Oxford Textbook of Palliative Medicine最新文献_第2页

Oxford Textbook of Palliative Medicine Pub Date : 2021-08-01 DOI: 10.1093/med/9780198821328.003.0047

P. Hoskin

{"title":"Management issues in bone pain","authors":"P. Hoskin","doi":"10.1093/med/9780198821328.003.0047","DOIUrl":"https://doi.org/10.1093/med/9780198821328.003.0047","url":null,"abstract":"Bone is a common site of metastatic disease with common tumours, in particular, lung, breast, and prostate, frequently spreading to the skeleton. Particular problems may arise from skeletal metastases; pain is a common problem in over 75% of patients and pathological fracture can be catastrophic in terms of mobility and integrity of the spinal canal. The function of the skeleton results in specific challenges when dealing with bone pain, with most patients having multiple sites of metastases, many having variable pain intensity in relation to movement and weight bearing, and more difficult cases progressing to develop neurological complications. Prevention of bone metastases and skeletal damage is an important approach and pain management requires optimization of medication and radiotherapy. Pathological fractures present a specific challenge, best treated surgically and with the role of radiotherapy still poorly defined. A new paradigm has emerged with the recognition that, in some patients, bone metastases may represent an oligometastatic state in which ablative treatment such as stereotactic radiotherapy can result in a prolonged disease-free interval and deferred toxic systemic treatment interventions.","PeriodicalId":369448,"journal":{"name":"Oxford Textbook of Palliative Medicine","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115031839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessment and management of thrombotic complications 血栓性并发症的评估和处理

Oxford Textbook of Palliative Medicine Pub Date : 2021-08-01 DOI: 10.1093/med/9780198821328.003.0069

S. Noble, N. Pease, Nicolas Chinn-Yee

{"title":"Assessment and management of thrombotic complications","authors":"S. Noble, N. Pease, Nicolas Chinn-Yee","doi":"10.1093/med/9780198821328.003.0069","DOIUrl":"https://doi.org/10.1093/med/9780198821328.003.0069","url":null,"abstract":"Venous thromboembolism (VTE) is a common complication of cancer and its treatments and may confer a significant symptom burden on patients. Sometimes such symptoms are attributed to other cancer-associated pathologies and may thereby go undiagnosed as a VTE and not be treated. Rather than being one single entity, cancer-associated thrombosis (CAT) is a highly heterogeneous phenomenon which will vary with primary cancer, stage, and treatment regimen. The treatment of CAT has many challenges since anticoagulation is often associated with a high rate of VTE recurrence and bleeding. While there are several classes of anticoagulants currently available, each have their perceived benefits and downsides. These become more complex with disease progression with little robust data to inform management in the advanced cancer population and at the end of life. Furthermore, a significant proportion of patients seen by specialist palliative care teams comprise a population who were excluded from the major CAT trials. It is common to encounter cases where the evidence is lacking, such as recurrent VTE, thrombocytopenia, and bleeding. Other challenges and uncertainties lie with the role of VTE prevention in hospices and specialist palliative care units, where patients are highly thrombotic but the benefits or risks of thromboprophylaxis are unclear. This chapter presents the most up-to-date data pertaining to the treatment and prevention of CAT with particular emphasis on patients nearing the end of life.","PeriodicalId":369448,"journal":{"name":"Oxford Textbook of Palliative Medicine","volume":"148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116622290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Practical considerations including difficult conversations 实际的考虑，包括困难的对话

Oxford Textbook of Palliative Medicine Pub Date : 2021-08-01 DOI: 10.1093/med/9780198821328.003.0030

S. Block

引用次数: 0

Practical bioethics in the care of patients with advanced illness 晚期病人护理中的实用生命伦理学

Oxford Textbook of Palliative Medicine Pub Date : 2021-08-01 DOI: 10.1093/med/9780198821328.003.0105

