MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Palliative Medicine' source. Sun, 21 Mar 2010 17:18:30 +0100 http://www.medworm.com/index.php?rid=3379831&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20233896%26dopt%3DAbstract Authors: Fraser LK, Fleming T, Miller M, Draper ES, McKinney PA, Parslow RC We aim to describe the demographics and clinical characteristics of children discharged to palliative care from 31 paediatric intensive care units in Great Britain, using a cohort of admissions and discharges from the database of paediatric intensive care units (Paediatric Intensive Care Audit Network (PICANet)). The patients included in this study were children discharged alive from paediatric intensive care units (n = 68882) between 1 January 2004 and 31 December 2008. The main outcome measure was Odds Ratios for discharge of children from paediatric intensive care units to palliative care and their referral destination. We found that palliative care status was recorded for 68,090 live discharges from paediat... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3379831 Tue, 16 Mar 2010 00:00:00 +0100 3379831 http://www.medworm.com/index.php?rid=3336197&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20194636%26dopt%3DAbstract Authors: PMID: 20194636 [PubMed - in process] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3336197 Mon, 01 Mar 2010 00:00:00 +0100 3336197 http://www.medworm.com/index.php?rid=3303187&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20176616%26dopt%3DAbstract Authors: Gibbins J, McCoubrie R, Maher J, Wee B, Forbes K In their first year of work, newly qualified doctors will care for patients who have palliative care needs or who are dying, and they will need the skills to do this throughout their medical career. The General Medical Council in the United Kingdom has given clear recommendations that all medical students should receive core teaching on relieving pain and distress together with caring for the terminally ill. However, medical schools provide variable amounts of this teaching; some are able to deliver comprehensive programmes whilst others deliver very little. This paper presents the results of a mixed methods study which explored the structure and content of palliative care teaching in different UK medical schools, and revealed w... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3303187 Mon, 22 Feb 2010 00:00:00 +0100 3303187 http://www.medworm.com/index.php?rid=3303186&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20176617%26dopt%3DAbstract Authors: Wilson E, Seymour JE, Perkins P Since October 2007 staff across health and social care services in England and Wales have been guided by the Mental Capacity Act (2005) in the provision of care for those who may lack capacity to make some decisions for themselves. This paper reports on the findings from a study with 26 staff members working in three palliative and three neurological care centres. Semistructured interviews were used to gain an understanding of their knowledge of the Mental Capacity Act, the issue of capacity itself and the documentation processes associated with the introduction of the Act and in line with advance care planning. Within this setting advance care planning is a key part of care provision and the mental capacity of service users is a regular issue. ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3303186 Mon, 22 Feb 2010 00:00:00 +0100 3303186 http://www.medworm.com/index.php?rid=3303185&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20176618%26dopt%3DAbstract Authors: Cleary JF, Hutson P, Joranson D PMID: 20176618 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3303185 Mon, 22 Feb 2010 00:00:00 +0100 3303185 http://www.medworm.com/index.php?rid=3277117&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20156933%26dopt%3DAbstract We report on a study of the place of research on supportive, palliative and end-of-life care within the United Kingdom Research Assessment Exercise of 2001 and 2008. Sixty-seven Higher Education Institutions in 2001 and 66 in 2008 contributed work to the Research Assessment Exercise relevant to supportive, palliative and end-of-life care. This comprised 16 subject areas in 2001 and 25 in 2008, and was generated by 178 authors in 2001 and 176 authors in 2008. Seven 'high-intensity groups' of concentrated research activity were identified in 2001, and eight such groups in 2008. Between the years little growth occurred in contributions to the Research Assessment Exercise relating to supportive, palliative and end-of-life care, and the 'high-intensity groups' remain relatively fragile. With on... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3277117 Mon, 15 Feb 2010 00:00:00 +0100 3277117 http://www.medworm.com/index.php?rid=3277116&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20156934%26dopt%3DAbstract Authors: Shaw KL, Clifford C, Thomas K, Meehan H The Gold Standards Framework aims to optimize primary palliative care for patients nearing the end of their lives. This paper critically reviews the impact of the Gold Standards Framework since its introduction in 2001 and indicates direction for further research and development. Literature was accessed using specific databases and by contacting subject area specialists. The resultant literature was appraised using an established framework to evaluate healthcare interventions. Fifteen documents were reviewed. The quality of evidence is constrained by methodological limitations, but consistently demonstrates that the Gold Standards Framework improves general practice processes, co-working and the quality of palliative care. However, imple... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3277116 Mon, 15 Feb 2010 00:00:00 +0100 3277116 http://www.medworm.com/index.php?rid=3263190&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20145090%26dopt%3DAbstract Authors: Gillon S, Hurlow A, Rayment C, Zacharias H, Lennard R PMID: 20145090 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3263190 Tue, 09 Feb 2010 00:00:00 +0100 3263190 http://www.medworm.com/index.php?rid=3263189&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20145091%26dopt%3DAbstract Authors: Scott K PMID: 20145091 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3263189 Tue, 09 Feb 2010 00:00:00 +0100 3263189 http://www.medworm.com/index.php?rid=3263188&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20145092%26dopt%3DAbstract Authors: Higginson IJ, Hall S, Koffman J, Riley J, Gomes B PMID: 20145092 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3263188 Tue, 09 Feb 2010 00:00:00 +0100 3263188 http://www.medworm.com/index.php?rid=3248986&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20133320%26dopt%3DAbstract Authors: Alonso-Babarro A, Varela-Cerdeira MA, Torres I, Rodrí Guez-Barrientos R, Bruera E Using a decision-making and treatment checklist developed to facilitate the at-home palliative sedation process, we assessed the incidence and efficacy of palliative sedation for end-of-life cancer patients with intractable symptoms who died at home. We retrospectively reviewed the medical records of 370 patients who were followed by a palliative home care team. Twenty-nine of 245 patients (12%) who died at home had received palliative sedation. The mean age of the patients who received palliative sedation was 58 +/- 17 years, and the mean age of the patients who did not receive palliative sedation was 69 +/- 15 years (p = 0.002). No other differences were detected between patients who did o... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3248986 Wed, 03 Feb 2010 00:00:00 +0100 3248986 http://www.medworm.com/index.php?rid=3236830&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20123943%26dopt%3DAbstract Authors: Knapp CA, Madden VL, Curtis C, Sloyer PJ, Shenkman EA National experts have recognized a need for increased research in pediatric palliative care. However, when conducting research it is important to use rigorous methods, report significant and non-significant findings, and include information on responders and non-responders. Most studies do not present information on non-responders, yet this is critical as the results many not be generalizable if there are inherent differences between the two groups. Using survey data from parents whose children with life-limiting illnesses were enrolled in Florida's publicly funded pediatric palliative care program called Partners in Care: Together for Kids; this study investigates whether non-response bias exists, and if so, what character... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3236830 Mon, 01 Feb 2010 00:00:00 +0100 3236830 http://www.medworm.com/index.php?rid=3236829&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20123944%26dopt%3DAbstract This study aimed to articulate the experiences of family caregivers of people diagnosed with high-grade glioma and to describe their information and support needs. A grounded theory method was adopted. Twenty-one family caregivers of people with high-grade glioma were interviewed using a semi-structured interview guide. A constant comparison method of data analysis was employed. A central theme, A Time of Rapid Change and two sub-themes, Renegotiating Relationships and Learning to be a Caregiver, emerged to describe the experiences of participants. Caregiving was characterised by numerous role and life changes from the moment of diagnosis. Caregivers in this study reported experiences similar to those described by caregivers of people with other cancers. What differed for this group was th... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3236829 Mon, 01 Feb 2010 00:00:00 +0100 3236829 http://www.medworm.com/index.php?rid=3236828&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20123945%26dopt%3DAbstract Authors: Mason SR, Ellershaw JE The General Medical Council's call to modernize medical education prompted the University of Liverpool Medical School to develop a new undergraduate programme, integrating palliative medicine as 'core' curricula. Following successful piloting, the palliative medicine training programme was further developed and expanded. This paper examines whether the additional investment produces improved outcomes. In 1999, fourth year undergraduate medical students (Cohort 1, n = 217) undertook a 2-week pilot education programme in palliative medicine. Subsequently, the training programme was refined and extended, incorporating advanced communication skills training, an ethics project and individual case presentations (Cohort 2, n = 443). Congruent with the study's t... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3236828 Mon, 01 Feb 2010 00:00:00 +0100 3236828 http://www.medworm.com/index.php?rid=3236827&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20123946%26dopt%3DAbstract Authors: Perkins P, Day R, Foy C PMID: 20123946 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3236827 Mon, 01 Feb 2010 00:00:00 +0100 3236827 http://www.medworm.com/index.php?rid=3236826&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20123947%26dopt%3DAbstract Authors: Shaw KL, Badger FJ, Brook L, Brown Z, Cuddeford L, Thomas K, Wallis M PMID: 20123947 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3236826 Mon, 01 Feb 2010 00:00:00 +0100 3236826 http://www.medworm.com/index.php?rid=3236825&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20123948%26dopt%3DAbstract Authors: Minton O, Stone PC There is an increasing emphasis on using translational research to examine mechanisms and increase our understanding of disease. Translational research involves the use of basic science techniques to generate new treatments for use in a clinical setting - the so called 'bench to bedside' approach. This methodology could be used to enhance our understanding of complex symptoms such as cancer-related fatigue. This review will examine specifically the potential role of the science of protein structure and function (proteomics) as a technique to improve our knowledge in this area. This will include an explanation of the specific methods used in this research in order to increase our understanding of the mechanisms of cancer-related fatigue and discuss potential ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3236825 Mon, 01 Feb 2010 00:00:00 +0100 3236825 http://www.medworm.com/index.php?rid=3194665&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20085963%26dopt%3DAbstract Authors: Hales S, Zimmermann C, Rodin G To determine whether modern medicine is facilitating 'good' deaths, appropriate measures of the quality of dying and death must be developed and utilized. The purpose of this paper is to identify quality of dying and death measurement tools and to determine their quality. MEDLINE (1950-2008), Healthstar (1966-2008), and CINAHL (1982-2008) were searched using keyword terms 'quality of dying/death' and 'good/bad death'. Papers that described a quality of dying and death measure or that aimed to measure the quality of dying and death were selected for review. The evaluation criteria included a description of the measure development (validated or ad hoc), the provision of a definition of quality of dying and death, an empirical basis for the measure,... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3194665 Tue, 19 Jan 2010 00:00:00 +0100 3194665 http://www.medworm.com/index.php?rid=3194664&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20085964%26dopt%3DAbstract Authors: Thomas K, Hudson P, Oldham L, Kelly B, Trauer T While policy promotes comprehensive assessment of family carer needs and a plan to adequately meet family carer needs within palliative care, there is a lack of studies in the Australian context which examine the current type of assessment and types of care provided to family carers. The aims of this study were (1) to determine how carer needs are currently assessed and what level of support is available to family carers in three home-based palliative care services within Australia, (2) identify areas for improvement of support to carers and, (3) explore the barriers to offering carer support. A focus group and file audit were conducted at two metropolitan and one regional home-based palliative care service in Australia. These pa... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3194664 Tue, 19 Jan 2010 00:00:00 +0100 3194664 http://www.medworm.com/index.php?rid=3186500&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20080806%26dopt%3DAbstract Authors: Lundström S, Gyllenhammar E, Martinsson U, Strang P During recent years, research networks and collaboratives focusing on palliative care research have been established both nationally and internationally resulting in several ongoing projects. In 2002, a clinician-based research network, the Palliative Care Research Network in Sweden (PANIS), was established to stimulate research and development of palliative care in Sweden. The growing network, which today includes 60 specialized palliative care units, has used a web-based survey generator to collect data on symptom prevalence, treatment traditions and important issues in palliative care. Eleven different studies involving almost 11,000 patients have been performed within the network including studies on prevalence of an... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3186500 Fri, 15 Jan 2010 00:00:00 +0100 3186500 http://www.medworm.com/index.php?rid=3172526&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20064874%26dopt%3DAbstract Authors: Hanks G PMID: 20064874 [PubMed - in process] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3172526 Fri, 01 Jan 2010 00:00:00 +0100 3172526 http://www.medworm.com/index.php?rid=3105598&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20015917%26dopt%3DAbstract Authors: Campbell M, Grande G, Wilson C, Caress AL, Roberts D In order to provide equitable access to hospice at home palliative care services, it is important to identify the socio-economic factors associated with poorer access. In this population-based study we aimed to test the inverse care law by exploring how socio-economic status and other key demographic indicators were associated with referral rates in two distinct areas (Salford and Trafford) served by the same service. Secondary data from the UK National Census 2001, North West Cancer Intelligence Service (2004) and hospice at home service referral data (2004-06) was collated for both areas. Descriptive analysis profiled electoral ward characteristics whilst simple correlations and regression modelling estimated associations ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3105598 Wed, 16 Dec 2009 00:00:00 +0100 3105598 http://www.medworm.com/index.php?rid=3105597&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20015918%26dopt%3DAbstract Authors: Macdonald ME, Chilibeck G, Affleck W, Cadell S We assessed the sampling performance of research on parental perspectives in pediatric palliative care and examined if and how gender imbalance was treated. We undertook a systematic review of parental perspectives research in pediatric palliative care using MEDLINE, CINAHL, and PsycINFO. Study selection inclusion criteria were: (1) published between 1988 and 2008; (2) in English; (3) conducted in North America; (4) focused on parents of children aged 0-18 years who were expected to die or had died; (5) had 'parent' in the title; and (6) focused on parents' experiences or on parents' perspectives regarding the child's illness/death. Keyword searches produced a list of 2103 studies, of which 45 met the criteria for inclusion. The r... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3105597 Wed, 16 Dec 2009 00:00:00 +0100 3105597 http://www.medworm.com/index.php?rid=3105596&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20015919%26dopt%3DAbstract This study highlights significant training needs and suggests that the theoretical work and recently published consensus recommendations around breakthrough pain now need to be translated into day-to-day clinical practice. PMID: 20015919 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3105596 Wed, 16 Dec 2009 00:00:00 +0100 3105596 http://www.medworm.com/index.php?rid=3105595&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20015920%26dopt%3DAbstract Authors: Kirkova J, Walsh D, Rybicki L, Davis MP, Aktas A, Jin T, Homsi J We determined the relationship between symptom severity and distress for multiple cancer symptoms, and examined patient demographic influences on severity and distress in advanced cancer. A Cochran-Armitage trend test determined whether symptom distress increased with severity. Chi-square, Fisher's exact test and logistic regression analysis examined moderate/severe ('clinically important') and distressful symptoms by age (</=65 versus >65), gender, primary site group, and ECOG performance status. Forty-six symptoms were analyzed in 181 individuals. More than 50% of individuals with clinically important symptoms rated them as distressful. The median percentage of individuals with mild but still distressful ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3105595 Wed, 16 Dec 2009 00:00:00 +0100 3105595 http://www.medworm.com/index.php?rid=3105594&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20015921%26dopt%3DAbstract In this study we evaluated the efficacy and tolerability of sublingual fentanyl (SLF) for breakthrough pain (BTP) in adult opioid-tolerant cancer patients. Patients received one dose of placebo, SLF 100, 200 and 400 microg in random order at four pain episodes. The primary efficacy endpoint was pain intensity difference (PID) from baseline. Twenty-seven patients received study medication. Overall PID increased significantly with SLF 400 microg versus placebo (8.57 mm, p < 0.0001). Improvements were statistically different from placebo at 15 min (p = 0.005). SLF 100 and 200 microg showed a numerical trend towards improved pain relief. A dose that gave a clinically important reduction in pain (PID > 20 mm) was identified by 95% of patients. Reduced use of rescue medication (p < 0.00... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3105594 Wed, 16 Dec 2009 00:00:00 +0100 3105594 http://www.medworm.com/index.php?rid=3105593&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20015922%26dopt%3DAbstract Authors: Fergus CJ, Chinn DJ, Murray SA Recent changes to out-of-hours primary care in the UK have generated concerns about care for palliative care patients. The aim of this study was to identify key challenges and improvements to out-of-hours palliative care in a mixed urban and rural deprived area. We integrated data from three sources: interviews with patients and professionals, direct observations of services, and routine statistics. Key issues in the provision of care were the importance of good communication and having information available, the unwieldy process of accessing medical care out of hours, professionals bypassing routine out-of-hours care for palliative care patients, and out-of-hours care being provided by practitioners unaware of local services. We recommend provis... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3105593 Wed, 16 Dec 2009 00:00:00 +0100 3105593 http://www.medworm.com/index.php?rid=3105592&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20015923%26dopt%3DAbstract Authors: Taylor N, Fisher S, Butler C PMID: 20015923 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3105592 Wed, 16 Dec 2009 00:00:00 +0100 3105592 http://www.medworm.com/index.php?rid=3105591&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20015924%26dopt%3DAbstract Authors: Chambers J PMID: 20015924 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3105591 Wed, 16 Dec 2009 00:00:00 +0100 3105591 http://www.medworm.com/index.php?rid=3067535&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19965950%26dopt%3DAbstract Authors: Duke S, Bennett H The quality of research, and the resulting quality of evidence available to guide palliative care, is dependent on the ethical decisions underpinning its design, conduct and report. Whilst much has been published debating the ethics of palliative care research, an assessment of the quality and synthesis of the central debates is not available. Such a review is timely to inform research governance. The methodology of this study is based on the principles of systematic reviews. Fifty-seven papers were reviewed following a thorough search, and were critically appraised for their literary quality, the knowledge on which they drew and the research standards they addressed. The debates identified address vulnerability, moral appropriateness, consent, gate-keeping a... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3067535 Fri, 04 Dec 2009 00:00:00 +0100 3067535 http://www.medworm.com/index.php?rid=3015797&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19926643%26dopt%3DAbstract Authors: Gadoud AC, Rahman A PMID: 19926643 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3015797 Thu, 19 Nov 2009 00:00:00 +0100 3015797 http://www.medworm.com/index.php?rid=3015796&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19926644%26dopt%3DAbstract Authors: Payne S, Burton C, Addington-Hall J, Jones A The aims of this qualitative study were to identify patients' and family members' experiences of acute stroke and their preferences for end-of-life care. Twenty-eight purposely sampled patients with an acute stroke who had high (n = 13) and low (n = 15) disability were selected from 191 sequential cases admitted to two general hospitals in north-east England. In addition, 25 family members of other stroke patients were recruited. Views about current stroke services and preferences for end-of-life care were elicited in semi-structured interviews. Communication between patients and family members and healthcare professionals was consistently highlighted as central to a positive experience of stroke care. Honesty and clarity of informa... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3015796 Thu, 19 Nov 2009 00:00:00 +0100 3015796 http://www.medworm.com/index.php?rid=3015795&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19926645%26dopt%3DAbstract The objective of this study was to evaluate the key components of services for people with advanced heart failure from multiple perspectives and recommend how care might be delivered in line with UK policies on long-term conditions, palliative and end-of-life care. Serial interviews were conducted over 2 years with patients, case-linked family carers and professionals (n =162); followed by four focus groups involving patients, carers and key professionals (n =32). There were 36 patients with advanced heart failure, 30 family carers and 62 professionals included in the study from a UK health region with various heart failure care models. Participants confirmed the value of a key health professional coordinating care, holistic assessment and regular monitoring. A lack of time and resources d... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3015795 Thu, 19 Nov 2009 00:00:00 +0100 3015795 http://www.medworm.com/index.php?rid=3015794&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19926646%26dopt%3DAbstract Authors: Gillon S, Johnson M, Campbell C PMID: 19926646 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3015794 Thu, 19 Nov 2009 00:00:00 +0100 3015794 http://www.medworm.com/index.php?rid=3015793&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19926647%26dopt%3DAbstract Authors: Rigby J, Payne S, Froggatt K Relatively little is known about the type of physical environment which is needed and preferred by patients aged 65 and over, with a prognosis of 1 year or less, who are receiving care in hospitals, care homes and hospices, and their families and staff. A narrative literature review was conducted to identify and analyse evidence on this issue, with twenty-nine papers meeting the inclusion criteria. The patients were found to have a wide range of views on their environment, but there was some variation between the views of patients and those of their families and staff. Four main themes emerged: the physical environment should be 'homely'; it should support patients' need for social interaction and privacy; it should support the caring activities of... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3015793 Thu, 19 Nov 2009 00:00:00 +0100 3015793 http://www.medworm.com/index.php?rid=3015792&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19926648%26dopt%3DAbstract Authors: Dorman S, Smith V, Kirkham S PMID: 19926648 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3015792 Thu, 19 Nov 2009 00:00:00 +0100 3015792 http://www.medworm.com/index.php?rid=3000870&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19910394%26dopt%3DAbstract Authors: Bosma H, Apland L, Kazanjian A The role of culture is significant in hospice palliative care (HPC). While mainstream HPC has been well described in many Western countries, there is no conceptual clarity regarding the meaning of HPC among minority cultures and ethnicities. In this article we describe and critically appraise the findings of a literature synthesis of 15 qualitative studies regarding the conceptualization of HPC among culturally diverse populations. Three primary themes emerged regarding HPC. They highlight: (i) that HPC should attend to the physical, psychosocial and spiritual aspects of death and dying; (ii) that the ideal HPC provider demonstrates excellent knowledge and expertise about end-of-life care, and is respectful, genuine and compassionate; and (iii) t... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3000870 Thu, 12 Nov 2009 00:00:00 +0100 3000870 http://www.medworm.com/index.php?rid=3000869&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19910395%26dopt%3DAbstract Conclusions These findings provide a framework for future research concerning the needs of Deaf individuals facing the end of life and provide guidance for clinicians. PMID: 19910395 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3000869 Thu, 12 Nov 2009 00:00:00 +0100 3000869 http://www.medworm.com/index.php?rid=3000868&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19910396%26dopt%3DAbstract Authors: Lasheen W, Walsh D, Mahmoud F, Sarhill N, Rivera N, Davis M, Lagman R, Legrand S Morphine (M) is the opioid analgesic of choice for severe cancer pain. The IV to PO M equipotent switch ratio (CR) is controversial. We designed this prospective observational cohort to confirm the efficacy and safety of M IV to PO CR of 1:3. Consecutive cancer patients admitted to an inpatient palliative medicine unit were screened for inclusion. Pain was managed by palliative medicine specialists. They were blinded to the patient data collected, and the calculated CR. The switch was considered successful if the following criteria were met: (1) Pain adequately controlled: pain rated as none or mild (2) Number of RD less than 4 (for non incident pain) per 24 hours (3) No limiting side effects. We ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3000868 Thu, 12 Nov 2009 00:00:00 +0100 3000868 http://www.medworm.com/index.php?rid=3000867&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19910397%26dopt%3DAbstract Authors: Pollak K, Alexander SC, Grambow SC, Tulsky JA PMID: 19910397 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=3000867 Thu, 12 Nov 2009 00:00:00 +0100 3000867 http://www.medworm.com/index.php?rid=2918846&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19843620%26dopt%3DAbstract Conclusions: Many measurement instruments were identified, but most had not yet been adequately evaluated. The evaluation of existing instruments with good content validity should have priority over the development of new instruments. PMID: 19843620 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2918846 Mon, 19 Oct 2009 23:00:00 +0100 2918846 http://www.medworm.com/index.php?rid=2918845&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19843621%26dopt%3DAbstract This article describes and critically appraises the findings of a literature synthesis of 15 qualitative studies regarding the conceptualization of HPC among culturally diverse populations. Three primary themes emerged regarding HPC. They highlight i) that HPC should attend to the physical, psychosocial and spiritual aspects of death and dying; ii) that the ideal HPC provider demonstrates excellent knowledge and expertise about end of life care, and is respectful, genuine and compassionate; and (iii), that HPC should include a range of resources that alleviate the potential burdens associated with end of life care. The synthesis of this knowledge suggests that expectations regarding the scope of HPC across ethnic and cultural groups have more similarities than differences to the goals of m... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2918845 Mon, 19 Oct 2009 23:00:00 +0100 2918845 http://www.medworm.com/index.php?rid=2912675&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19837701%26dopt%3DAbstract Authors: Dewhurst F, Lee M, Wood B Parkinson's Disease (PD) is an irreversible degenerative neurological disorder with no known cure. Apomorphine is a potent short-acting D1/D2 dopamine agonist administered sub-cutaneously that is used in the treatment of PD. Optimising PD medication is an important aspect of end of life care. There are no previously reported cases of apomorphine providing symptom relief in terminal care of PD patients. This case highlights its potential benefits for symptom control at the end of life. PMID: 19837701 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2912675 Thu, 15 Oct 2009 23:00:00 +0100 2912675 http://www.medworm.com/index.php?rid=2912674&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19837702%26dopt%3DAbstract Conclusion: Such results provide a comprehensive picture of costs related to palliative care in Canada, by specifying the cost sharing between the PHCS, the family, and NFPO. PMID: 19837702 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2912674 Thu, 15 Oct 2009 23:00:00 +0100 2912674 http://www.medworm.com/index.php?rid=2912673&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19837703%26dopt%3DAbstract The objectives of this study were to establish the extent to which UK primary care has adopted recommended practices on supportive and palliative care of adults with cancer, and to relate this to participation in national initiatives. We conducted a cross-sectional postal questionnaire survey of a random sample of UK general practices. In total, 60.0% of practices (2096 of 3495) responded to the survey: 61.5% reported involvement with the Gold Standards Framework (GSF); 24.4% with the Liverpool or other End of Life Care Pathway; 12.3%, with the Preferred Place of Care (PPC) initiative; and 8.4% with Advance Care Planning (ACP). Participation in GSF contributed most to the variance in practice organization scores; and practice organization scores contributed most to the variance in clinical... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2912673 Thu, 15 Oct 2009 23:00:00 +0100 2912673 http://www.medworm.com/index.php?rid=2895409&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19825893%26dopt%3DAbstract Authors: O'Mahony S, McHenry J, Blank AE, Snow D, Karakas SE, Santoro G, Selwyn P, Kvetan V Nearly half of Americans who die in hospitals spend time in the intensive care unit (ICU) in the last 3 days of life. Minority patients who die in the ICU are less likely to formalize advance directives and surviving family members report lower satisfaction with the provision of information and sensitivity to their cultural traditions at the end-of-life. This is a descriptive report of a convenience sample of 157 consecutive patients served by a palliative care team which was integrated into the operations of an ICU at Montefiore Medical Center in the Bronx, New York, from August 2005 until August 2007. The team included an advance practice nurse (APN) and social worker. A separate case-control ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2895409 Mon, 12 Oct 2009 23:00:00 +0100 2895409 http://www.medworm.com/index.php?rid=2895408&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19825894%26dopt%3DAbstract The objective of this study was to review the literature on depression in palliative cancer care in order to identify which assessment methods and classification systems have been used in studies of depression. Extensive electronic database searches in PubMed, CancerLit, CINAHL, PsychINFO, EMBASE and AgeLine as well as hand search were carried out. In the 202 included papers, 106 different assessment methods were used. Sixty-five of these were only used once. All together, the Hospital Anxiety and Depression Scale (HADS) was the most commonly used assessment method. However, there were regional differences and while the HADS dominated in Europe it was quite seldom used in Canada or in the USA. Few prevalence and intervention studies used assessment methods with an explicit reference to a d... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2895408 Mon, 12 Oct 2009 23:00:00 +0100 2895408 http://www.medworm.com/index.php?rid=2895407&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19825895%26dopt%3DAbstract This study is the first to specifically investigate the views of Australian medical oncologists toward collaboration with specialist palliative care. While positive attitudes have been expressed, identified barriers to collaboration need attention. PMID: 19825895 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2895407 Mon, 12 Oct 2009 23:00:00 +0100 2895407 http://www.medworm.com/index.php?rid=2895406&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19825896%26dopt%3DAbstract We describe a case study where intranasal alfentanil provided rapid relief of symptoms preventing repeated hospital admissions. PMID: 19825896 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2895406 Mon, 12 Oct 2009 23:00:00 +0100 2895406 http://www.medworm.com/index.php?rid=2895405&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19825897%26dopt%3DAbstract This study explores the experiences of patients with COPD, particularly fears surrounding death and dying. Semi-structured interviews were conducted with 21 patients with moderate or severe COPD. Findings revealed that patient understanding of COPD was poor, most patients were unaware of the progressive nature of the condition, and few were aware they could die of COPD. Despite this, patients often expressed concerns that their condition might deteriorate. Patients had particular concerns regarding the manner of their death; the overriding fear was dying of breathlessness or suffocation. None of the patients' had discussed these fears with a health care professional. Improved patient education is needed in order to improve patients understanding of their condition and prognosis. Open commu... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2895405 Mon, 12 Oct 2009 23:00:00 +0100 2895405 http://www.medworm.com/index.php?rid=2859230&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19797338%26dopt%3DAbstract Authors: Selby D, Wright F, Stilos K, Daines P, Moravan V, Gill A, Chakraborty A This prospective study followed 35 patients admitted to hospital with malignant bowel obstruction (MBO) to evaluate quality of life (QOL). Subjects completed the Edmonton Symptom Assessment Scale (ESAS) and Rotterdam Symptom Checklist (RSCL) at recruitment, and at one week, one month and three months.The highest ranked ESAS scores at recruitment (which was generally 18-36 hours post admission to hospital) included loss of appetite (median=7.5), fatigue (6.5) and overall well-being (6.0). The total ESAS score improved by 7.5, 11.5 and 11.0 points respectively at one week, one month and three months (p<0.05, p<0.01, NS).RSCL median scores for physical and psychological subscales were high at baseline (... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2859230 Wed, 30 Sep 2009 23:00:00 +0100 2859230 http://www.medworm.com/index.php?rid=2859229&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19797339%26dopt%3DAbstract The objective of this study was to quantify the impact of standardized assessment and management tools on patient symptom scores in cancer-induced anorexia cachexia syndrome (ACS) using a within-group study design. Baseline assessments included the Patient Generated Subjective Global Assessment (PG-SGA) tool and an amended Symptoms and Concerns Checklist (SCC). Symptom management strategies, written for this project, were instigated. Follow-up SCC scores were collected at 2 and 4 weeks. Forty out of 79 patients referred were recruited; 29/79 (36.7%) were too unwell or had died prior to consent. At baseline, the PG-SGA tool revealed 250 active symptoms associated with ACS. Total PG-SGA score was above 9 for all patients. Predominant interventions involved simple dietary advice and prescript... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2859229 Wed, 30 Sep 2009 23:00:00 +0100 2859229 http://www.medworm.com/index.php?rid=2859228&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19797340%26dopt%3DAbstract Authors: Mas C, Albaret MC, Sorum P, Mullet E The purpose of this study is to analyze French general practitioners' attitudes toward prescribing opiate painkillers for dying patients and compare them with their attitudes toward making frequent home visits. One hundred and fifteen general practitioners indicated the acceptability of prescribing opiates in 48 scenarios of terminal cancer patients with different levels of age, gender, stated pain, request for painkillers, and signs of depression; 103 of them also indicated the acceptability of making frequent home visits in the same 48 scenarios. The responses were analyzed using analysis of variance and cluster analysis. For prescribing opiates, four clusters of physicians were found: 13 prescribed primarily in response to stated pain; 4... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2859228 Wed, 30 Sep 2009 23:00:00 +0100 2859228 http://www.medworm.com/index.php?rid=2810305&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19762368%26dopt%3DAbstract Authors: Agnew A, Manktelow R, Taylor BJ, Jones L Bereavement needs assessment for specialist palliative care services has been highlighted as important by NICE guidance on palliative care for adults with cancer. Identifying and implementing appropriate bereavement measurement tools has remained a challenge. This paper identifies and reviews bereavement measurement tools to determine their suitability for use within bereavement services and hospice settings. Cochrane, MEDLINE, PsycINFO and CINAHL, electronic databases were searched, yielding 486 papers. From fifty-nine full text papers appraised, 10 measurement tools were analysed in detail. Some tools had been tested on specific populations which limited transferability to specialist palliative care settings; some lacked adequate theo... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2810305 Wed, 16 Sep 2009 23:00:00 +0100 2810305 http://www.medworm.com/index.php?rid=2810304&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19762369%26dopt%3DAbstract Authors: Turner M, Payne S Hospice trustees are volunteers who are vital to the governance and management of independent, charitable hospices, yet little is known about their roles and concerns. This paper presents some findings from a qualitative study which explored the views and perspectives of hospice trustees in the UK. Twenty hospice trustees took part in semi-structured telephone interviews, which were analysed using an iterative thematic approach. Nine themes emerged from the analysis, and were grouped into two major categories. One theme, 'becoming a trustee', is presented in this paper to illustrate trustees' concerns about the challenges they face in adapting to change. The pace of change currently facing hospices in the UK is an issue of particular concern to trustees, pres... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2810304 Wed, 16 Sep 2009 23:00:00 +0100 2810304 http://www.medworm.com/index.php?rid=2668569&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19648221%26dopt%3DAbstract This article explores the nature of the adverse responses to the survey. The majority of complaints were received from family members rather than from patients. Complaints described dissatisfaction with the topic, little warning about the study and felt it to be inappropriate for their family member's level of health. Survey instruments used to determine attitudes and needs in relation to end-of-life patient care are likely to elicit adverse responses that should be reported in a similar way to other investigational studies. Also arising from adverse responses and the complaint process, is the impact of criticism on study researchers. PMID: 19648221 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2668569 Thu, 30 Jul 2009 23:00:00 +0100 2668569 http://www.medworm.com/index.php?rid=2668568&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19648222%26dopt%3DAbstract Authors: Gott M, Gardiner C, Small N, Payne S, Seamark D, Barnes S, Halpin D, Ruse C The English End of Life Care Strategy promises that all patients with advanced, life limiting illness will have the opportunity to participate in Advance Care Planning (ACP). For patients with Chronic Obstructive Pulmonary Disease (COPD), the barriers to this being achieved in practice are under-explored. Five focus groups were held with a total of 39 health care professionals involved in the care of patients with COPD. Participants reported that discussions relating to ACP are very rarely initiated with patients with COPD and identified the following barriers: inadequate information provision about the likely course of COPD at diagnosis; lack of consensus regarding who should initiate ACP and in which... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2668568 Thu, 30 Jul 2009 23:00:00 +0100 2668568 http://www.medworm.com/index.php?rid=2668567&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19648223%26dopt%3DAbstract This study used psychometric methods such as item response theory and intraclass correlation coefficients. Ultimately, 20 items in 5 domains including 'philosophy', 'pain', 'dyspnoea', 'psychiatric problems" and 'gastrointestinal problems' were selected. For these items, the intraclass correlation was 0.88 overall and 0.61-0.82 in each domain; the Kuder-Richardson formula 20 in internal consistency was 0.81. Validity and reliability of the instrument were established. This tool is designed to evaluate a wider range of palliative care knowledge than currently available assessments and can be used for general physicians and nurses. The evaluation of educational programmes and the clarification of actual knowledge acquired are possible using this instrument. PMID: 19648223 [PubMed - as su... