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
Anticipatory mourning: processes of expected loss in palliative care
Clukey , L
Page: 316-325
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
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
`A voyage of grief and beauty': supporting a dying family member with an intellectual disability
Marlow , S . ; Martin , M .
Page: 342-349
Palliative care nurse consultants in Melbourne: a snapshot of their clinical role
Author(s): O Connor , M . ; Peters , L . ; Walsh , K .
Page: 350-355
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.
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.
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.
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
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
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 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
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
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
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
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 ;
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
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
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.
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
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
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.
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
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
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
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.
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
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.
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.
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.
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