based on the definition of specialized palliative care adopted for the study, the Northern Health Authority has, for instance, just two such service locations, and well over half of its population do not have reasonable spatial access to such care. CONCLUSION: Strategic location analysis methods must be developed and used to accurately locate future palliative services in order to provide spatial access to the greatest number of people, and to ensure that limited health resources are allocated wisely. Improved spatial access has the potential to reduce travel-times for patients, for palliative care workers making home visits, and for travelling practitioners. These methods are particularly useful for health service planners - and provide a means to rationalize their decision-making. Moreover, they are extendable to a number of health service allocation problems.

BMC Palliative Care

Palliative care in advanced dementia; a mixed methods approach for the development of a complex intervention
Elizabeth L Sampson ; Ingela Thune - Boyle ; Riitta Kukkastenvehmas ; Louise Jones ; Adrian Tookman ; Michael King and Martin R Blanchard
ISSUE: 2008 ; VOL 7
[PDF] [Abstract]
Page: 8

International Journal of Palliative Nursing 2008 Vol 14 Part 6

Discussions at the end of life
Mula , C
Page: 263

What do community nurse specialists do? An activity analysis
Newbury , J . ; de Leeuw , W . ; Newton , C .
Page: 264-273

Spirituality in palliative care: what language do we need ?
Byrne , M
Page: 274-280

Saying it in song: music therapy as a carer support intervention
O Kelly , J
Page: 281-286

Families' transition to a Canadian paediatric hospice. Part two: results of a pilot study
Author(s): Steele , R . ; Derman , S . ; Cadell , S . ; Davies , B . ; Siden , H . ; Straatman , L
Page: 287-296

The grief experience of same-sex couples within an Irish context
Author(s): Glackin , M . ; Higgins , A .
Page: 297-302

Transferring knowledge: evaluating the use of a telephone advice line
Author(s): Carr , S . M . ; Lhussier , M . ; Wilcockson , J .
Page: 303-308

Friday 22 August 2008

Paediatric palliative care.

Paediatric palliative care.
Lancet, 28 Jun 2008, vol. 371, no. 9631,
p. 2169
Darlington-Anne-Sophie-E, van-den-Heuvel-Eibrink-Marry-M, Passchier- Jan.
Publication type
Comment, Letter.
Comment on: Lancet. 2008 Mar 8; 371(9615):852-64.

Paediatric palliative care.
Lancet 28 Jun 2008, vol. 371, no. 9631, p. 2169
Vissers-Kris-C-P, Engels-Yvonne, Verhagen-Constans.
Comment, Letter.
Comment on: Lancet. 2008 Mar 8; 371(9615):852-64.

Impact of specialty on attitudes of Australian medical practitioners to end-of-life decisions.

Impact of specialty on attitudes of Australian medical practitioners to end-of-life decisions.
Full text available at ProQuest
The Medical journal of Australia 21 Apr 2008, vol. 188, no. 8
p. 450-6
Parker-Malcolm-H, Cartwright-Colleen-M, Williams-Gail-M.
Abstract
OBJECTIVE: To compare attitudes and practices of Australian medical practitioners, by specialty, to a range of medical decisions at the end of life. DESIGN, SETTING AND PARTICIPANTS: As part of an international study, in 2003, a structured questionnaire was mailed to 2964 medical practitioners drawn from membership registers of Australian and Australasian professional colleges. Data from 1478 questionnaires were statistically analysed using validated instruments. MAIN OUTCOME MEASURES: Practitioners' willingness to comply with requests from patients and/or their relatives for symptom relief which might also hasten death; provision of terminal sedation and euthanasia, or willingness to provide these on their own initiative. RESULTS: Respondents reported being much more willing to comply with a patient's request for increasing symptom relief, even at risk of hastening death, than for terminal sedation. Over a quarter of respondents would provide terminal sedation to competent patients on their own initiative. A small number of respondents would intentionally hasten death. There were significant differences by specialty for all three actions. Oncologists, palliative care physicians and geriatricians were least likely to actively hasten death, and more likely to act unilaterally to relieve symptoms as a medical necessity. CONCLUSIONS: Perceptions about the causation of death and aspects of medical culture appear to influence physicians' attitudes towards medical decisions at the end of life. Our findings have implications for medical education, interprofessional communication and discussion between the medical profession and the community.

