Palliative care - constipation: How long is it before different laxative preparations take effect? Time to wait for laxative effect | Prescribing information | Palliative care - constipation | CKS | NICE Search CKS… Menu Time to wait for laxative effect Palliative care - constipation: How long is it before different laxative preparations take effect? Last revised in October 2016 How long is it before different laxative preparations take effect? For information on times for different laxative

Palliative care - constipation: How do laxatives work? How laxatives work | Prescribing information | Palliative care - constipation | CKS | NICE Search CKS… Menu How laxatives work Palliative care - constipation: How do laxatives work? Last revised in October 2016 How do laxatives work? Bulk-forming laxatives (ispaghula husk, methylcellulose, and sterculia) act by retaining fluid within the stool and increasing faecal mass, leading to stimulation of peristalsis. They also have stool-softening

Palliative care - constipation: Diagnosis of constipation in palliative care Diagnosis | Diagnosis | Palliative care - constipation | CKS | NICE Search CKS… Menu Diagnosis Palliative care - constipation: Diagnosis of constipation in palliative care Last revised in October 2016 Diagnosis of constipation in palliative care Suspect constipation when: Stools are hard, uncomfortable, or difficult to pass, and are less frequent than usual; or the person has a sense of incomplete evacuation after (...) , are thrombocytopenic, or who have rectal or anal disease), or on gentle digital examination of the stoma (if the person has a colostomy). 98% of faecal impactions occur in the rectum. Careful examination can usually distinguish a faecal mass from a tumour or cyst: firm pressure exerted by a finger will leave a palpable indentation in hard faeces. Suspect bowel obstruction when any of the following symptoms or signs are present: Absence of passage of flatus per rectum. Colicky, abdominal pain and abdominal

Palliative care - constipation: Adverse effects of oral laxatives Adverse effects of oral laxatives | Prescribing information | Palliative care - constipation | CKS | NICE Search CKS… Menu Adverse effects of oral laxatives Palliative care - constipation: Adverse effects of oral laxatives Last revised in October 2016 Adverse effects of oral laxatives Most adverse effects can be avoided or reduced by increasing the dose of oral laxatives gradually. Advise people to start at the lowest dose

Palliative cancer care - pain: What issues should I consider before prescribing pregabalin? Pregabalin | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Pregabalin Palliative cancer care - pain: What issues should I consider before prescribing pregabalin? Last revised in October 2016 What issues should I consider before prescribing pregabalin? For prescribing information, see the section on in the CKS topic on . © .

Palliative care - constipation Palliative care - constipation | Topics A to Z | CKS | NICE Search CKS… Menu Palliative care - constipation Palliative care - constipation Last revised in October 2016 Constipation is defecation that is unsatisfactory because of infrequent stools, difficult stool passage, or seemingly incomplete defecation. Diagnosis Management Prescribing information Background information Palliative care - 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 palliative care 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

Palliative cancer care - pain: What issues should I consider before prescribing hyoscine butylbromide? Hyoscine butylbromide | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Hyoscine butylbromide Palliative cancer care - pain: What issues should I consider before prescribing hyoscine butylbromide? Last revised in October 2016 What issues should I consider before prescribing hyoscine butylbromide? Hyoscine butylbromide should not be administered to people (...) , and blurred vision. CKS found no evidence on the extent to which these occur in people in the terminal phase of illness. Hyoscine butylbromide does not readily cross the blood–brain barrier and therefore does not produce central nervous system adverse effects. These recommendations are based on the Summary of Product Characteristics published by the manufacturer [ ], and the Palliative Care Formulary [ ]. © .

Palliative care - oral: Topical artificial saliva and saliva stimulant products Topical artificial saliva and saliva stimulant products | Prescribing information | Palliative care - oral | CKS | NICE Search CKS… Menu Topical artificial saliva and saliva stimulant products Palliative care - oral: Topical artificial saliva and saliva stimulant products Last revised in October 2018 Topical artificial saliva and saliva stimulant products Product choice to treat dry mouth Any topical artificial

Palliative care - oral: Topical antifungals Topical antifungals | Prescribing information | Palliative care - oral | CKS | NICE Search CKS… Menu Topical antifungals Palliative care - oral: Topical antifungals Last revised in October 2018 Topical antifungals Recommended topical antifungal Topical nystatin or topical miconazole are recommended for first-line treatment of oral candida infection. Few trials have compared the use of topical anticandidal treatments in people with cancer (...) in palliative care [ ]. Nystatin is recommended as it only needs to be prescribed for 7 days and resistance to nystatin is uncommon [ ]. Miconazole also only needs to be prescribed for 7 days. It is an imidazole antifungal which provides a different therapeutic option to nystatin as it belongs to a different antifungal class. However, resistance to miconazole is becoming increasingly common, especially in people who are immunocompromised [ ]. Amphotericin is not recommended as it needs to be prescribed

