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

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.