1/21. methylphenidate for depression in hospice practice: a case series.Psychostimulants such as methylphenidate have been used for depression in cancer patients. We report the successful use of methylphenidate to treat depression in 10 consecutive patients with advanced cancer. A rapid onset of effect was noted. appetite, concentration, fatigue, and sedation also improved in some persons. No severe side effects were noted.- - - - - - - - - - ranking = 1keywords = hospice (Clic here for more details about this article) |
2/21. Terminal sedation for existential distress.Although sedation for existential distress has been actively discussed in the palliative care literature, empirical reports are limited. A retrospective cohort study was performed to clarify the physical conditions of terminally ill cancer patients who expressed existential distress and received sedation. Of 248 consecutive hospice inpatients, 20 patients expressed a belief that their lives were meaningless and received sedation. The target symptoms for sedation were dyspnea (n = 10), agitated delirium (n = 8), and pain (n = 1). Only one patient received sedation for psychological distress alone, although physical symptoms were acceptably relieved. The Palliative Performance Scale just before sedation was 10 (n = 7), 20 (n = 11), 30(n = 1), and 40(n = 1). All but one patient could take nourishment orally of only mouthfuls or less. edema, dyspnea at rest, and delirium were observed in 10, 13, and 14 cases, respectively. The Palliative Prognostic Index was greater than 6.0 in all but one case with a mean of 12 /- 3.3. In conclusion, in our practice, sedation was principally performed for physical symptoms of cancer patients in very late stages. Further research is encouraged to establish standard therapy for existential distress of the terminally ill.- - - - - - - - - - ranking = 0.25keywords = hospice (Clic here for more details about this article) |
3/21. When does the responsibility of our care end: bereavement.Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at massachusetts General Hospital, founded the Kenneth B. Schwartz Center. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and sustenance to the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Two vignettes are presented of a caregiver's response to the death of a patient, contrasting the extremes of involved compassion for the family and fractured relationships. grief for loss is an inevitable part of life and a common part of cancer care. Support of the bereaved may be one of the hardest tasks for cancer care professionals, who are confronted with the limits of modern medicine. There is a responsibility to provide grieving families with support and care; care that goes beyond the death. A compassionate response helps both those who suffer and those who care. Complicated and uncomplicated bereavement, grief reactions, resources for bereavement counseling, and the role of condolence letters are reviewed.- - - - - - - - - - ranking = 0.097384156302049keywords = bereavement (Clic here for more details about this article) |
4/21. massage and aromatherapy massage: nursing art and science.This article begins by reviewing the place of complementary therapies in palliative care from the perspective of UK professional organizations, namely the Nursing and midwifery Council (NMC) (formerly the United Kingdom Central Council for Nursing, midwifery and health Visiting (UKCC)) and the British Medical association (BMA). It then reviews recent research on the use of massage and aromatherapy massage in palliative care and comments on their credibility and implications, thereby addressing nursing science. The art of nursing is explored through four case histories where massage was used intuitively when words were difficult or seemed inadequate. To conclude, by focusing on the therapies provided by a UK hospice, there is consideration of the practicalities of implementing massage and aromatherapy massage in a specialist palliative care unit.- - - - - - - - - - ranking = 0.25keywords = hospice (Clic here for more details about this article) |
5/21. Multidimensional continuous pain assessment chart (MCPAC) for terminal cancer patients: a preliminary report.Current use of pain measures is limited in clinical practice. The common pain measures neither target nor monitor the changes that occur with time with regard to the effect of other parameters associated with pain control. Changes in parameters, such as pain type, various pharmacological and nonpharmacological interventions, dosage of medications, and use of rescue doses, usually complicate pain control in terminal cancer patients. The authors propose use of a multidimensional, continuous pain chart that permits better assessment and control of pain. The chart integrates visual analogue pain assessment, special treatment techniques, regular medications and rescue doses, co-analgesics, pain categories, parameters relating to quality of life, sleep, and mobility. A total of 1,178 assessments were performed in 100 consecutive patients with full compliance. The chart permitted a continuous monitoring of patients 'most important needs concerned with pain control and was easily integrated into the hospice daily routines. We conclude that the chart represents an effective and friendly graphic tool to monitor pain and associated parameters that relate to the quality of the broad spectrum of pain control. The hope is that this tool may improve pain control by hospice professionals and facilitate communication between patients and the interdisciplinary team members.- - - - - - - - - - ranking = 0.5keywords = hospice (Clic here for more details about this article) |