Palliative care - oral: Scenario: Oral pain Scenario: Oral pain | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Oral pain Palliative care - oral: Scenario: Oral pain Last revised in October 2018 Scenario: Oral pain From age 16 years onwards. Topical pain relief Treat the underlying cause of oral pain where possible. If this is not possible or not fully effective, treat pain symptomatically. For mild to moderate oral pain, use topical non-opioid analgesia (...) . For localized pain: Choline salicylate gel — short-lived effect. Excessive use should be avoided because it can lead to ulceration, particularly if the gel is trapped under dentures. Benzydamine spray — relatively short duration of action, and numbness and stinging are sometimes a problem. Lidocaine 5% ointment or 10% spray — duration of action of topical local anaesthetics, such as lidocaine, is relatively short, and these agents will not provide continuous pain relief throughout the day. Care should also

Palliative care - oral: Scenario: Prevention Scenario: Prevention | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Prevention Palliative care - oral: Scenario: Prevention Last revised in October 2018 Scenario: Prevention From age 16 years onwards. Self care Brush the teeth twice a day with a soft toothbrush and fluoride-containing toothpaste, and rinse with water, or a fluoride or antiseptic mouthwash. Note: a 'sore mouth' toothpaste or a child's toothpaste (...) an antiseptic mouthwash, such as chlorhexidine. Use chlorhexidine mouthwash if gum disease is diagnosed. For more information on mouthwashes, see . Take adequate fluids. Clean debris from the teeth. Dental floss, or chewing pineapple (contains ananase, which is a cleansing enzyme), fresh or unsweetened, may help to remove debris. The frequency of mouth care should be increased to: Every 2 hours if there is a high risk of oral problems (any persons with advanced disease or neurological impairment

Covid-19 and the role of oxygen in palliative care at home Covid-19 and the role of oxygen in palliative care at home - CEBM CEBM The Centre for Evidence-Based Medicine develops, promotes and disseminates better evidence for healthcare. Navigate this website Covid-19 and the role of oxygen in palliative care at home May 26, 2020 26 May 2020 Dr Lyn Jenkins, on behalf of Correspondence to: If I were to come down with severe Covid-19 and choose to stay at home rather than go into hospital, would I (...) benefit from receiving oxygen? Among the many questions surrounding palliative care at home, that’s the one that persistently nags at me. There is that high-flow oxygen in hospital would improve my chances of survival but what about home-delivered oxygen? Does low-flow oxygen through a mask or nasal tubes, or a positive pressure ventilation machine (such as that which relieves breathing problems during sleep), make a difference to survival? I’ve not come across any case studies or random control

Health Sciences, The University of Oxford. Dr Clare Gardiner PhD is a Senior Research Fellow at the Palliative and End of Life Care Studies Group, in the Health Sciences School, The University of Sheffield. SEARCH TERMS Database: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily <1946 to May 06, 2020> Search Strategy: ——————————————————————————– 1 palliative care/ or palliative medicine/ or palliat*.mp. or hospices/ or terminally ill/ or terminal care (...) The role and response of primary care and community nursing in the delivery of palliative care in epidemics and pandemics: a rapid review to inform practice and service delivery during the COVID-19 pandemic The role and response of primary care and community nursing in the delivery of palliative care in epidemics and pandemics: a rapid review to inform practice and service delivery during the COVID-19 pandemic - CEBM CEBM The Centre for Evidence-Based Medicine develops, promotes

of palliative care and hospice services in epidemics and pandemics: a rapid review to inform practice during the COVID-19 pandemic. J Pain Symptom Manage. 2020. 5. Borasio GD, Gamondi C, Obrist M, Jox R, For The Covid-Task Force Of Palliative C. COVID- 19: decision making and palliative care. Swiss Med Wkly. 2020;150:w20233. Appendix 1: PubMed search terms: ((palliative care[MeSH Terms] OR palliat*[title/abstract] OR hospices[MeSH Terms] OR “terminal care”[title/abstract] OR "terminally ill"[title/abstract (...) ])) AND ((2019- nCoV[title/abstract] or nCoV[title/abstract] or covid-19[title/abstract] or covid19[title/abstract] or "covid 19"[title/abstract] OR "coronavirus"[MeSH Terms] OR "coronavirus"[title/abstract])) PubMed search terms: ((palliative care[MeSH Terms] OR palliat*[title/abstract] OR hospices[MeSH Terms] OR “terminal care”[title/abstract] OR "terminally ill"[title/abstract])) AND ("pandemics"[MeSH Terms] OR "pandemic*"[title/abstract]) Document History Original search 28 March 2020 Review 12 April

Management of people with COVID-19 who are receiving palliative care Risks of more complex grief and bereavement may be increased due to restrictions on patient contacts during the dying process, social distancing and community isolation, and increased financial and relationships stressors. PP [NSW Health] MANAGEMENT OF PEOPLE WITH COVID- 19 WHO ARE RECEIVING P ALLIA TIVE CARE People requiring palliative care and COVID- 19 This population includes people with COVID-19 whose prognosis due to co (...) such as communication boards, electronic communication devices). PP [Taskforce] Respiratory distress and a diagnosis of COVID-19 will likely cause high levels of anxiety and distress. There may be worsening of pre- existing mental health conditions. PP [SA Health] Communicate with patients and support their mental wellbeing to help alleviate any anxiety and fear they may have about COVID-19. PP [NICE] COVID-19 limits face-to-face contact, which is an important part of palliative care. Ensure that regular