End-of-life care in the trauma intensive care unit

Changing the culture around end-of-life care in the trauma intensive care unit.
The Journal of trauma Jun 2008, vol. 64, no. 6
p. 1587-93
Abstract
BACKGROUND: Ten percent to 20% of trauma patients admitted to the intensive care unit (ICU) will die from their injuries. Providing appropriate end-of-life care in this setting is difficult and often late in the patients' course. Patients are young, prognosis uncertain, and conflict common around goals of care. We hypothesized that early, structured communication in the trauma ICU would improve end-of-life care practice. METHODS: Prospective, observational, prepost study on consecutive trauma patients admitted to the ICU before and after a structured palliative care intervention was integrated into standard ICU care. The program included part I, early (at admission) family bereavement support, assessment of prognosis, and patient preferences, and part II (within 72 hours) interdisciplinary family meeting. Data on goals of care discussions, do-not-resuscitate (DNR) orders and withdrawal of life support (W/D) were collected from physician rounds, family meetings, and medical records. RESULTS: Eighty-three percent of patients received part I and 69% part II intervention. Discussion of goals of care by physicians on rounds increased from 4% to 36% of patient-days. During intervention, rates of mortality (14%), DNR (43%), and W/D (24%) were unchanged, but DNR orders and W/D were instituted earlier in hospital course. ICU length of stay was decreased in patients who died. CONCLUSIONS: Structured communication between physician and families resulted in earlier consensus around goals of care for dying trauma patients. Integration of early palliative care alongside aggressive trauma care can be accomplished without change in mortality and has the ability to change the culture of care in the trauma ICU.

Palliative care - Annals of Oncology

Palliative care
Annals of Oncology July 2008 ; VOL 19 ; PART suppl_5
Page: v160 - v160

Tuesday 29 July 2008

New Library book

In the Health Sciences Library:
Royal College of Physicians
Palliative care services : meeting the needs of patients Nov 2007
Shelved at 616.994 ROY

Thursday 17 July 2008

Delivering effective end-of-life care: developing partnership working

Delivering effective end-of-life care: developing partnership working
Wednesday 15 October 2008, 10.00am–4.15pm Royal College of Obstetricians and Gynaecologists, London
Recognition of the need for good-quality end-of-life care is at the heart of the government's new End of Life Care Strategy. Produced in partnership between The King's Fund, Marie Curie Cancer Care and the National Council for Palliative Care, this one-day conference will highlight the key challenges involved in implementing the strategy.
Much pioneering work has been done by a wide range of organisations across health and social care. In order to enable greater choice for those at the end of their life, there is now a move towards more effective commissioning and co-ordination of this care. We will share good practice and innovation using case studies and interactive workshops, with a focus on partnership working.
We are delighted to announce that Professor Mike Richards CBE, Chair, End of Life Care Strategy Advisory Board and National Clinical Director for Cancer, will give the keynote address and that the full conference programme is available on our website.
Confirmed speakers include the following:
Dr James Beattie, National Clinical Lead, NHS Heart Improvement Programme and Consultant Cardiologist, Birmingham Heartlands Hospital, on delivering effective end-of-life care for non-cancer patients.
Dr Andrew Daley, Consultant, Bradford Teaching Hospitals NHS Foundation Trust, on identifying and better understanding your palliative care patients.
Martin Green, Chief Executive, English Community Care Association, on the challenges of partnership working.
Penny Hansford, Director of Nursing, St Christopher's Hospice, on delivering staff skills.
Martin McShane, Director of Strategic Planning and Health Outcomes, Lincolnshire Primary Care Trust, on the challenges of commissioning.