Robert C. Macauley

{"title":"Practical bioethics in the care of patients with advanced illness","authors":"Robert C. Macauley","doi":"10.1093/med/9780198821328.003.0105","DOIUrl":"https://doi.org/10.1093/med/9780198821328.003.0105","url":null,"abstract":"Perhaps no field of medicine faces more ethical dilemmas than palliative care, ranging from age-old questions (such as what constitutes ‘a good death’) to novel dilemmas stemming from technological innovation to a conflict of values in a multicultural context. Failure to identify and resolve these issues can fracture relationships and exacerbate suffering. Precisely because matters of morality are not quantifiable like other areas of medicine—and each person is a moral agent with their own beliefs and values—ethics may appear to be the one aspect of healthcare where everyone (regardless of training or role) possesses the tools to solve problems; in practice, however, it often seems that no one does. This chapter defines ethical dilemmas and equips clinicians with tools to recognize dilemmas that are ethical in nature, and those that only appear to be. Once identified as ethical, a structured approach consciously modelled on clinical assessment ensures that all relevant considerations are taken into account. Through effective communication and thoughtful use of additional resources (such as mediation, family meetings, and second opinions), the dilemma often can be resolved. When this does not occur, ethics consultation plays a valuable role both as prelude and complement to palliative care consultation. In situations where the best response remains unclear—or if clear, impossible to implement—clinicians may experience moral distress, which should be identified, navigated, and optimally prevented through conscious steps.","PeriodicalId":369448,"journal":{"name":"Oxford Textbook of Palliative Medicine","volume":"199 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133757602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sleep disorders 睡眠障碍

Oxford Textbook of Palliative Medicine Pub Date : 2021-08-01 DOI: 10.1093/med/9780198821328.003.0068

K. Mystakidou, E. Parpa, E. Tsilika

引用次数: 0

Management issues in visceral pain 内脏疼痛的处理问题

Oxford Textbook of Palliative Medicine Pub Date : 2021-08-01 DOI: 10.1093/med/9780198821328.003.0049

V. T. Chang

{"title":"Management issues in visceral pain","authors":"V. T. Chang","doi":"10.1093/med/9780198821328.003.0049","DOIUrl":"https://doi.org/10.1093/med/9780198821328.003.0049","url":null,"abstract":"Visceral pain is pain that arises from, in, or around internal organs. Common examples include chest pain from cardiac muscle injury and functional abdominal pain. In populations with serious chronic illness, visceral pain is common. In those with cancer, for example, well-known visceral pain syndromes include pain from pancreatic cancer and bowel obstruction. Recent advances have increased our understanding of the diagnostic challenges and therapeutic possibilities for patients with visceral pain syndromes. Understanding the basis of referred pain is a key component of patient assessment. The complexity of visceral nociception and pain signalling is being unravelled through anatomical, immunohistochemical, imaging, and functional studies. On a molecular level, families of receptors have now been described that will lead to a future with innovative therapies. This knowledge has developed within the paradigms of pain pathways, peripheral activation, and peripheral and central sensitization, thereby linking and distinguishing visceral pain from somatic and neuropathic pain. Treatment options for visceral pain encompass a wide variety of medical, interventional, and psychological approaches. Appropriate diagnostic measures and careful consideration of therapeutic options are needed to optimize patient outcomes.","PeriodicalId":369448,"journal":{"name":"Oxford Textbook of Palliative Medicine","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124212415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ethical issues in physician aid-in-dying 医师协助死亡的伦理问题

Oxford Textbook of Palliative Medicine Pub Date : 2021-08-01 DOI: 10.1093/med/9780198821328.003.0110

L. J. Materstvedt

引用次数: 1

Integration of spiritual care into palliative care service delivery models 将精神护理纳入姑息治疗服务模式

Oxford Textbook of Palliative Medicine Pub Date : 2021-08-01 DOI: 10.1093/med/9780198821328.003.0101