Improved Quality of Death and Dying in Care Homes: A Palliative Care Stepped Wedge Randomized Control Trial in Australia Mortality in care homes is high, but care of dying residents is often suboptimal, and many services do not have easy access to specialist palliative care. This study examined the impact of providing specialist palliative care on residents' quality of death and dying.Using a stepped wedge randomized control trial, care homes were randomly assigned to crossover from control (...) to intervention using a random number generator. Analysis used a generalized linear and latent mixed model. The trial was registered with ANZCTR: ACTRN12617000080325.Twelve Australian care homes in Canberra, Australia.A total of 1700 non-respite residents were reviewed from the 12 participating care homes. Of these residents, 537 died and 471 had complete data for analysis. The trial ran between February 2017 and June 2018.Palliative Care Needs Rounds (hereafter Needs Rounds) are monthly hour-long staff-only

Palliative Care for Geriatric Trauma Patients, Trauma Center Care and Routine Processes for Care - Evidence-Based Review Downloaded from https://journals.lww.com/jtrauma by SHrJlXRiF9wyGdmDxC/n4ZvpFObN52W8/pJs1OP5wSe8gFsvgypyd1IoKm1sOFkZv1K8SX2R9B65BkYPRgcPtPTSC/ubO7ynQxHVVztWt8diOe6metvPjVQIEhwIX51W on 04/05/2019 Downloaded from https://journals.lww.com/jtrauma by SHrJlXRiF9wyGdmDxC/n4ZvpFObN52W8/pJs1OP5wSe8gFsvgypyd1IoKm1sOFkZv1K8SX2R9B65BkYPRgcPtPTSC/ubO7ynQxHVVztWt8diOe6metvPjVQIEhwIX51W (...) ,LawrenceLottenberg,MD, CalebMentzer,DO,AnneMosenthal,MD,KaushikMukherjee,MD,MSci,JoshuaNash,DO, BryceRobinson,MD,MS,KristanStaudenmayer,MD,MS,RebeccaWright,PhD, JamesYon,MD,andMarieCrandall,MD,MPH, Jacksonville,Florida BACKGROUND: Despiteanagingpopulationandincreasingnumberofgeriatrictraumapatientsannually,gapsinourunderstandingofbestprac- ticesforgeriatrictraumapatientspersist.Weknowthattraumacentercareimprovesoutcomesforinjuredpatientsgenerally,and palliative care processes can improve outcomes for disease

Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries: The PACE Cluster-Randomized Clinical Trial High-quality evidence on how to improve palliative care in nursing homes is lacking.To investigate the effect of the Palliative Care for Older People (PACE) Steps to Success Program on resident and staff outcomes.A cluster-randomized clinical trial (2015-2017) in 78 nursing homes in 7 countries comparing PACE Steps to Success Program (intervention) with usual care (control (...) ). Randomization was stratified by country and median number of beds in each country in a 1:1 ratio.The PACE Steps to Success Program is a multicomponent intervention to integrate basic nonspecialist palliative care in nursing homes. Using a train-the-trainer approach, an external trainer supports staff in nursing homes to introduce a palliative care approach over the course of 1 year following a 6-steps program. The steps are (1) advance care planning with residents and family, (2) assessment, care planning

Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial To assess the impact of early triggered palliative care consultation on the outcomes of high-risk ICU patients.Single-center cluster randomized crossover trial.Two medical ICUs at Barnes Jewish Hospital.Patients (n = 199) admitted to the medical ICUs from August 2017 to May 2018 with a positive palliative care screen indicating high risk for morbidity or mortality.The medical ICUs were randomized (...) to intervention or usual care followed by washout and crossover, with independent assignment of patients to each ICU at admission. Intervention arm patients received a palliative care consultation from an interprofessional team led by board-certified palliative care providers within 48 hours of ICU admission.Ninety-seven patients (48.7%) were assigned to the intervention and 102 (51.3%) to usual care. Transition to do-not-resuscitate/do-not-intubate occurred earlier and significantly more often

Palliative care interventions for people with multiple sclerosis. People with multiple sclerosis (MS) have complex symptoms and different types of needs. These demands include how to manage the burden of physical disability as well as how to organise daily life, restructure social roles in the family and at work, preserve personal identity and community roles, keep self-sufficiency in personal care, and how to be part of an integrated care network. Palliative care teams are trained to keep open (...) with it and their families.To assess the effects (benefits and harms) of palliative care interventions compared to usual care for people with any form of multiple sclerosis: relapsing-remitting MS (RRMS), secondary-progressive MS (SPMS), primary-progressive MS (PPMS), and progressive-relapsing MS (PRMS) We also aimed to compare the effects of different palliative care interventions.On 31 October 2018, we conducted a literature search in the specialised register of the Cochrane MS and Rare Diseases of the Central Nervous