6/21. Treatable complications of cancer patients referred to an in-patient hospice.This paper illustrates the importance of accurate diagnoses and treatments of complications in terminally ill cancer patients. The paper reports on five hospice in-patients who completely recovered from life-threatening complications; three of them had been incorrectly labeled as "imminently dying" by the referring physicians. The paper concludes that it would be beneficial for patients to receive examinations and a trial of medical treatment in their continuing treatment settings.- - - - - - - - - - ranking = 1.25keywords = hospice (Clic here for more details about this article) |
7/21. Characteristics of the grieving process: a pilot study of 10 Korean spouses of patients who passed away from cancer.The purpose of this descriptive study was to identify the characteristics of the grieving process of Korean spouses who lost their partner to cancer. Five women and five men were recruited by convenience sampling from surviving spouses attending a follow up program at a hospice center in Seoul, korea. In-depth interviews, observation, and instruments on grief stage and grief responses were used to collect data. Interviews were tape recorded, transcribed, and analyzed line by line to discover recurrent patterns and themes. Gender differences were noted for grief responses (physical, cognitive, emotional, social and spiritual) and factors influencing grief.- - - - - - - - - - ranking = 0.25keywords = hospice (Clic here for more details about this article) |
8/21. Oncological emergencies in the pediatric intensive care unit.The overall 5-year survival rate of children with cancer has now reached 77%, an increase of about 45% in the past 25 years. Newer therapies, including hematopoietic cell transplantation and cutting edge chemotherapeutics evolving in the form of molecular and biological cell targeted agents, are being researched and developed and are responsible for the change in survival rates over time. Also, despite the national trend toward hospice and palliative care, children with chronic and life threatening illnesses, continue to die in the hospital setting, often in the intensive care unit. Previous studies of children with complications of cancer and its therapy document poor outcomes among those who do require intensive care. These trends are changing, however, currently leaving a hopeful, optimistic view of the outcome in children with cancer complications admitted to the pediatric intensive care unit. It is imperative that nurses and intensive care staff understand pediatric cancer and its potential emergent consequences in order to respond to the symptoms of life threatening events.- - - - - - - - - - ranking = 0.25keywords = hospice (Clic here for more details about this article) |
9/21. Stereotaxic placement of a ventricular catheter and reservoir for the administration of morphine sulfate.Patients with intractable pain due to cancer present a unique challenge to both medical and nursing personnel. This case study illustrates a unique home hospice managed pain control regime that has been implemented for a terminal cancer patient with intractable pain. A ventricular catheter attached to a reservoir was stereotaxically implanted for the administration of preservative-free morphine sulfate. The presentation will include the history of intraspinal morphine, the surgical placement of the ventricular access devise, and the procedure for intraventricular morphine administration. Also, the preoperative nursing assessment and patient family education will be discussed. education of hospice nurses in the technique of injection, postoperative pain assessment, monitoring of side effects and discharge planning will conclude the presentation.- - - - - - - - - - ranking = 0.5keywords = hospice (Clic here for more details about this article) |
10/21. Continuity of care for the cancer patient with chronic pain.The care of patients with cancer and chronic pain, often complicated and demanding, strains the resources of a single physician. Continuity of care programs, such as that developed by the Pain Service of Memorial Sloan-Kettering Cancer Center (new york), with good communication and liaison work between hospital and community, add a much needed dimension to the pain management of these patients in the home. Although continuity of care programs resemble hospice programs in philosophy, there are major differences in admission criteria: the program is not restricted to dying individuals; patients may live alone; they may receive active therapy with a focus on cure or remission; and they continue to receive their care, including pain management, within a standard medical system under the supervision of their primary physician and nurse.- - - - - - - - - - ranking = 0.25keywords = hospice (Clic here for more details about this article) |
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