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Latest & greatest articles for palliative care
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Palliativecare - nausea and vomiting Palliativecare - nausea and vomiting - NICE CKS Clinical Knowledge Summaries Share Palliativecare - nausea and vomiting: Summary Nausea is an unpleasant sensation of the need to vomit, which is often accompanied by autonomic symptoms (for example pallor, cold sweat, salivation, and tachycardia). Vomiting (emesis) is the forceful ejection of stomach contents through the mouth. There are many causes of nausea and vomiting in the palliativecare setting (...) the stage of the person’s illness, their prognosis, the severity of their symptoms, and the wishes of the person and their family. Simple measures may help relieve nausea and vomiting in palliativecare. They include: Ensuring access to a large bowl, tissues, and water. Eating snacks consisting of a few mouthfuls rather than large meals. Drinking cool fizzy drinks rather than still or hot drinks. Relaxation techniques. Parenteral hydration, if appropriate. Cognitive behavioural therapy (for anticipatory
Palliativecare - oral Palliativecare - oral - NICE CKS Clinical Knowledge Summaries Share Palliativecare - oral: Summary Common oral problems in palliativecare include dry mouth, painful mouth, halitosis, alteration of taste, and excessive salivation. They may result from poor oral intake, drug treatments, local irradiation, oral tumours, or chemotherapy. Oral symptoms may significantly affect the person's quality of life, causing eating, drinking, and communication problems, and oral (...) discomfort and pain. When assessing a person with oral symptoms in palliativecare: Ask about dry mouth, oral pain, halitosis, alteration in taste, excessive salivation, bad breath, difficulty chewing, difficulty speaking, dysphagia, and bleeding. Examine the oral cavity for signs of dehydration, level of oral hygiene, ulceration and vesicles, erythema or white patches, local tumour, bleeding, and infection. The cause of most oral problems can be diagnosed on the basis of clinical features alone
Palliativecare - malignant skin ulcer Palliativecare - malignant skin ulcer - NICE CKS Clinical Knowledge Summaries Share Palliativecare - malignant skin ulcer: Summary A malignant ulcer is a proliferative or cavitating primary or secondary cancer in the skin. It may appear as a crater-like wound, a nodular 'fungus', or a 'cauliflower' lesion. Most malignant ulcers develop from a breast, head and neck, or skin cancer. Malignant ulcers are most likely to develop in people older than 70 years (...) of life as much as possible. Ensuring a professional with expertise in wound management is involved in the person's care (such as a district nurse, palliativecare or tissue viability nurse). This professional can advise on the need for cleansing, debridement, and the correct selection and use of dressings. Referral where appropriate to an oncologist or palliativecare specialist for advice if further cancer treatment is possible (such as radiotherapy, chemotherapy, hormone therapy, or surgical
Palliativecare - general issues Palliativecare - general issues - NICE CKS Clinical Knowledge Summaries Share Palliativecare - general issues: Summary Palliativecare is defined as the active holistic care of people with advanced, progressive illness. Professionals providing general palliativecare services should: Be involved as early as possible after diagnosis. Aim to meet the needs of the patient and their family within the limits of their knowledge and competence. Seek specialist advice (...) : Should be based on locally agreed protocols and guidelines, delivered within the context of a managed system or pathway. Requires a multidisciplinary team because of the potential multidimensional nature of problems in palliativecare. Have I got the right topic? Have I got the right topic? From age 16 years onwards. This CKS topic covers the general management issues related to palliativecare and incorporates guidance from the National Institute for Health and Care Excellence on Improving
Palliativecare - dyspnoea Palliativecare - dyspnoea - NICE CKS Clinical Knowledge Summaries Share Palliativecare - dyspnoea: Summary Breathlessness is an objective observable sign, whereas dyspnoea is a subjective described symptoms of difficulty in breathing. Anxiety is often a major component of dyspnoea. Dyspnoea can result from impaired ventilation or increased ventilatory demand, or both factors. There are multiple possible causes of dyspnoea in people with cancer, including: Direct (...) causes — such as primary lung cancer or lung metastases. Indirect effects of cancer — such as pleural effusion, superior vena cava syndrome, anaemia, pulmonary embolism, and surgery. Non-malignant causes — such as pneumonia, chronic obstructive pulmonary disease, heart failure, and anxiety. Assessment of someone with dyspnoea in a palliativecare setting involves asking about: Features of the dyspnoea (for example severity, timing, onset, and precipitating and exacerbating factors). Associated
