Latest & greatest articles for palliative care

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Top results for palliative care

101. Palliative care - secretions: Which antimuscarinic should I prescribe?

Palliative care - secretions: Which antimuscarinic should I prescribe? Which antimuscarinic to prescribe | Prescribing information | Palliative care - secretions | CKS | NICE Search CKS… Menu Which antimuscarinic to prescribe Palliative care - secretions: Which antimuscarinic should I prescribe? Last revised October 2016 Which antimuscarinic should I prescribe? Atropine, hyoscine hydrobromide, hyoscine butylbromide, and glycopyrronium bromide can be used to treat respiratory secretions (...) , although this is an off-label indication in palliative care. Atropine, hyoscine hydrobromide and butylbromide start to take effect within 15 minutes of subcutaneous administration; glycopyrronium bromide takes up to 45 minutes to start taking effect. Hyoscine may therefore be preferred if rapid action is required, such as when the patient, family, or carers are very distressed by noisy secretions. Hyoscine hydrobromide is available in a transdermal patch formulation (not generally used

2019 NICE Clinical Knowledge Summaries

102. Palliative care - secretions: What dose of antimuscarinic should I use?

Palliative care - secretions: What dose of antimuscarinic should I use? Dose of antimuscarinic | Prescribing information | Palliative care - secretions | CKS | NICE Search CKS… Menu Dose of antimuscarinic Palliative care - secretions: What dose of antimuscarinic should I use? Last revised October 2016 What dose of antimuscarinic should I use? Initially give a subcutaneous bolus injection of an antimuscarinic drug to treat noisy respiratory secretions, and if there is a positive response (...) Glycopyrronium bromide 200 to 400 micrograms subcutaneously 30 to 60 minutes 600 to 1200 micrograms† * Hyoscine hydrobromide 1 mg can be administered every 72 hours via a transdermal patch (not commonly used for this indication in palliative care). The patch may be easier to use than subcutaneous administration, but it has a slow onset of action, and it is not well absorbed. In addition, the dose is insufficient for most people.† † Some experts suggest higher doses of glycopyrronium may be used

2019 NICE Clinical Knowledge Summaries

103. Palliative care - secretions: Scenario: Assessment

Palliative care - secretions: Scenario: Assessment Scenario: Assessment | Management | Palliative care - secretions | CKS | NICE Search CKS… Menu Scenario: Assessment Palliative care - secretions: Scenario: Assessment Last revised October 2016 Scenario: Assessment From age 16 years onwards. How should I assess a person with respiratory secretions in palliative care? Consider . Assess for the likely causes of noisy respiratory secretions in people in the last days of life. Establish whether (...) on guidance from the National Institute for Health and Care Excellence [ ; ] and expert opinion [ ]. Pooling of saliva is the most common cause of rattling breathing in a person who is terminally ill [ ]. The information on recognizing the terminal phase is based on expert opinion from palliative care resources that were developed from clinical experience [ ; ]. © .

2019 NICE Clinical Knowledge Summaries

104. Palliative care - secretions: Scenario: Noisy respiratory secretions at the end of life

Palliative care - secretions: Scenario: Noisy respiratory secretions at the end of life Scenario: Noisy respiratory secretions at the end of life | Management | Palliative care - secretions | CKS | NICE Search CKS… Menu Scenario: Noisy respiratory secretions at the end of life Palliative care - secretions: Scenario: Noisy respiratory secretions at the end of life Last revised October 2016 Scenario: Noisy respiratory secretions at the end of life From age 16 years onwards. What conservative (...) measures may ease symptoms in people with problematic respiratory secretions? Reposition the person on one side with the upper body elevated. Appropriate body positioning encourages postural drainage. Basis for recommendation This recommendation is based on expert opinion from palliative care textbooks [ ; ]. When should I consider the use of drug treatment for respiratory secretions at the end of life? Consider drug treatment in addition to conservative management if: Positioning (and suction

2019 NICE Clinical Knowledge Summaries

105. Palliative care - secretions: How do I know my patient has it?

Palliative care - secretions: How do I know my patient has it? Diagnosis | Diagnosis | Palliative care - secretions | CKS | NICE Search CKS… Menu Diagnosis Palliative care - secretions: How do I know my patient has it? Last revised October 2016 How do I know my patient has it? Pooling of secretions such as saliva in the hypopharynx is likely if a gurgling, rattling, or bubbling noise can be heard persistently from the person's airway during the terminal phase of life. For more information (...) on identifying the terminal phase of life, see . Basis for recommendation This information is based on expert opinion in a palliative care text book [ ]. © .

