American Journal of Hospice and Palliative Medicine®最新文献

{"title":"Improving efficacy, efficiency and economics of hospice individualized drug therapy","authors":"J. Lycan, P. Grauer, M. Mihalyo, B. Houchen","doi":"10.1177/104990910201900213","DOIUrl":"https://doi.org/10.1177/104990910201900213","url":null,"abstract":"The rising cost of drug therapy coupled with late referrals and decreasing length of stay is a prescription for financial woes in the capitated hospice health care arena. The drive to provide the best symptom management in endof-life care and still maintain a fiscally sound bottom line highlights a need for examination of the ways that hospices assess individual patient drug therapy and factors that influence drug choices. Performing an individualized drug therapy evaluation promotes effective, efficient, and economical care.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"66 1","pages":"135 - 138"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77950374","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}

{"title":"Dying from hematological cancers","authors":"R. Enck","doi":"10.1177/104990910201900201","DOIUrl":"https://doi.org/10.1177/104990910201900201","url":null,"abstract":"oncologists are also trained in hematology and often care for patients with hematological malignancies, such as leukemia and lymphoma. Although there may be little difference in biologic behavior between a leukemic blast cell and a lung cancer cell, there remains a common perception among physicians that dying from relapsed acute leukemia and progressive lung cancer differ. To substantiate this assumption, just review the most recent hematological textbooks for chapters on pain and symptom management as well as psychological treatment and the point will be obvious. Furthermore, the article in this issue of the American Journal of Hospice & Palliative Care by Pam McGrath1 validates the idea that patients dying with hematological malignancies are given scant attention in regard to palliative care. In this must-read study, McGrath1 interviewed the mostly female caregivers of 10 predominantly male patients with blood malignancies, i.e., five had acute lymphocytic leukemia, two had acute myeloblastic leukemia, one had chronic myelocytic leukemia, one had chronic lymphocytic leukemia, and one had lymphoma. The qualitative analysis of these interviews was based on the principle of saturation of data, that is, common themes emerge when a number of the participants say the same thing. Several important observations were made from this study including:","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"25 1","pages":"79 - 80"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83969292","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}

{"title":"Call for manuscripts","authors":"","doi":"10.1177/104990910201900216","DOIUrl":"https://doi.org/10.1177/104990910201900216","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"83 1","pages":"144 - 144"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83441333","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}

{"title":"Perspectives of relatives and health care workers on care of terminally ill patients in the UK","authors":"P. Ferry, Richard H. Hancock, Cindy Newton, John Taylor, K. Horton","doi":"10.1177/104990910201900211","DOIUrl":"https://doi.org/10.1177/104990910201900211","url":null,"abstract":"Two parallel questionnaires were used to explore perceptions of health-care workers (HCWs) and the relatives of terminally ill patients on the quality of care received by the patients. There was general agreement between the two groups of respondents in most of the assessed areas. The relatives, however, were more satisfied with the control of pain and psychological symptoms than the HCWs, and the HCWs perceived the control of diarrhea, skin problems, and swallowing problems more positively than did the relatives. There also was some variation between the two groups in their perception of the care received by the relatives during visits at the hospital, with the relatives’ group being more positive. Although HCWs reported that time to deal with patients and their families was inadequate, the relatives’ group was generally satisfied with the standards in place.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"100 1","pages":"121 - 128"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80304324","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}

{"title":"Palliative sedation vs. terminal sedation: What’s in a name?","authors":"W. Jackson","doi":"10.1177/104990910201900202","DOIUrl":"https://doi.org/10.1177/104990910201900202","url":null,"abstract":"existential suffering and proposal of clinical guidelines for the sedation of patients with intractable physical, mental or spiritual distress1,2 are cogent, welcome contributions to the field of palliative medicine. His comments contain much to admire, including the emphasis on the patient’s symptoms, not the patient’s death, as the focus of care. His recommendation that the treatment (including drug dosages) be adjusted based on the patient’s symptoms gives this sometimes controversial practice a sensible clinical platform that withstands rigorous ethical investigation (for example, utilizing Jonsen’s four-box method3 of clinical ethical analysis). Content notwithstanding, however, I most admire Rousseau’s reviews for what they lack— the perpetuation of the linguistic quagmire, “terminal sedation.” Attributed to Robert E. Enck, MD,4 the phrase “terminal sedation” is commonly used for the clinical practice of utilizing therapeutic sedation in imminently dying patients, as a means of palliating symptoms which are not ameliorated by other, less aggressive measures. Debate concerning the ethical implications of the practice has been, at times, lively—ranging from case descriptions praising its efficacy and humaneness5 to editorials decrying it as “slow euthanasia.”6,7 For most clinicians, however, the practice seems to be an acceptable method of treating patients with otherwise intractable symptoms, provided that the focus of drug titration is symptom relief, not the patient’s death.8,9 This distinction appeals to the ethical principle of double effect: if the patient’s death is an undesired but anticipated secondary effect of the treatment, this is allowable, as the secondary effect was not intended.10 As this intervention grows in acceptance and in frequency, the use of the term “terminal sedation” to describe it should be abandoned. As Chater et. al. have pointed out,11 the phrase is confusing, in that the object of the adjective “terminal” is not explicit. Does it apply to the sedation (implying that the object of the practice is sedating someone to death) or to the patient (implying that the patient is in the final stage of illness)? Since this ambiguity is always present, the phrase is often interpreted to imply intent to kill. This interpretation has the potential to restrict patient access of state-of-the art palliative care, by leaving patients and families confused about their physicians’ intent, and by leaving physicians fearful that their palliative interventions will be wrongly prejudged as “mercy killing.”12,13 These considerations not withstanding, many authors8,9,14-20 (formerly including Rousseau himself21) have persisted in describing the clinical practice of sedating terminally ill patients with intractable physical, mental, or spiritual distress as terminal sedation. In explaining their position, Quill and Byock maintain that doing so is necessary to distinguish sedation in antemortem care from sedation in other settings (such a","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"78 1","pages":"81 - 82"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83896663","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}