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2668567 Thu, 30 Jul 2009 23:00:00 +0100 2668567 http://www.medworm.com/index.php?rid=2668566&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19648224%26dopt%3DAbstract Authors: Lundorff L, Jønsson B, Sjøgren P Cognitive impairment seems to be highly prevalent in patients with advanced cancer. Modafinil, a novel vigilance and wake-promoting agent, may be an alternative treatment. We wanted to investigate this treatment on attentional and psychomotor dysfunction in cancer patients. 28 cancer patients with a tiredness score of 50 mm or more on a scale of 0 to 10 (0 = no tiredness, 10 = worst possible tiredness) and Karnofsky Performance Status 40-70 were included. All medications were kept stable during the trial despite short acting opioids for breakthrough pain. On day 1 the patients were randomly assigned to receive 200 mg Modafinil orally or placebo and on day 4 they crossed-over to the alternative treatment. Finger Tapping Test (FTT), Tra... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2668566 Thu, 30 Jul 2009 23:00:00 +0100 2668566 http://www.medworm.com/index.php?rid=2668565&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19648225%26dopt%3DAbstract Authors: Storr T, Quibell R Presentation of three palliative care patients who were given ketamine as an analgesic and subsequently developed significant and debilitating urological symptoms. In one patient there was resolution of symptoms following cessation of ketamine, but some symptoms persisted until death in the other two. Possible mechanisms for damage to the urothelium by ketamine are suggested. PMID: 19648225 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2668565 Thu, 30 Jul 2009 23:00:00 +0100 2668565 http://www.medworm.com/index.php?rid=2661003&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19643950%26dopt%3DAbstract This article explores perceptions of service users and key stakeholders of palliative care services about problems encountered in journeys between care settings during end-of-life care. This article draws on data from interviews with stakeholders (n = 44), patients (n = 16), carers (n = 19) and bereaved carers (n = 20); and focus groups (n = 9) with specialist nurses. Data were gathered in three areas of the United Kingdom. Data were analysed using a framework approach. Transport problems between care settings emerged as a key theme. Four particular problems were identified: (1) urgent need for transport due to patients' rapidly changing condition; (2) limited time to organise transfers; (3) the management of specialist equipment and (4) the need to clarify the resuscitation status of pati... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2661003 Wed, 29 Jul 2009 23:00:00 +0100 2661003 http://www.medworm.com/index.php?rid=2661002&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19643951%26dopt%3DAbstract Authors: Tsujikawa M, Yokoyama K, Urakawa K, Onishi K The McGill Quality of Life Questionnaire (MQOL), which consists of 16 items constructing physical, psychological, existential and support subscales and one item of overall quality of life (QOL), has been developed to assess QOL of terminal cancer patients. To examine if MQOL Japanese version (MQOL-J) is applicable, it was administered to 83 terminal cancer patients in palliative care wards several days after admission and then 7 to 10 days after the first interview. Cronbach's alpha coefficient for four subscales was 0.584-0.860. Sixteen items were classified into four factors by factor analysis, similar to the original English version. The results indicated that psychological and existential domains of the MQOL-J significantly rela... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2661002 Wed, 29 Jul 2009 23:00:00 +0100 2661002 http://www.medworm.com/index.php?rid=2661001&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19643952%26dopt%3DAbstract Authors: Draper H, Ives J, Pall H, Smith S, Damery S, Wilson S PMID: 19643952 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2661001 Wed, 29 Jul 2009 23:00:00 +0100 2661001 http://www.medworm.com/index.php?rid=2611689&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19605604%26dopt%3DAbstract In conclusion, nurses accept a wide variety of ELDs being practiced with terminally ill patients. PMID: 19605604 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2611689 Tue, 14 Jul 2009 23:00:00 +0100 2611689 http://www.medworm.com/index.php?rid=2611688&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19605605%26dopt%3DAbstract Authors: Nikles J, Mitchell G, Walters J, Hardy J, Good P, Rowett D, Shelby-James T, Currow D Many of the drugs prescribed commonly to palliative care patients have potentially significant side-effects and are of unproven benefit. The acquisition of evidence to support the prescribing of these drugs has been very slow. Single patient trials (SPTs) (also known as n-of-1 trials) offer a potential means of obtaining the evidence necessary to support or refute the use of several of the drugs and interventions whose use is currently based on physician experience or anecdote alone. A list of SPTs considered "most urgent", for commonly employed treatments and for the most common and most troublesome symptoms in palliative care is presented. These are drugs for which the gap between evidence a... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2611688 Tue, 14 Jul 2009 23:00:00 +0100 2611688 http://www.medworm.com/index.php?rid=2580602&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19581338%26dopt%3DAbstract Authors: Bush SH, Wearne HJ, Reilly PE, Chacko R, Palmer JL Little has been reported regarding the nature of home visits by palliative care specialist physicians to assist in the management of complex cases. We determined the characteristics, actionable clinical findings and recommendations made during consecutive home visits conducted by a specialist physician for patients registered with a community palliative care service. Patient demographic information and clinical records were reviewed. Ninety-one patients received a total of 104 home and residential facility visits. Median patient age was 59 (Q1-Q3, 43-72). Ten children (under the age of 14) received a total of 15 visits. Seventy-three patients (80%) had a cancer diagnosis. Median visit duration was 60 min (Q1-Q3, 45-60). The ma... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2580602 Sun, 05 Jul 2009 23:00:00 +0100 2580602 http://www.medworm.com/index.php?rid=2549234&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19528137%26dopt%3DAbstract Authors: George R PMID: 19528137 [PubMed - in process] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2549234 Sun, 28 Jun 2009 07:09:04 +0100 2549234 http://www.medworm.com/index.php?rid=2473449&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19477886%26dopt%3DAbstract Authors: Badger F, Clifford C, Hewison A, Thomas K The Gold Standards Framework in Care Homes programme aims to improve the quality of end-of-life care for residents. The impact of introducing phase 2 of the programme to homes in England was evaluated. A pre-post survey design was adopted, focusing on indicators identified as markers of good end-of-life care. The 95 homes in phase 2 of the programme were invited to participate in the evaluation. Homes completed a baseline survey of care provision and an audit of the five most recent resident deaths. The survey and audit were repeated post programme completion. Forty-nine homes returned completed pre- and post-surveys, 44 returned pre- and post-data on deaths. Although some staff found completion of the programme challenging, homes that... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473449 Wed, 03 Jun 2009 04:00:00 +0100 2473449 http://www.medworm.com/index.php?rid=2473447&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19477887%26dopt%3DAbstract In conclusion the results suggest that, contrary to existing guidelines, HPN is used to supplement oral intake, and not only for patients with a non-functioning gastrointestinal tract. PMID: 19477887 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473447 Wed, 03 Jun 2009 04:00:00 +0100 2473447 http://www.medworm.com/index.php?rid=2473443&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19494055%26dopt%3DAbstract We examined methods of measuring and reporting congruence to highlight variations impairing cross-study comparisons. Medline, PsychInfo, CINAHL, and Web of Science were systematically searched for clinical research studies examining patient preference and congruence as an outcome. Data were extracted into a matrix, including purpose, reported congruence, and method for eliciting preference. Studies were graded for quality. Using tables of preferred versus actual places of death, an overall congruence (total met preferences out of total preferences) and a kappa statistic of agreement were determined for each study. Twelve studies were identified. Percentage of congruence was reported using four different definitions. Ten studies provided a table or partial table of preferred versus actual d... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473443 Wed, 03 Jun 2009 04:00:00 +0100 2473443 http://www.medworm.com/index.php?rid=2473440&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19494056%26dopt%3DAbstract Authors: Seale C PMID: 19494056 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473440 Wed, 03 Jun 2009 04:00:00 +0100 2473440 http://www.medworm.com/index.php?rid=2473467&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19346275%26dopt%3DAbstract Authors: van der Steen JT, Gijsberts MJ, Knol DL, Deliens L, Muller MT After-death reporting by proxies on end-of-life outcomes is used in research and can also be used to target institutions directly to improve practice. We compared the scores of family caregivers and nurses on two End-of-Life in Dementia Scales (EOLD) scales: Symptom Management (SM; range 0-45) over the last 3 months of life and Comfort Assessment in Dying (CAD; range 14-42). Higher scores represent better outcomes. Four Dutch nursing homes retrospectively enrolled 48 decedents with dementia. Total mean scores for family caregivers and nurses were 28.7 (SD 9.6) versus 25.2 (SD 12.7) for the SM and 31.7 (SD 5.5) versus 32.8 (SD 8.2) for the CAD. Mean item scores also did not differ much. Concordance Correlation Coeffi... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473467 Mon, 01 Jun 2009 04:00:00 +0100 2473467 http://www.medworm.com/index.php?rid=2473463&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19433472%26dopt%3DAbstract This article reports on the qualitative interview component of a national evaluation of the NHS End of Life Care Programme. It describes and discusses the views and experiences of 37 stakeholders of the Programme in relation to its development and implementation, impact and sustainability. The sample comprises individuals holding different roles in, and contrasting views and experiences of the Programme, and from various locations in England. Overall, the aims, approach and impact of the Programme were described positively, although concerns about achieving sustainability were widespread. The extent of support for the Programme's primary aim to extend and improve end of life care, and the contribution of the hardworking and skilled individuals involved with its implementation, were highlig... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473463 Mon, 01 Jun 2009 04:00:00 +0100 2473463 http://www.medworm.com/index.php?rid=2473452&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19477884%26dopt%3DAbstract Authors: van der Heide A, Onwuteaka-Philipsen B, Deliens L, van Delden J, van der Maas P PMID: 19477884 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473452 Thu, 28 May 2009 04:00:00 +0100 2473452 http://www.medworm.com/index.php?rid=2473451&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19477885%26dopt%3DAbstract The objectives of this study are to ascertain how many patients who died in a district general hospital in England might have been able to be cared for at home, to obtain the cost of each inpatient stay, to make an estimate of the maximum resource implications of care packages for these patients, and to calculate the savings in hospital admissions that could be used for the development of community services. These objectives are dependant on full implementation of the End of Life Strategy. A descriptive study of all inpatient deaths in one year in a district general hospital in the south west of England was conducted. Data collection - case notes of all patients who died at the hospital from the beginning of June 2006 to end of May 2007. A total of 599 case notes of 627 patients who died i... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473451 Thu, 28 May 2009 04:00:00 +0100 2473451 http://www.medworm.com/index.php?rid=2473445&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19477888%26dopt%3DAbstract This article will explain that the experience of dying benefits from being situated and analysed in a broader context of cultural experience, as suggested by the theory and study of human suffering. Conversely, the theory and methods involved in studies of human suffering can gain from a mortal view of vulnerability, grief, social ambiguity and identity changes characteristic of experiences at the end of life. PMID: 19477888 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473445 Thu, 28 May 2009 04:00:00 +0100 2473445 http://www.medworm.com/index.php?rid=2473457&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19460830%26dopt%3DAbstract Authors: Ahluwalia S, Fried T Outpatient palliative care can provide significant benefits to seriously ill patients, but several barriers to appropriate referrals remain. No study has examined the physician factors associated with referral to outpatient palliative care. To determine physician factors, with a focus on physician beliefs, associated with referral to palliative care. Cross-sectional study of 170 primary care physicians at Kaiser Permanente (KP), a large non-profit Health Maintenance Organisation (HMO), using a self-administered questionnaire. Of the 145 respondents, 100 (70%) reported referring any patients to the palliative care program in the prior year, with a median of 3 referrals (interquartile range 2, 6). Factors associated with referral included working at KP betwe... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473457 Thu, 21 May 2009 04:00:00 +0100 2473457 http://www.medworm.com/index.php?rid=2473456&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19460831%26dopt%3DAbstract Authors: Ache K, Wallace L Although established guidelines for developing low-literacy patient education materials are available, poorly designed material continue to be disseminated. We evaluated the readability and layout of English-language end-of-life patient education materials available on the Internet. Internet websites of five national palliative care organizations were searched to identify patient education materials for review. A convenience sample of 15 patient education materials per palliative care organization (n = 75) was downloaded and printed. The Simplified Measure of Gobbledygook (SMOG) was used to calculate the reading grade level (readability) of the text, while the layout features was assessed using criteria from the User-Friendliness Tool (UFT). The reading grade... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473456 Thu, 21 May 2009 04:00:00 +0100 2473456 http://www.medworm.com/index.php?rid=2473455&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19460832%26dopt%3DAbstract Authors: Mullick A, Beynon T, Colvin M, Morris M, Shepherd L, Cave L, Lowell J, Asmall N, Carey I PMID: 19460832 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473455 Thu, 21 May 2009 04:00:00 +0100 2473455 http://www.medworm.com/index.php?rid=2473454&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19460833%26dopt%3DAbstract Authors: Grogan E, Beattie R, Campbell C, George R, Harlow T, Macgregor B, Oliver D, Thorns A, Noble B PMID: 19460833 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473454 Thu, 21 May 2009 04:00:00 +0100 2473454 http://www.medworm.com/index.php?rid=2473453&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19460834%26dopt%3DAbstract We report our experience of the terminal care of 40 patients with CF with regard to the circumstances of death, lung transplantation status, specific symptoms and provision of palliative treatments. The transition from disease modifying treatments to palliative care was particularly complex. Patients had a high level of symptoms requiring palliation and most died in hospital. Palliative care is a crucial component of a CF service and requires the specialist skills of both the CF and palliative care teams. PMID: 19460834 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473453 Thu, 21 May 2009 04:00:00 +0100 2473453 http://www.medworm.com/index.php?rid=2473462&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19443521%26dopt%3DAbstract This study provides 'palliative patient' perspectives to strengthen recommended models of spiritual care delivery. It shows that user opinions on training can be helpful not only in deciding objectives but also how to achieve them. PMID: 19443521 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473462 Thu, 14 May 2009 04:00:00 +0100 2473462 http://www.medworm.com/index.php?rid=2473461&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19443522%26dopt%3DAbstract Authors: Dorman S, Hayes J, Pease N Brain metastases are a common complication of non-small cell lung cancer (NSCLC). Prognosis is poor and the effectiveness of whole brain radiotherapy (WBRT) is uncertain for patients with moderate performance status. Studies on WBRT effectiveness have thus far used outcome measures, such as survival, performance status and cognitive function. The aim of this study was to study what patients with recently diagnosed brain metastases from NSCLC want from their treatment. We carried out semistructured interviews with nine patients with brain metastases from NSCLC, for whom the benefit of WBRT is uncertain. Interpretative phenomenological analysis was used. Themes identified included quality versus quantity of life, factors contributing to quality of life... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473461 Thu, 14 May 2009 04:00:00 +0100 2473461 http://www.medworm.com/index.php?rid=2473460&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19443523%26dopt%3DAbstract Authors: Lee W, Price A, Rayner L, Hotopf M PMID: 19443523 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473460 Thu, 14 May 2009 04:00:00 +0100 2473460 http://www.medworm.com/index.php?rid=2473459&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19443524%26dopt%3DAbstract This study used participant feedback to qualitatively evaluate an intervention (Assessing Caregivers for Team Intervention through Videophone Encounters [ACTIVE]) that used videophone technology to include patients and/or their family caregivers in hospice interdisciplinary team meetings. Data were generated during individual interviews with hospice staff members and family caregivers who participated in ACTIVE intervention. Modified grounded theory procedures served as the primary analysis strategy. Results indicated that ACTIVE intervention enhanced team functioning in terms of context, structure, processes and outcomes. Participants discussed challenges and offered corresponding recommendations to make the intervention more efficient and effective. Data supported the ACTIVE intervention... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473459 Thu, 14 May 2009 04:00:00 +0100 2473459 http://www.medworm.com/index.php?rid=2473458&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19443525%26dopt%3DAbstract Authors: Johnsen A, Petersen M, Pedersen L, Groenvold M Little is known about the need for palliative care among advanced cancer patients who are not in specialist palliative care. The purpose was to identify prevalence and predictors of symptoms and problems in a nationally representative sample of Danish advanced cancer patients. Patients with cancer stage 3 or 4 from 54 hospital departments (n = 1630) received the EORTC QLQ-C30 questionnaire. Mean scores were calculated according to the scoring manual and in addition a 'symptom/problem' and a 'severe symptom/problem' was defined and calculated. Multiple logistic regression was used to identify predictors. In total, 977 (60%) patients participated. The most frequent symptoms/problems were fatigue (57%; severe 22%) followed by reduced... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473458 Thu, 14 May 2009 04:00:00 +0100 2473458 http://www.medworm.com/index.php?rid=2473466&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19351793%26dopt%3DAbstract ConclusionCare for children and their families should be coordinated by a multidisciplinary team in consultation with children and their families, and should be linked and integrated with the treating hospital in collaboration with community services. PMID: 19351793 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473466 Tue, 07 Apr 2009 04:00:00 +0100 2473466 http://www.medworm.com/index.php?rid=2473465&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19351794%26dopt%3DAbstract Authors: Johnson A, Abernathy T, Howell D, Brazil K, Scott S This paper presents a detailed description of health care resource utilisation and costs of a pilot interdisciplinary health care model of palliative home care in Ontario, Canada. The descriptive evaluation entailed examining the use of services and costs of the pilot program: patient demographics, length of stay broken down by disposition (discharged, alive, death), access to services/resources, use of family physician and specialist services, and drug use. There were 434 patients included in the pilot program. Total costs were approximately CAN$2.4 million, and the cost per person amounted to approximately CAN$5586.33 with average length of stay equal to over 2 months (64.22 days). One may assume that length of stay would b... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473465 Tue, 07 Apr 2009 04:00:00 +0100 2473465 http://www.medworm.com/index.php?rid=2473464&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19351795%26dopt%3DAbstract Authors: Svidén G, Fürst C, von Koch L, Borell L AimThe aim of the study was to study the outcomes of palliative day care, in terms of health-related quality of life and the emotional well-being of cancer patients participating in a palliative day care programme for a period of five weeks, compared with a group of palliative cancer patients not participating in day-care.MethodsThe day care sample comprised of patients in a palliative day care programme delivered in two different day care facilities. Participants in the comparison group were recruited from a palliative home care service facility. All patients had a cancer diagnosis. The participants were invited to respond to two questionnaires once a week for a period of five weeks; the European Organization for Research and ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473464 Tue, 07 Apr 2009 04:00:00 +0100 2473464 http://www.medworm.com/index.php?rid=2473468&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19346274%26dopt%3DAbstract ConclusionPediatric palliative care programs should use the DCS to measure the effectiveness of services aimed at supporting families with high levels of decisional conflict. PMID: 19346274 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2473468 Fri, 03 Apr 2009 04:00:00 +0100 2473468 http://www.medworm.com/index.php?rid=2297403&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19318458%26dopt%3DAbstract Authors: Grande G PMID: 19318458 [PubMed - in process] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297403 Sun, 29 Mar 2009 12:17:21 +0100 2297403 http://www.medworm.com/index.php?rid=2297400&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19318459%26dopt%3DAbstract This study estimates the frequency of different medical end-of-life decisions (ELDs) made in the United Kingdom (UK) in 2007-2008, comparing these with 2004. Postal survey was carried out with 8857 medical practitioners, of whom 3733 (42%) practitioners replied, with 2869 having attended a person who died in the previous year. The proportion of UK deaths involving (1) voluntary euthanasia (0.21%; CI: 0-0.52), (2) physician-assisted suicide (0.00%) and (3) ending of life without an explicit request from the patient (0.30%; CI: 0-0.60) is low. Better questions about ELDs showed both non-treatment decisions (21.8%; CI: 19.0-24.5) and double effect measures (17.1%; CI: 14.6-19.6) to be much less common than suggested in earlier estimates, rarely involving intent to end life or being judged to ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297400 Sun, 29 Mar 2009 12:16:38 +0100 2297400 http://www.medworm.com/index.php?rid=2297397&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19318460%26dopt%3DAbstract This study reports UK doctors' opinions about legalisation of medically assisted dying (euthanasia and physician-assisted suicide), comparing this with the UK general public. A postal survey of 3733 UK medical practitioners was done. The majority of UK doctors are opposed to legalisation, contrasting with the UK general public. Palliative medicine specialists are particularly opposed. A strong religious belief is independently associated with opposition to assisted dying. Frequency of treating patients who die is not independently associated with attitudes. Many doctors supporting legalisation also express reservations and advocate safeguards; many doctors opposing legalisation believe and accept that treatment and nontreatment decisions may shorten life. It is hoped that future debates ab... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297397 Sun, 29 Mar 2009 12:15:53 +0100 2297397 http://www.medworm.com/index.php?rid=2297393&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19318461%26dopt%3DAbstract This study has documented in detail the longitudinal anticholinergic load associated with medications used in a palliative care population between referral and death, demonstrating the biggest contributor to anticholinergic load in a palliative care population is from symptom-specific medications, which increased as death approached. PMID: 19318461 [PubMed - in process] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297393 Sun, 29 Mar 2009 12:15:04 +0100 2297393 http://www.medworm.com/index.php?rid=2297390&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19318462%26dopt%3DAbstract Authors: Schulz V, Kozell K, Biondo PD, Stiles C, Tonkin K, Hagen NA Malignant wounds, caused by the direct invasion of cancer into the skin, occur in cancer patients with primary skin tumours and as cutaneous metastasis in approximately 10% of patients with metastatic internal malignancies. Malignant wounds have a profound impact on patients, family members and health care providers. The assessment of the patient with malignant wounds can be complex and there is no widely accepted, consistent approach. Valid, descriptive survey research methods were used to develop the Malignant Wound Assessment Tool (MWAT). The authors developed two versions of the MWAT: a brief clinical version (MWAT-C) and a more detailed research version (MWAT-R). Domains include clinical wound features, physical ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297390 Sun, 29 Mar 2009 12:13:54 +0100 2297390 http://www.medworm.com/index.php?rid=2297387&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19324922%26dopt%3DAbstract Authors: Larochelle M, Rodriguez K, Arnold R, Barnato A Discrepancies between patient wishes and end-of-life treatment decisions have been documented, and the determinants of end-of-life treatment decisions are not well understood. Our objective was to understand hospital staff perceptions of the role of acute care hospital medical doctors in end-of-life treatment intensity. In 11 purposively sampled Pennsylvania hospitals, we completed 108 audiotaped semistructured interviews with key informants involved in decision making or discharge planning. Using grounded theory, we qualitatively analysed transcripts using constant comparison to identify factors affecting end-of-life treatment decisions. A predominant theme identified was that end-of-life treatment intensity depends on the doctor... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297387 Thu, 26 Mar 2009 04:00:00 +0100 2297387 http://www.medworm.com/index.php?rid=2297384&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19324923%26dopt%3DAbstract This study describes current ACP practice in care homes for older people drawing on data from a questionnaire survey (n = 213) of, and interviews (n = 15) with, care home managers. Whilst consultation about general care is taking place in the majority of homes surveyed using both formal and informal processes, the number of residents that have completed any ACP processes varies. Managers face intrinsic and extrinsic challenges related to the ascertaining of, and the implementing of wishes as they address ACP in the care home context. Until these wider contextual factors are addressed it will be difficult for staff in care homes to effectively undertake and implement ACP in care homes. PMID: 19324923 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297384 Thu, 26 Mar 2009 04:00:00 +0100 2297384 http://www.medworm.com/index.php?rid=2297382&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19324924%26dopt%3DAbstract Authors: Stephenson J PMID: 19324924 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297382 Thu, 26 Mar 2009 04:00:00 +0100 2297382 http://www.medworm.com/index.php?rid=2297440&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19304803%26dopt%3DAbstract We report the case of a patient with tonsillar carcinoma, presenting with insomnia and symptoms of obstructive sleep apnoea/hypopnea syndrome (OSAHS), which were exacerbated following an increase in benzodiazepine dose. There is a growing body of evidence describing OSAHS in patients treated for head and neck cancer. However, to our knowledge, there are no reports relating to the population of patients with progressive disease, whose management is palliative. We would advise consideration be given to the possibility of OSAHS in a patient presenting with an oropharyngeal tumour and sleep disturbance and would also suggest caution in the prescription of benzodiazepines and other sedative medication to this group of patients. PMID: 19304803 [PubMed - as supplied by publisher] (Source: Pal... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297440 Fri, 20 Mar 2009 04:00:00 +0100 2297440 http://www.medworm.com/index.php?rid=2297435&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19304804%26dopt%3DAbstract Authors: Grande G, Stajduhar K, Aoun S, Toye C, Funk L, Addington-Hall J, Payne S, Todd C Informal carers are central to the achievement of end of life care and death at home and to policy aims of enabling patient choice towards end of life. They provide a substantial, yet hidden contribution to our economy. This entails considerable personal cost to carers, and it is recognised that their needs should be assessed and addressed. However, we lack good research evidence on how best to do this. The present position paper gives an overview of the current state of carer research, its gaps and weaknesses, and outlines future priorities. It draws on a comprehensive review of the carer literature and a consensus meeting by experts in the field. Carers' needs and adverse effects of caregiving h... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297435 Fri, 20 Mar 2009 04:00:00 +0100 2297435 http://www.medworm.com/index.php?rid=2297429&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19304805%26dopt%3DAbstract Authors: Malcolm C, Knighting K, Forbat L, Kearney N The Delphi process, widely used in health research to seek consensus on key issues amongst large stakeholder groups, was adopted to allow families, hospice staff/volunteers and linked professionals to identify and prioritise future research priorities for children's hospice care. In the qualitative Round 1, interviews with families (n = 5), linked professionals (n = 18) and focus groups with hospice staff and volunteers (n = 44) led to the generation of 56 research topics categorised within 14 broad themes. To give a larger number of stakeholders (n = 621) (including families n = 293; hospice staff/volunteers n = 216 and professionals n = 112) the opportunity to rate the importance of each research topic and seek group consensus on t... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297429 Fri, 20 Mar 2009 04:00:00 +0100 2297429 http://www.medworm.com/index.php?rid=2297422&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19304806%26dopt%3DAbstract Authors: Currow D, Agar M, Smith J, Abernethy A Palliative oxygen for refractory dyspnoea is frequently prescribed, even when the criteria for long-term home oxygen (based on survival, rather than the symptomatic relief of breathlessness) are not met. Little is known about how palliative home oxygen affects symptomatic breathlessness. A 4 -year consecutive cohort from a regional community palliative care service in Western Australia was used to compare baseline breathlessness before oxygen therapy with dyspnoea sub-scales on the symptom assessment scores (SAS; 0-10) 1 and 2 weeks after the introduction of oxygen. Demographic and clinical characteristics of people who responded were included in a multi-variable logistic regression model. Of the study population (n = 5862), 21.1% (n = 12... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297422 Fri, 20 Mar 2009 04:00:00 +0100 2297422 http://www.medworm.com/index.php?rid=2297418&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19304807%26dopt%3DAbstract Authors: Rietjens R, Buiting H, Pasman H, van der Maas P, van Delden J, van der Heide A Although guidelines restrict the use of continuous deep sedation to patients with refractory physical symptoms and a short life-expectancy, its use is not always restricted to these conditions. A focus group study of physicians was conducted to gain more insight in the arguments for and against the use of continuous deep sedation in several clinical situations. Arguments in favour of continuous deep sedation for patients with a longer life-expectancy were that the overall clinical situation is more relevant than life-expectancy alone, and that patients' wishes should be followed. Continuous deep sedation for patients with predominantly emotional/existential suffering was considered appropriate when ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297418 Fri, 20 Mar 2009 04:00:00 +0100 2297418 http://www.medworm.com/index.php?rid=2297413&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19304808%26dopt%3DAbstract Authors: Ahlner-Elmqvist M, Bjordal K, Jordhøy M, Kaasa S, Jannert M In a longitudinal study of 297 palliative care patients, 280 patients were followed from inclusion to death. Characteristics and health-related quality of life (HRQL) of the participants and those who later dropped out were compared at inclusion, and 3 and 2 months before their death. At inclusion, the dropouts were older (P = 0.001), had reduced Karnofsky performance score (P < 0.001), received more help from the local authority (P = 0.004) and had reduced HRQL compared with patients who continued in the study and completed the next questionnaire. There were no differences in any of the HRQL parameters between participants and dropouts 3 months before death. Two months before death, differences in HRQL were f... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297413 Fri, 20 Mar 2009 04:00:00 +0100 2297413 http://www.medworm.com/index.php?rid=2297409&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19304809%26dopt%3DAbstract We describe a case of bleeding secondary to gastric cancer that failed to settle, despite treatment with tranexamic acid, etamsylate and sucralfate. Thalidomide was prescribed for its antiangiogenic properties. Bleeding settled within 1 week of starting 300 mg of thalidomide nocte. The effect appeared to be dose dependant, with bleeding recurring only when the dose was reduced to 100 mg of thalidomide nocte. PMID: 19304809 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297409 Fri, 20 Mar 2009 04:00:00 +0100 2297409 http://www.medworm.com/index.php?rid=2297405&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19304810%26dopt%3DAbstract This study explored which post-funeral remembrance activities are most significant and important to people living with death-related loss, and why those particular activities are chosen. A total of 43 participants took part in a mixed-method study using 2 different data sets: a self-report questionnaire and semi-structured interviews. To add further contextual data to support the study, a third dataset was created when six hospice bereavement counsellors met as a Focus Group. Results indicated that although formal remembrance events are valued, informal rituals created by the bereaved are more important and significant to them. Results could be divided into four different categories: rituals to maintain a 'direct link', or those undertaken 'for' the deceased, rituals that remember the dece... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2297405 Fri, 20 Mar 2009 04:00:00 +0100 2297405 http://www.medworm.com/index.php?rid=2274222&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19286741%26dopt%3DAbstract Authors: Knudsen A, Aass N, Fainsinger R, Caraceni A, Klepstad P, Jordhøy M, Hjermstad M, Kaasa S One of the aims of the European Palliative Care Research Collaborative (EPCRC) is to achieve consensus on a classification system for cancer pain. We performed a systematic literature review to identify existing classification systems and domains/items used to classify cancer patients with pain. In a systematic search in the databases Medline and Embase, covering 1986-2006, 692 hits were obtained. 92 papers were evaluated to address pain classification. Six standardised classification systems were identified; three of them systematically developed and partially validated. Both pain characteristics and patient characteristics relevant for cancer pain classification were included in the... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2274222 Fri, 13 Mar 2009 04:00:00 +0100 2274222 http://www.medworm.com/index.php?rid=2259849&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19270032%26dopt%3DAbstract This study shows that the CINAHL, Embase and PsycINFO bibliographic databases hold sizeable repositories of palliative care articles not indexed on Medline. It also highlights the number and range of journals publishing palliative care content. In 2005 alone, 1985 journals published 6983 items. These findings show the challenges for palliative care professionals in managing the complex evidence base for this diverse field of care and the importance of mechanisms that facilitate the identification of palliative care information. Dissemination strategies that ensure that new knowledge reaches the many audiences implicit in the range of journals publishing palliative care are also critical in supporting improvements in clinical practice and service delivery. PMID: 19270032 [PubMed - as su... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2259849 Fri, 06 Mar 2009 05:00:00 +0100 2259849 http://www.medworm.com/index.php?rid=2259848&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19270033%26dopt%3DAbstract Authors: Spathis A, Dhillan R, Booden D, Forbes K, Vrotsou K, Fife K Cancer-related fatigue is the most prevalent and distressing symptom experienced by patients with advanced cancer. Central nervous system stimulants have been shown to relieve fatigue in nonmalignant disease. Modafinil is a stimulant with a selective site of action in the brain that is better tolerated than traditional stimulants, such as methylphenidate. The aim of this study was to determine the feasibility of conducting a randomised controlled trial to assess the efficacy and safety of modafinil for the treatment of fatigue in patients with lung cancer. Twenty patients with non-small cell lung cancer were recruited to this open-label study. Modafinil was taken in a fixed dose-titration schedule of 100 mg daily for ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2259848 Fri, 06 Mar 2009 05:00:00 +0100 2259848 http://www.medworm.com/index.php?rid=2259847&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19273566%26dopt%3DAbstract Authors: Douglas C, Murtagh FE, Chambers EJ, Howse M, Ellershaw J Improvement in end-of-life-care is required for patients dying with chronic kidney disease (CKD). The UK government now recommends that tools such as the Liverpool Care Pathway for the Dying Patient (LCP) be used to enhance the care of those patients dying with CKD. The LCP was originally developed for patients dying with terminal cancer, however has been shown to be transferable to patients dying with heart failure or stroke. On this background, in 2005 a UK National Renal LCP Steering Group was formed. The aim was to determine whether or not the generic LCP was transferable to patients dying with CKD. An Expert Consensus sub-group was established to produce evidence-based prescribing guidelines to allow safe and effect... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2259847 Sun, 01 Mar 2009 05:00:00 +0100 2259847 http://www.medworm.com/index.php?rid=2259846&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19273567%26dopt%3DAbstract Authors: Wiffen PJ, Eccleston C PMID: 19273567 [PubMed - in process] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2259846 Sun, 01 Mar 2009 05:00:00 +0100 2259846 http://www.medworm.com/index.php?rid=2234716&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19251829%26dopt%3DAbstract Authors: Knapp C, Thompson L, Madden V, Shenkman E Children have traditionally been referred to palliative care when curative treatments were exhausted. Recently, experts have suggested that children could benefit from palliative care early in their courses of illness. Using survey data from 303 paediatricians in Florida and California, this study assesses if paediatricians would refer children to palliative care early in their course of illness. Results showed that more years in practice were associated with decreased odds of referring children to palliative care. Academic practice setting and more Medicaid patients were associated with greater odds of referral prior to the end of life. Hispanic paediatricians, those with more experience and those who practice in a hospital setting we... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2234716 Fri, 27 Feb 2009 05:00:00 +0100 2234716 http://www.medworm.com/index.php?rid=2234715&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19251830%26dopt%3DAbstract Authors: Michiels E, Deschepper R, Bilsen J, Mortier F, Deliens L Objective of this study is to examine physicians' practices regarding information disclosure to terminally ill patients and to their relatives, without informing the patient. A questionnaire had been sent to a random sample of 3014 Belgian physicians from different specialties frequently involved in end-of-life care. Responses were analysed using weighted percentages, Chi-square, Mann-Whitney U-tests and a multivariate ordinal logistic regression. Response rate was 58%. Both clinical specialists and general practitioners (GPs) discuss most topics related to terminal illness with their patients except end-of-life hastening options, spirituality, life expectancy and options to withhold/withdraw life-sustaining treatment. T... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2234715 Fri, 27 Feb 2009 05:00:00 +0100 2234715 http://www.medworm.com/index.php?rid=2234714&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19251831%26dopt%3DAbstract This study investigated (a) whether carer bereavement outcome is affected by the achievement of the patient's and/or carers' preferred place of death and (b) the relationship between carer satisfaction with end of life care and bereavement outcome. Participants were 216 carers of patients referred to hospice at home (H@H). Prospective recording of preferred and actual place of death were obtained from H@H records. Carers' level of grief and mental health and assessment of end of life care were obtained through postal survey three to four months post-bereavement. Fulfilment of carer preference for place of death only related to post-bereavement mental health at P < 0.1. Adequacy of psychological support showed the clearest relationship with bereavement outcome both in univariate and mult... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2234714 Fri, 27 Feb 2009 05:00:00 +0100 2234714 http://www.medworm.com/index.php?rid=2234713&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19251832%26dopt%3DAbstract Authors: Cadell S, Ho G, Jacques L, Wilson K, Davies B, Steele R PMID: 19251832 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2234713 Fri, 27 Feb 2009 05:00:00 +0100 2234713 http://www.medworm.com/index.php?rid=2234712&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19251833%26dopt%3DAbstract Authors: Wiese C, Bartels U, Ruppert D, Marung H, Luiz T, Graf B, Hanekop G Palliative care medical emergencies as a consequence of advanced cancer account for approximately 3% of all prehospital emergency cases. Therefore, prehospital emergency physicians (EP) are confronted with 'end of life decisions'. No educational content exists concerning palliative medicine in emergency medicine curricula. Over the course of 6 months, we interviewed 150 EPs about their experiences in 'end of life decisions' using a specific questionnaire. The total response rate was 69% (n = 104). Most of the interviewed EPs (89%, n = 93) had been confronted with palliative care medical emergencies and expressed uncertainties in dealing with these difficult situations, especially in the area of psychosocial car... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2234712 Fri, 27 Feb 2009 05:00:00 +0100 2234712 http://www.medworm.com/index.php?rid=2234711&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19251834%26dopt%3DAbstract Authors: Addington-Hall J, O'Callaghan A The importance of evaluating systematically the effectiveness of hospice care has been noted for at least 20 years. There is, however, limited evidence about whether and how the care provided to terminally ill patients by in-patient hospices in the UK differs from that provided in NHS hospitals. In this article, we, therefore, present a comparison of hospice in-patient care and hospital care for cancer patients in the UK, from the perspective of bereaved relatives who had experienced both types of care during the last 3 months of the patient's life. The Office of National Statistics drew a random sample of 800 deaths in South London in 2002, and sent the person who registered the death (the informant) a Views of Informal Carers - Evaluation of S... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2234711 Fri, 27 Feb 2009 05:00:00 +0100 2234711 http://www.medworm.com/index.php?rid=2234710&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19251835%26dopt%3DAbstract Discussion of the physiology of breathlessness is included. PMID: 19251835 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2234710 Fri, 27 Feb 2009 05:00:00 +0100 2234710 http://www.medworm.com/index.php?rid=2122479&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19153131%26dopt%3DAbstract Authors: Yong D, Kwok A, Wong D, Suen M, Chen W, Tse D Palliative care for end-stage renal disease (ESRD) is developing in Hong Kong. This is the first local study to explore the symptom burden and quality of life (QOL) of ESRD patients on chronic dialysis and palliative care. This was a prospective cross-sectional study conducted on ESRD patients in a hospital in Hong Kong from January 2006 to April 2007. Data collected included demographics, socioeconomic status, modified Charlson Comorbidity Index (CCI), prevalence and intensity of 23 ESRD-related symptoms as rated by numerical rating scale (0-10), Brief Pain Inventory and QOL by MOS SF-36. A total of 179 ESRD patients completed the study; 45 patients (25.1%) were in the palliative care group and 134 patients (74.9%) in the dialysis... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2122479 Mon, 19 Jan 2009 05:00:00 +0100 2122479 http://www.medworm.com/index.php?rid=2122478&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19153132%26dopt%3DAbstract Authors: Robertson K, Hutchison S Anaemia is common in advanced cancer, may develop for several reasons, and is not always symptomatic. Our observations of the seemingly indiscriminate prescription of iron-replacement therapy (IRT) for anaemic palliative care patients, and our practice of discontinuing IRT in patients with normal red-cell indices, prompted a study to determine (1) the prevalence of anaemia in our patients, (2) what proportion had iron deficiency, (3) the prevalence and benefits of IRT and (4) the prevalence of side effects attributable to IRT. The prevalence of anaemia was 65%. We found a 9% prevalence of iron deficiency, and suggestive but inconclusive evidence of iron deficiency in a further 41%, but only three (27%) of these patients had typical iron deficiency red-... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2122478 Mon, 19 Jan 2009 05:00:00 +0100 2122478 http://www.medworm.com/index.php?rid=2122477&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19153133%26dopt%3DAbstract Authors: Lundström S, Fürst C, Friedrichsen M, Strang P Treatment with corticosteroids often results in increased appetite, reduced nausea and improved well-being in patients with advanced metastatic cancer. Therefore, we have studied the existential impact of starting corticosteroid treatment as symptom control in this patient group using qualitative content analysis with both a descriptive and an interpretative focus. Ten patients were interviewed before and after 1 week of treatment with 4 mg betamethasone. Prior to treatment, patients reported distressing symptoms, deterioration and diminished autonomy, symbolising threat and death. Corticosteroid treatment produced symptom relief in the majority of the patients. They reported enhanced physical abilities and experienced f... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2122477 Mon, 19 Jan 2009 05:00:00 +0100 2122477 http://www.medworm.com/index.php?rid=2111176&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19144764%26dopt%3DAbstract Authors: Groves KE PMID: 19144764 [PubMed - in process] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2111176 Thu, 01 Jan 2009 05:00:00 +0100 2111176 http://www.medworm.com/index.php?rid=2111175&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19144765%26dopt%3DAbstract The objective of this study was to demonstrate the efficacy, safety and patient acceptability of the use of intranasal sufentanil for cancer-associated breakthrough pain. This was a prospective, open label, observational study of patients in three inpatient palliative care units in Australia. Patients on opioids with cancer-associated breakthrough pain and clinical evidence of opioid responsiveness to their breakthrough pain were given intranasal (IN) Sufentanil via a GO Medical patient controlled IN analgesia device. The main outcome measures were pain scores, need to revert to previous breakthrough opioid after 30 min, number of patients who chose to continue using IN sufentanil, and adverse effects. There were 64 episodes of use of IN sufentanil for breakthrough pain in 30 patients. The... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2111175 Thu, 01 Jan 2009 05:00:00 +0100 2111175 http://www.medworm.com/index.php?rid=2062362&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19098108%26dopt%3DAbstract This study describes the effects of a problem-based palliative care course on perceived competence and knowledge in a representative Dutch cohort of residents in internal medicine. Before and after the course, we carried out a questionnaire survey and knowledge test in 91 residents. The results show that many residents felt they had limited competence or were incompetent when taking care of patients in the palliative care phase. This was particularly true with respect to communication concerning euthanasia and physician-assisted suicide or hastened death (86% and 85% respectively reported limited competence or incompetence). Participants reported that they received inadequate training in palliative care and believed that specific education would make them feel more competent. The number of... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2062362 Fri, 19 Dec 2008 05:00:00 +0100 2062362 http://www.medworm.com/index.php?rid=2062361&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19098109%26dopt%3DAbstract Authors: Sheils R, Ankrett H, Edwards A, Hicks F, Kiely M, Lennard R, Rock C PMID: 19098109 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2062361 Fri, 19 Dec 2008 05:00:00 +0100 2062361 http://www.medworm.com/index.php?rid=2062360&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19098110%26dopt%3DAbstract Authors: Giles S, Miyasaki J Little is known about the lived health-care experiences of persons living with palliative stage Parkinson's disease and the family members who care for them. An exploratory phenomenological investigation was adopted to understand participant's lived health-care experiences and the needs flowing from them. Three family groupings participated in semi-structured in-depth interviews. Interpretative phenomenological analysis revealed three main themes: missing information, being on your own, wanting and not wanting to know. Findings support previous research that indicate palliative care needs are not being met in our current health-care model and that palliative care services should be multi-disciplinary team-based in order to provide comprehensive support to p... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2062360 Fri, 19 Dec 2008 05:00:00 +0100 2062360 http://www.medworm.com/index.php?rid=2041132&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19073780%26dopt%3DAbstract Authors: Corli O, Apolone G, Pizzuto M, Cesaris L, Cozzolino A, Orsi L, Enterri L The amount and quality of information and awareness in cancer patients' is a topic frequently debated, but few studies have focussed on terminal patients. This is the objective of the present study that involved two different palliative home-care units in Italy, which recruited 550 terminal cancer patients. Data from patients and their caregivers was prospectively collected with special attention to information patients were provided with when their cancer was diagnosed and patients' awareness of their current health condition. In the case of the information, 67.0% of patients reported they were previously informed about their diagnosis, but only 58.0% seemed to be aware of their terminal condition. The c... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2041132 Wed, 10 Dec 2008 05:00:00 +0100 2041132 http://www.medworm.com/index.php?rid=2041131&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19073781%26dopt%3DAbstract This study aimed to ascertain the constructions placed upon disability by patients with MSCC. The method consisted of a series of nine process-tracing, longitudinal case studies, involving 58 interviews with 9 patients, 6 carers and 29 staff in one National Health Service region. A context-mechanism-outcome configuration was adopted as a conceptual basis for data collection, together with a constant comparative method of data analysis. Patients' orientation to disability incorporated two apparently inconsistent attitudes. Patients acknowledged that their situation had changed and that their future plans would need to accommodate altered circumstances. However, they also resisted the idea of themselves as disabled, wanting to retain an image of themselves as resourceful and resilient. Patie... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2041131 Wed, 10 Dec 2008 05:00:00 +0100 2041131 http://www.medworm.com/index.php?rid=2041130&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19073782%26dopt%3DAbstract This article discusses several clinical scenarios to better understand these decisions and the effects of changes in the law. It also discusses how multidisciplinary teams in children's hospices (and other supportive clinical systems) can best support young people and families with and without recourse to the law. PMID: 19073782 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2041130 Wed, 10 Dec 2008 05:00:00 +0100 2041130 http://www.medworm.com/index.php?rid=2041129&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19073783%26dopt%3DAbstract Authors: Bensink M, Armfield N, Pinkerton R, Irving H, Hallahan A, Theodoros D, Russell T, Barnett A, Scuffham P, Wootton R Videotelephony (real-time audio-visual communication) has been used successfully in adult palliative home care. This paper describes two attempts to complete an RCT (both of which were abandoned following difficulties with family recruitment), designed to investigate the use of videotelephony with families receiving palliative care from a tertiary paediatric oncology service in Brisbane, Australia. To investigate whether providing videotelephone-based support was acceptable to these families, a 12-month non-randomised acceptability trial was completed. Seventeen palliative care families were offered access to a videotelephone support service in addition to the 24 ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2041129 Wed, 10 Dec 2008 05:00:00 +0100 2041129 http://www.medworm.com/index.php?rid=2041128&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19073784%26dopt%3DAbstract This study shows the variability in belief system and attitudes to end of life decision making both within and between clinical groups. This may have practical implications for the clinical care given and the place of care. The personal belief system of consultants was not shown to affect their overall attitudes to withdrawing life-sustaining treatment or physician-assisted suicide. PMID: 19073784 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=2041128 Wed, 10 Dec 2008 05:00:00 +0100 2041128 http://www.medworm.com/index.php?rid=1999587&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19039055%26dopt%3DAbstract Authors: Powell R, Downing J, Radbruch L, Mwangi-Powell F, Harding R PMID: 19039055 [PubMed - in process] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1999587 Mon, 01 Dec 2008 05:00:00 +0100 1999587 http://www.medworm.com/index.php?rid=1999586&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19039056%26dopt%3DAbstract Authors: Hanks G PMID: 19039056 [PubMed - in process] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1999586 Mon, 01 Dec 2008 05:00:00 +0100 1999586 http://www.medworm.com/index.php?rid=1999588&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19039054%26dopt%3DAbstract The objective of this systematic review was to identify studies that compare specialised palliative care models between them assessing their effectiveness or cost-effectiveness. We searched studies published between 2003 and 2006 in several electronic databases and updated the search in MEDLINE up to 2008. Papers published before 2003 were identified by means of previous systematic reviews and manual search. Studies with broad designs comparing two or more specialised palliative care programmes in adults with terminal illness were selected. Six systematic reviews, three studies on effectiveness and one cost study were included. All systematic reviews drew the conclusion that specialised palliative care is more effective than conventional care. The methodological limitations of the original... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1999588 Thu, 27 Nov 2008 05:00:00 +0100 1999588 http://www.medworm.com/index.php?rid=1992501&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19028827%26dopt%3DAbstract Authors: Hudson P, Thomas T, Quinn K, Aranda S Despite the promotion of family meetings as an essential tool for information sharing and planning in palliative care, minimal evidence exists to show their effectiveness. We sought to rectify this gap in evidence-based practice by evaluating recently developed clinical guidelines for facilitating family meetings. Palliative care nurses were trained to conduct family meetings using the guidelines. To assess the effectiveness of the guidelines, primary family carers who attended a family meeting completed a self-report instrument to measure unmet needs at three time periods: immediately before the meeting (T1), immediately after the meeting (T2) and two days after the meeting (T3). Phone interviews with carers were also conducted at T3. Pat... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1992501 Fri, 21 Nov 2008 05:00:00 +0100 1992501 http://www.medworm.com/index.php?rid=1970038&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19010967%26dopt%3DAbstract Authors: Ryan K, Leonard M, Guerin S, Donnelly S, Conroy M, Meagher D The Confusion Assessment Method (CAM) is widely used in the palliative care setting despite the fact that its performance in this population has not been validated. The aim of the study was to determine the sensitivity and specificity of the CAM when used by Non-Consultant Hospital Doctors (NCHDs) working in a specialist palliative care unit. A pilot phase was performed in which NCHDs received a 1-hour training session based on the original CAM training manual. 32 patients underwent 33 assessments in the pilot phase but the sensitivity of the CAM was only 0.5 (0.22-0.78) and specificity was 1.0 (0.81-1.0). An 'enhanced' training programme was devised that took place over two 1-hour sessions and involved case-based le... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1970038 Fri, 14 Nov 2008 05:00:00 +0100 1970038 http://www.medworm.com/index.php?rid=1952902&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18996979%26dopt%3DAbstract Authors: Luthy C, Cedraschi C, Pautex S, Rentsch D, Piguet V, Allaz A Residents in training are first-line physicians in hospital settings and they are in the process of developing knowledge and mastering clinical skills. They have to confront complex tasks calling upon their personal background, professional identity and relationships with the patients. We conducted a qualitative study investigating the difficulties they perceive in end-of-life care. In all, 24 consecutive residents were presented with a written query asking them to indicate the difficulties they identify in the management of patients hospitalised for end-of-life care. Their responses were submitted to content analysis. Physicians' mean age was 28 +/- 2.2 years, 37% were women, average postgraduate training duration w... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1952902 Fri, 07 Nov 2008 05:00:00 +0100 1952902 http://www.medworm.com/index.php?rid=1952901&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18996980%26dopt%3DAbstract Authors: Kwon Y, Shin D, Lee J, Heo D, Hong Y, Kim SY, Yun Y We investigated the impact of perception of socioeconomic burden on beliefs regarding a patient's autonomy in end-of-life (EOL) decision making. We also sought to identify the characteristics of individuals who advocate patient autonomy and their attitudes toward other EOL issues. A total of 1055 individuals from the Korean general population were interviewed through a telephone survey using a structured questionnaire that was designed to investigate public attitudes toward various EOL issues. Of 1019 individuals included in the analysis, 635 (62.3%) specified the patient and 221 (21.7%) the family, when asked who is the appropriate decision maker in terms of EOL decisions in the absence of perception of socioeconomic burden.... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1952901 Fri, 07 Nov 2008 05:00:00 +0100 1952901 http://www.medworm.com/index.php?rid=1952900&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18996981%26dopt%3DAbstract Authors: Abernethy A, Burns C, Wheeler J, Currow D Interventions designed to assist informal caregivers who serve individuals at or near the end of life have predominantly focused on caregiving spouses. Can we define other caregiver subpopulations - by intensity of care provided - so as to enable better a) identification of caregiver needs and b) targeting of support to caregivers? The Health Omnibus Survey, an annual face-to-face survey in South Australia, collects health-related data from a representative sample of 4400 households. Piloted questions included in the 2001-2005 Health Omnibus surveys addressed death of a loved one, caregiving provided, impact of caregiving and caregiver characteristics. Of 18,224 respondents, 5302 reported a loved one's death due to terminal illness in ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1952900 Fri, 07 Nov 2008 05:00:00 +0100 1952900 http://www.medworm.com/index.php?rid=1925112&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18974174%26dopt%3DAbstract This article describes health and social care professionals' perceptions of palliative care and facilitators and barriers to the delivery of such care for patients with advanced chronic obstructive pulmonary disease. Health professionals participated in semi structured interviews and focus groups which were analysed using content analysis. According to participants, care of patients with chronic obstructive pulmonary disease is focused upon the management of symptoms, with emphasis focused predominately on an acute model of care. Key barriers towards the delivery of palliative care included the reluctance to negotiatie end-of-life decisions and a perceived lack of understanding among patients and carers regarding the illness trajectory. Consequently the delivery of palliative care was view... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1925112 Thu, 30 Oct 2008 04:00:00 +0100 1925112 http://www.medworm.com/index.php?rid=1925111&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18974175%26dopt%3DAbstract Authors: Spoon A, Centeno C, Rodriguez J, Ros W PMID: 18974175 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1925111 Thu, 30 Oct 2008 04:00:00 +0100 1925111 http://www.medworm.com/index.php?rid=1912111&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18952744%26dopt%3DAbstract Authors: Stephenson J PMID: 18952744 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1912111 Fri, 24 Oct 2008 04:00:00 +0100 1912111 http://www.medworm.com/index.php?rid=1912110&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18952745%26dopt%3DAbstract Authors: Torvik K, Kaasa S, Kirkevold O, Rustøen T The aims of this study were to describe the pain and use of pain medication in nursing home patients and examine which variables that were associated with pain. Inpatients (n = 307) older than 64 years from nursing homes were included. Pain was measured with a 4-point verbal rating scale in the self-reported group (SRG) and Doloplus-2 in the proxy-rated group (PRG). The mean age was 86 years (SD, 7), and more than two-thirds were female. A total of 128 (60%) patients were able to self-report their pain. Approximately 50% of the SRG reported 'pain now', and of these, nearly 50% reported moderate or severe pain intensity. Better cognitive function was associated with higher pain and receiving more potent pain medication in the SRG. ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1912110 Fri, 24 Oct 2008 04:00:00 +0100 1912110 http://www.medworm.com/index.php?rid=1912109&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18952746%26dopt%3DAbstract Authors: Innes S, Payne S Open communication in cancer care has gained increasing importance in recent years and diagnostic disclosure is now common place. However, there is a significant variability in the sharing of prognostic information. Information needs may vary significantly over the disease trajectory, and there has been relatively little work done focussing on late illness. Using systematic review procedures, 13 studies were identified that addressed this issue. The evidence shows that all patients wanted honesty from their professional team and the vast majority wanted some broad indication of their prognosis, but that preferences for quantitative information were more varied. Benefits associated with realistic awareness included enhanced control and end-of-life planning, whi... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1912109 Fri, 24 Oct 2008 04:00:00 +0100 1912109 http://www.medworm.com/index.php?rid=1912108&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18952747%26dopt%3DAbstract In this study, the respondents were family members and friends to a patient who had died at a palliative care unit. The aim was to explore wishes and needs for, access to and effects of social support in the bereaved. We found that the grieving person's wishes for social support from their network and the network also provided most social support. The network consisted of the close family, the origin family, relatives and friend. Support from the professional staff was required when the network was dysfunctional or when the grieving person did not want to burden members of his/her own network. The need for social support from professional staff was most needed close to the death and some time after. PMID: 18952747 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1912108 Fri, 24 Oct 2008 04:00:00 +0100 1912108 http://www.medworm.com/index.php?rid=1912107&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18952748%26dopt%3DAbstract Authors: Simon S, Higginson I Hospital palliative care teams (HPCTs) are well established as multi-professional services to provide palliative care in an acute hospital setting and are increasing in number. However, there is still limited evaluation of them, in terms of efficacy and effectiveness. The gold standard method of evaluation is a randomised control trial, but because of methodological (e.g., randomisation), ethical and practical difficulties such trials are often not possible. HPCT is a complex intervention, and the specific situation in palliative care makes it challenging to evaluate (e.g., distress and cognitive impairment of patients). The quasi-experimental before-after study design has the advantage of enabling an experimental character without randomisation. But this ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1912107 Fri, 24 Oct 2008 04:00:00 +0100 1912107 http://www.medworm.com/index.php?rid=1912106&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18952749%26dopt%3DAbstract Authors: Lundh Hagelin C, Wengström Y, Ahsberg E, Fürst C To understand the relation between fatigue and patients emotional situation at the end of life, this cross-sectional study aimed to explore the association between multidimensional aspects of fatigue, emotional functioning and quality of life (QoL) in patients with advanced cancer at the end of life. Patients with advanced cancer answered fatigue related measurements (Borg Category Ratio-10 scale, Multidimensional Fatigue Inventory-20, Swedish Occupational Fatigue Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30), when admitted for specialised palliative care. A total of 228 patients with a median length of survival of 63 days were included. In relation ... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1912106 Fri, 24 Oct 2008 04:00:00 +0100 1912106 http://www.medworm.com/index.php?rid=1912105&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18952750%26dopt%3DAbstract Authors: Turner M, Payne S PMID: 18952750 [PubMed - as supplied by publisher] (Source: Palliative Medicine) Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1912105 Fri, 24 Oct 2008 04:00:00 +0100 1912105 http://www.medworm.com/index.php?rid=1912104&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18952751%26dopt%3DAbstract Authors: Soto-Cárdenas M, Pelayo-García G, Rodríguez-Camacho A, Segura-Fernández E, Mogollo-Galván A, Giron-Gonzalez J We analyzed the principal risk factors of venous thromboembolism (VTE) (immobilization, recent surgery and previous VTE), prophylaxis with low-molecular weight heparin (LMWH) and complications (i.e. severe bleeding, recurrence and death). Patients with advanced cancer under palliative care (PC) and with VTE, were reviewed during the three years before the study. 71 Patients were diagnosed with VTE. 88.7% were outpatients. The risk factors present were: immobilizations in 28 patients (39.4%), recent surgery in 5 (7%) and previous VTE in 23 (32.5%). Prophylaxis was used in 4 (14.3%) patients with immobilization, no patient with recent surgery, an... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1912104 Fri, 24 Oct 2008 04:00:00 +0100 1912104 http://www.medworm.com/index.php?rid=1912103&cid=s_36859_78_f&fid=36859&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18952752%26dopt%3DAbstract Authors: Jack B, Littlewood C, Eve A, Murphy D, Khatri A, Ellershaw J The Minimum Data Set (MDS) for UK specialist palliative care services was developed in 1995 to provide annual data on palliative care services. Data collected is used for local and national purposes including service management, monitoring and audit, the commissioning of services and the development of national policy. The emergence of Payment by Results and HealthCare Resource Groups, which will have an impact on the funding processes, together with identified limitations of the current MDS resulted in a project to revise the MDS. An action research approach was used for the project and had distinctive phases including modifying the MDS, a pilot phase and an expert panel consultation. Modifications to all the sectio... Palliative Medicine journals http://www.medworm.com/rss/comments.php?id=1912103 Fri, 24 Oct 2008 04:00:00 +0100 1912103