2019 NICE Clinical Knowledge Summaries

106. Palliative care - secretions: How do I administer anti-emetic drugs via a syringe driver?

Palliative care - secretions: How do I administer anti-emetic drugs via a syringe driver? Administering drugs via syringe driver | Prescribing information | Palliative care - secretions | CKS | NICE Search CKS… Menu Administering drugs via syringe driver Palliative care - secretions: How do I administer anti-emetic drugs via a syringe driver? Last revised October 2016 How do I administer anti-emetic drugs via a syringe driver? Drug delivery via syringe drivers is an option if the person cannot (...) take medicines by mouth. Only drugs that are known to be safe and effective when administered subcutaneously should be used. Use water for injection as the diluent when mixing drugs in a syringe driver (except for ketamine or octreotide). Before mixing drugs, check their compatibility. Always follow local palliative care guidelines or seek advice from local palliative care services or hospital pharmacy drug information services before mixing drugs in a syringe driver. Data are most often available

2019 NICE Clinical Knowledge Summaries

107. Palliative care - secretions: Adverse effects of antimuscarinics

Palliative care - secretions: Adverse effects of antimuscarinics Adverse effects of antimuscarinics | Prescribing information | Palliative care - secretions | CKS | NICE Search CKS… Menu Adverse effects of antimuscarinics Palliative care - secretions: Adverse effects of antimuscarinics Last revised October 2016 Adverse effects of antimuscarinics Common adverse effects of antimuscarinic drugs include dry mouth, constipation, urinary retention, agitation, drowsiness and blurred vision (...) butylbromide and glycopyrronium bromide do not readily cross the blood–brain barrier and therefore do not produce central nervous system adverse effects. The information regarding the adverse effect profile of antimuscarinic drugs is based on expert opinion in a systematic review [ ], the Palliative Care Formulary [ ], and the manufacturers' Summaries of Product Characteristics [ ; ; ]. © .

2019 NICE Clinical Knowledge Summaries

108. Palliative care - secretions

Palliative care - secretions Palliative care - secretions | Topics A to Z | CKS | NICE Search CKS… Menu Palliative care - secretions Palliative care - secretions Last revised October 2016 During the terminal phase of a person's illness, airway secretions may accumulate and result in gurgling and rattling noises during breathing Diagnosis Management Prescribing information Background information Palliative care - secretions: Summary During the terminal phase of a person's illness, airway (...) to: Salivary and bronchial secretions Chest infection Aspiration Gastric reflux Pulmonary oedema Bronchorrhoea (the production of 100 mL or more per day of watery mucus) When managing a person with noisy respiratory secretions at the end of life: It is essential to recognize the signs of dying in order to provide appropriate care. Repositioning the person on one side with the upper body elevated, can encourage postural drainage. If repositioning and is ineffective an antimuscarinic drug can be considered

2019 NICE Clinical Knowledge Summaries

109. Palliative care - oral: Scenario: Oral candida infection

Palliative care - oral: Scenario: Oral candida infection Scenario: Oral candida infection | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Oral candida infection Palliative care - oral: Scenario: Oral candida infection Last revised in October 2018 Scenario: Oral candida infection From age 16 years onwards. Oral candida infection Manage predisposing local and systemic for oral candida infection in conjunction with anticandidal treatment. In immunocompetent people (...) and chlorhexidine mouthwash [ ]. Basis for recommendation These recommendations represent the general consensus from palliative care resources and local guidelines written by experts on the basis of experience of clinical practice [ ; ; ; ; ; ]. From an evidence-based perspective: Few trials have compared the use of topical anticandidal treatments in people with cancer in palliative care [ ]. A Cochrane review investigated treatment of oral candidiasis in people with cancer receiving treatment and found

2019 NICE Clinical Knowledge Summaries

110. Palliative care - oral: Scenario: End of life care

Palliative care - oral: Scenario: End of life care Scenario: End of life care | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: End of life care Palliative care - oral: Scenario: End of life care Last revised in October 2018 Scenario: End of life care From age 16 years onwards. How to recognize the terminal phase It can often be difficult to be certain that a person is dying, but it is essential to recognize the signs of dying in order to appropriately care (...) based on the National Institute for Health and Care Excellence (NICE) guideline Care of dying adults in the last days of life [ ]. The basis for the NICE recommendations has been briefly summarized in this section. For detailed information on the evidence NICE used to make these recommendations, see the full How should I manage oral care in the terminal phase? The management of dry mouth should be included in the person's care plan. Consider changing or stopping medications which are causing dry

2019 NICE Clinical Knowledge Summaries

111. Palliative care - oral: Scenario: Halitosis, excessive salivation and altered taste

Palliative care - oral: Scenario: Halitosis, excessive salivation and altered taste Scenario: Halitosis, excessive salivation and altered taste | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Halitosis, excessive salivation and altered taste Palliative care - oral: Scenario: Halitosis, excessive salivation and altered taste Last revised in October 2018 Scenario: Halitosis, excessive salivation and altered taste From age 16 years onwards. Halitosis due to an oral (...) cause if possible. Modification of dentures may help. Review drug causes such as buprenorphine, clonazepam, haloperidol, risperidone, venlafaxine and ketamine. Head positioning (such as preventing the chin/jaw from dropping and avoiding a flexed neck) with or without suction may help. Local palliative care guidelines on excessive salivation should be followed. If these are not available, specialist advice should be sought regarding off-licence drug management of excessive salivation. There are few