{"title":"Post-thoracotomy pain syndrome: An opportunity for palliative care","authors":"S. Baumrucker","doi":"10.1177/104990910201900203","DOIUrl":"https://doi.org/10.1177/104990910201900203","url":null,"abstract":"is a specialty in search of a niche. Referring providers often do not know what palliative care services do, or how they can help them to care for their patients; misconceptions that palliative care is just for patients at end of life or that it is synonymous with anesthesiology pain services abound. It will take years of providing services that improve the quality of life of thousands before palliative care becomes a household word. Identifying syndromes that are easily ameliorated, affect thousands every year, and commonly go untreated or unrecognized would not only be an opportunity to serve patients, but would provide a chance for palliative care to increase its profile. Due to an apparent statistical fluke over the last couple of weeks, our palliative care service has noted an increase in patients presenting with persistent pain after surgical thoracotomy. The patients, who generally have had moderate, persistent pain over the surgical site, following the intercostal space, report burning, tingling, and occasionally sharp pains that are constant and unremitting. These persons often reported that their surgeon told them that post-surgical pain was to be expected and to “live with it.” Until the creation of palliative care services around the country, patients with similar stories often had no other option. New data have emerged, however, that may improve outcomes and decrease patient suffering over the long term. Chronic post-thoracotomy pain syndrome (PTPS) is defined as “chronic dysesthetic burning and aching in the general area of the incision that persists at least two months after thoracotomy,”1 and is generally considered to be a post-surgical neuropathic syndrome of one or more intercostal nerves. Up to 60 percent of patients report persistent pain a month after surgery,2 and 35 to 50 percent report pain at one to two years.3 Most patients experience mild to moderate pain; the incidence of severe pain is 3 to 5 percent.4 Given the sheer numbers of thoracotomies performed in this modern age, the data indicate that the number of people suffering chronic sequelae is also large. Women and those with significant pain on post-op day one seem to be at highest risk for PTPS.2 In 1996, Katz followed patients 18 months after lateral thoracotomy and found that early post-operative pain was the only factor that significantly predicted longterm pain.3 The study showed a significant relationship between higher pain scores at 24 and 48 hours and longterm pain. However, cumulative morphine use was similar in both groups. Given that patients with decreased pain in the immediate post-op period had a decreased incidence of long-term pain, it would seem logical that improving post-operative pain control might proactively prevent chronic complications. However, in 2000, Hu published a study that seemed to argue against this concept. Hu’s project, a retrospective review of 159 patients","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"94 1","pages":"83 - 84"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77534537","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}

{"title":"Book Review: Pilgrim Heart: The Inner Journey Home","authors":"T. A. Welk","doi":"10.1177/104990910201900113","DOIUrl":"https://doi.org/10.1177/104990910201900113","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"1 1","pages":"60 - 60"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84199074","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}

{"title":"Management of symptomatic ascites in recurrent ovarian cancer patients using an intra-abdominal semi-permanent catheter","authors":"Tara D Iyengar, T. Herzog","doi":"10.1177/104990910201900108","DOIUrl":"https://doi.org/10.1177/104990910201900108","url":null,"abstract":"Ascites is commonly present in women with advanced-stage ovarian cancer. No standardized protocol exists for the treatment of the patient with recurrent ovarian cancer and rapidly reaccumulating malignant ascites. Palliation of symptoms is most commonly achieved through repeated paracentesis, a procedure that potentially results in injury to intra-abdominal organs, infection, and patient discomfort. Our goal was to improve patient comfort by alleviating symptoms and reducing the need for paracentesis. The Pleurx ® catheter offers a number of potential advantages over traditional treatment modalities. Clearly, larger study numbers are required to quantify the morbidity associated with the Pleurx ® catheter.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"4 1","pages":"35 - 38"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79081110","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}

{"title":"Hospice marketing and outreach to the orthodox Jewish community revisited","authors":"A. Gordon","doi":"10.1177/104990910201900111","DOIUrl":"https://doi.org/10.1177/104990910201900111","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"29 1","pages":"57 - 58"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84607854","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}

{"title":"Overcoming the tendency to lie to dying patients","authors":"Matt Stolick","doi":"10.1177/104990910201900107","DOIUrl":"https://doi.org/10.1177/104990910201900107","url":null,"abstract":"A meaningful death can be fostered for a patient and his or her family with the aid of medical treatment, specifically through the alleviation of the patient’s suffering and pain. To recognize the dying process is a part of the art of medicine. Compassionate care for dying patients includes a move from a curative model of care to a palliative model of care in defining the primary goal. Hospice volunteer training and practice is sufficient palliative care training to develop these skills. The time has come for incorporating palliative care into the curriculum of medical school.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"26 1","pages":"29 - 34"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75943377","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}