Yvan Beaussant, Alexandra N. Nichipor, T. Balboni

{"title":"Integration of spiritual care into palliative care service delivery models","authors":"Yvan Beaussant, Alexandra N. Nichipor, T. Balboni","doi":"10.1093/med/9780198821328.003.0101","DOIUrl":"https://doi.org/10.1093/med/9780198821328.003.0101","url":null,"abstract":"Addressing spirituality within serious illness is a core dimension of palliative care delivery. However, spiritual care frequently lacks integration within the care of patients and families facing serious illness. This chapter discusses the integration of spiritual care into palliative care delivery. Requisite to this integration is a clear understanding of definitions and palliative care guidelines informing spiritual care provision. Furthermore, integration is informed and motivated by a large body of evidence showing how spiritual and religious factors frequently play salient roles in serious illness and influence palliative care outcomes. The integration of spiritual care into palliative care practice relies on a generalist–specialist model, within which all members of the interdisciplinary palliative care team are responsible for spiritual care provision. Non-spiritual care specialist members of the palliative care team are responsible for generalist spiritual care delivery, including taking spiritual histories and screening for spiritual needs. The care team also includes spiritual care specialists, typically board-certified chaplains, who provide in-depth spiritual care delivery to patients and families and aid the care team in understanding the spiritual and religious dimensions of care. Additionally, data regarding tested spiritual care interventions are discussed as potential tools palliative care teams can employ to improve patient care and outcomes. Finally, the integration of spiritual care into palliative care teams presents both opportunities and challenges that must be considered as efforts needed to foster more seamless spiritual care delivery within palliative care.","PeriodicalId":369448,"journal":{"name":"Oxford Textbook of Palliative Medicine","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129003358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Interventional radiology in the palliation of cancer 介入放射学在缓解癌症中的应用

Oxford Textbook of Palliative Medicine Pub Date : 2021-08-01 DOI: 10.1093/med/9780198821328.003.0082

T. Sabharwal, N. Fotiadis, A. Adam

{"title":"Interventional radiology in the palliation of cancer","authors":"T. Sabharwal, N. Fotiadis, A. Adam","doi":"10.1093/med/9780198821328.003.0082","DOIUrl":"https://doi.org/10.1093/med/9780198821328.003.0082","url":null,"abstract":"Interventional radiology uses image guidance to perform minimally invasive therapeutic and diagnostic procedures. It is an integral part of the multidisciplinary team managing patients with cancer. Interventional radiology is involved in all stages of the cancer patient’s journey starting from performing image-guided biopsies for the diagnosis of cancer, venous access procedures, and therapeutic procedures, and focuses on the palliation of symptoms and improvement in the quality of life. All interventional procedures carry some risk, which is related to the underlying condition, the nature of the procedure, and the experience of the radiologist. Therefore, it is important in patients with advanced malignant disease receiving palliative care to contemplate only those procedures that will alleviate symptoms, and in which the potential benefits outweigh the risks. This chapter presents the drainage, stenting, feeding, embolization, ablation, and supportive interventional radiology procedures which could potentially benefit patients undergoing palliative care. The focus will be on the indications, contraindications, and likely outcomes, rather than on detailed technical descriptions.","PeriodicalId":369448,"journal":{"name":"Oxford Textbook of Palliative Medicine","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127767903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Health services research in palliative and end of life care 缓和和临终关怀的卫生服务研究

Oxford Textbook of Palliative Medicine Pub Date : 2021-08-01 DOI: 10.1093/med/9780198821328.003.0126

T. Smets, L. Deliens

{"title":"Health services research in palliative and end of life care","authors":"T. Smets, L. Deliens","doi":"10.1093/med/9780198821328.003.0126","DOIUrl":"https://doi.org/10.1093/med/9780198821328.003.0126","url":null,"abstract":"Clear information about the effectiveness of services and interventions is often lacking in palliative care service planning. The development of palliative care services and interventions should be based on evidence that they will increase the likelihood of desired outcomes, but also understanding the process of the intervention and how it might work in practice are vital in building an evidence base that informs policy and practice. Health services research in palliative care covers topics such as palliative care needs, access to palliative care, quality of care and feasibility, effectiveness, and cost of palliative care services and interventions. Patients needing palliative care often have complex needs and require complex services and interventions. The Medical Research Council guidance for developing, evaluating, and implementing complex interventions, the MORECare statement on ‘best practice’ methods for research evaluating end of life care, and the Medical Research Council guidance on process evaluation offer useful support for researchers undertaking health services research. To evaluate complex services and interventions, a wide ranch of study designs can be used. Studies that enrol patients with advanced illness present unique challenges, both ethical and methodological.","PeriodicalId":369448,"journal":{"name":"Oxford Textbook of Palliative Medicine","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116832236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1