Palliativecare - cough Palliativecare - cough - NICE CKS Clinical Knowledge Summaries Share Palliativecare - cough: Summary Cough is a defensive reflex that occurs in response to stimulation of irritant receptors which are found in the airways. It has two functions — to prevent foreign material entering the lower respiratory tract, and to clear secretions from the lungs and airways. Cough in people with cancer is most commonly associated with cancer of the airways, lungs, pleura (...) , and mediastinum, but tumours metastasizing to the thorax can also cause cough. In people with cancer, the most common cause of acute cough is respiratory tract infection. Other possible non-malignant causes include post-nasal drip, asthma, chronic obstructive pulmonary disease, and gastro-oesophageal reflux disease. When assessing someone with cough in palliativecare, the following should be elicited: The impact on the person's quality of life. The severity, time of onset, and duration of the cough
Palliativecare - constipation Palliativecare - constipation - NICE CKS Clinical Knowledge Summaries Share Palliativecare - constipation: Summary Constipation is defecation that is unsatisfactory because of infrequent stools, difficult stool passage, or seemingly incomplete defecation. Stools are often dry and hard, and may be abnormally large or abnormally small. About 80% of people with cancer will require treatment with laxatives at some time. People receiving palliativecare have multiple (...) causes of constipation, such as: Drugs, for example, opioid analgesics, antimuscarinic drugs, antacids. Secondary effects of disease, for example, dehydration, inadequate dietary fibre, inactivity, delirium, spinal cord compression, lack of privacy. Direct effects of malignant tumours, causing bowel obstruction, hypercalcaemia, nerve damage. When assessing a person with constipation in palliativecare: The history should include information about the frequency and character of stools, discomfort
Palliative cancer care - pain Palliative cancer care - pain - NICE CKS Clinical Knowledge Summaries Share Palliative cancer care - pain: Summary Cancer-related pain may be persistent or breakthrough (episodic), and influenced by physical, psychological, social and spiritual factors. Breakthrough pain may be: Unpredictable (spontaneous). Predictable (incident) and related to movement or activity. The type of pain experienced depends on the underlying cause, and may be somatic, visceral (...) or neuropathic pain. It can be caused by direct effects of a tumour, cancer treatment, related to procedures such as dressing changes, or unrelated to the underlying cancer. When assessing pain for a person in palliativecare: A validated structured pain assessment tool may be helpful. The impact on quality of life should be discussed. If appropriate, an examination should be performed — looking particularly for specific points of tenderness and signs of neurological deficit which may suggest spinal cord
Palliativecare - secretions Palliativecare - secretions - NICE CKS Clinical Knowledge Summaries Share Palliativecare - secretions: Summary During the terminal phase of a person's illness, airway secretions may accumulate and result in gurgling and rattling noises during inspiration and expiration. It may be difficult to tell whether noisy secretions in the last few hours of life are causing distress to the person, but such noises may be distressing to some families or carers. Listen (...) during the review of this topic. QOF indicators QOF indicators Table 1 . Indicators related to palliativecare in the Quality and Outcomes Framework of the General Medical Services contract. Indicator Points Payment stages PC001 The contractor establishes and maintains a register of all patients in need of palliativecare/support irrespective of age 3 — PC002 The contractor has regular (at least 3 monthly) multidisciplinary case review meetings where all patients on the palliativecare register
What processes decrease the risk of opioid toxicity following interventional procedures for uncontrolled pain in palliativecare or cancer patients? Review Methods Search Strategy: A systematic search was conducted across a wide-ranging set of data- bases: Ovid Medline, including In-Process & Other Non-Indexed Citations, Ovid Embase, Ebsco CINAHL and Cochrane Library. The preliminary search strategy was devel- oped on Ovid Medline using both text words and Medical subject headings from January (...) 2006 to February 2017 restricted to English language humans. The search strategy was modified to capture indexing systems of the other databases. (Search strategies available upon request). To identify additional papers, the following website was searched: palliativecare knowledge network Furthermore electronic tables of content for the last two years were scanned for British Journal of Anaesthesia, Journal of Pain and Symptom Management, Pain and Palliative medicine. Reference lists of systematic
Palliativecare in heart failure: facts and numbers Millions of people worldwide have heart failure. Despite enormous advances in care that have improved outcome, heart failure remains associated with a poor prognosis. Worldwide, there is poor short-term and long-term survival. The 1 year survival following a heart failure admission is in the range of 20-40% with between-country variation. For those living with heart failure, the symptom burden is high. Studies report that 55 to 95% of patients (...) experience shortness of breath and 63 to 93% experience tiredness. These symptoms are associated with a high level of distress (43-89%). Fewer patients experience symptoms such as constipation (25-30%) or dry mouth (35-74%). However, when they do, such symptoms are associated with high levels of distress (constipation: 15-39%; dry mouth: 14-33%). Psychological symptoms also predominate with possibly as many as 50% experiencing depression. Palliativecare services in heart failure are not widely available
Parents' and families' experiences of palliative and end-of-life neonatal care in neonatal settings: a systematic review protocol. The overall objective of this systematic review is to identify, critically appraise and synthesize the parents' and families' experiences of palliative and end-of-life neonatal care at facilities/services globally. The specific review question is: what are parents' and families' experiences of palliative and end-of-life neonatal care?
Palliativecare interventions in advanced dementia. Dementia is a chronic, progressive and ultimately fatal neurodegenerative disease. Advanced dementia is characterised by profound cognitive impairment, inability to communicate verbally and complete functional dependence. Usual care of people with advanced dementia is not underpinned universally by a palliative approach. Palliativecare has focused traditionally on care of people with cancer but for more than a decade, there have been (...) increased calls worldwide to extend palliativecare services to include all people with life-limiting illnesses in need of specialist care, including people with dementia.To assess the effect of palliativecare interventions in advanced dementia and to report on the range of outcome measures used.We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 4 February 2016. ALOIS contains records of clinical trials identified from monthly searches of several major
Association Between PalliativeCare and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis. The use of palliativecare programs and the number of trials assessing their effectiveness have increased.To determine the association of palliativecare with quality of life (QOL), symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers.MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL to July 2016.Randomized clinical trials (...) of palliativecare interventions in adults with life-limiting illness.Two reviewers independently extracted data. Narrative synthesis was conducted for all trials. Quality of life, symptom burden, and survival were analyzed using random-effects meta-analysis, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-palliativecare scale (FACIT-Pal) instrument (range, 0-184 [worst-best]; minimal clinically important difference [MCID], 9 points); and symptom burden
Effect of Inpatient PalliativeCare on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial. During hospitalization for hematopoietic stem cell transplantation (HCT), patients receive high-dose chemotherapy before transplantation and experience significant physical and psychological symptoms and poor quality of life (QOL).To assess the effect of inpatient palliativecare on patient- and caregiver-reported outcomes during hospitalization for HCT (...) and 3 months after transplantation.Nonblinded randomized clinical trial among 160 adults with hematologic malignancies undergoing autologous/allogeneic HCT and their caregivers (n = 94). The study was conducted from August 2014 to January 2016 in a Boston hospital; follow-up was completed in May 2016.Patients assigned to the intervention (n=81) were seen by palliativecare clinicians at least twice a week during HCT hospitalization; the palliative intervention was focused on management of physical
Pharmacological interventions for pruritus in adult palliativecare patients. This is an update of the original Cochrane review published in 2013 (Issue 6). Pruritus occurs in patients with disparate underlying diseases and is caused by different pathologic mechanisms. In palliativecare patients, pruritus is not the most prevalent but is one of the most puzzling symptoms. It can cause considerable discomfort and affects patients' quality of life.To assess the effects of different (...) pharmacological treatments for preventing or treating pruritus in adult palliativecare patients.For this update, we searched CENTRAL (the Cochrane Library), and MEDLINE (OVID) up to 9 June 2016 and Embase (OVID) up to 7 June 2016. In addition, we searched trial registries and checked the reference lists of all relevant studies, key textbooks, reviews and websites, and we contacted investigators and specialists in pruritus and palliativecare regarding unpublished data.We included randomised controlled trials