2019 NICE Clinical Knowledge Summaries

112. Palliative care - oral: Scenario: Mouth ulcers and mucositis

Palliative care - oral: Scenario: Mouth ulcers and mucositis Scenario: Mouth ulcers and mucositis | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Mouth ulcers and mucositis Palliative care - oral: Scenario: Mouth ulcers and mucositis Last revised in October 2018 Scenario: Mouth ulcers and mucositis From age 16 years onwards. Aphthous ulcers Correct any underlying iron, folate, or vitamin B 12 deficiency if the prognosis allows. Treatment choices should be guided (...) of metronidazole decreases with prolonged or repeated use. Resistance to metronidazole by the odour-producing anaerobes is unlikely to develop [ ]. Bleeding ulcers The recommendation on management of bleeding ulcers is based on expert opinion in a palliative care textbook [ ]. Neutropenic ulcers Seek urgent specialist advice if neutropenia is suspected from the appearance of the ulcer (see ) or if confirmed by a blood test. Basis for recommendation The basis for this recommendation is pragmatic advice

2019 NICE Clinical Knowledge Summaries

113. Palliative care - oral: Scenario: Assessment

Palliative care - oral: Scenario: Assessment Scenario: Assessment | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Assessment Palliative care - oral: Scenario: Assessment Last revised in October 2018 Scenario: Assessment From age 16 years onwards. Assessment Perform a full history and examination. Assess concurrent symptoms, psychological state, social needs, and spiritual needs. For more information, see the CKS topic on . Assess the person's: Understanding (...) of the diagnosis and their current problems. Coping ability, and how their family/carer is coping. Nutritional status and whether their fluid intake is adequate. Level of oral hygiene and whether they can carry out routine oral care. Estimate the likely prognosis, if possible. For further information, see the , which is part of the Gold Standards Framework and the CKS topic on . Basis for recommendation These recommendations are based on national guidance from the National Institute for Health and Care

2019 NICE Clinical Knowledge Summaries

114. Palliative care - oral: Scenario: Dry mouth

Palliative care - oral: Scenario: Dry mouth Scenario: Dry mouth | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Dry mouth Palliative care - oral: Scenario: Dry mouth Last revised in October 2018 Scenario: Dry mouth From age 16 years onwards. Managing underlying cause Treat any of the following underlying causes of dry mouth if appropriate: Adverse effect of a being taken. Reduce the dose or change the drug if possible. However, in practice, it is often very (...) prescriptions 'ACBS'. Note: some products contain mucin from pigs (for example AS Saliva Orthana ® ) which may be unacceptable to certain groups of people, such as vegetarians, and people of Jewish or Muslim faith. Basis for recommendation These recommendations are based on palliative care textbooks and local guidelines written by experts on the basis of experience of clinical practice [ ; ; ; ]. A Cochrane review [ ] found: Limited evidence that pilocarpine is effective in increasing saliva production

2019 NICE Clinical Knowledge Summaries

115. Palliative care - oral: Oral pilocarpine

Palliative care - oral: Oral pilocarpine Oral pilocarpine | Prescribing information | Palliative care - oral | CKS | NICE Search CKS… Menu Oral pilocarpine Palliative care - oral: Oral pilocarpine Last revised in October 2018 Oral pilocarpine Contraindications Pilocarpine should be avoided in people who: Have asthma. Have chronic obstructive pulmonary disease. Have uncontrolled cardiovascular and/or renal disease. Have acute iritis. Are pregnant. Are breastfeeding. How to use Pilocarpine

2019 NICE Clinical Knowledge Summaries

116. Palliative care - oral: Oral antifungals

Palliative care - oral: Oral antifungals Oral antifungals | Prescribing information | Palliative care - oral | CKS | NICE Search CKS… Menu Oral antifungals Palliative care - oral: Oral antifungals Last revised in October 2018 Oral antifungals Recommended oral antifungals In immunocompetent people, oral fluconazole is recommended for second-line treatment if candidiasis persists. In immunocompromised people, oral fluconazole is generally preferred for first-line treatment. Oral antifungals

2019 NICE Clinical Knowledge Summaries

117. Clinical Practice Guidelines for Quality Palliative Care

Clinical Practice Guidelines for Quality Palliative Care PEDIATRICS Volume 143, number 1, January 2019:e20183310 FROM THE AMERICAN ACADEMY OF PEDIATRICS The American Academy of Pediatrics has endorsed the following publication: National Coalition for Hospice and Palliative Care, National Consensus Project. Clinical Practice Guidelines for Quality Palliative Care. 4th ed. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018. Available at: www. nationalcoalition hpc. org/ ncp (...) . All statements of endorsement from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, retired, or revised at or before that time. Clinical Practice Guidelines for Quality Palliative Care To cite: Clinical Practice Guidelines for Quality Palliative Care. Pediatrics. 2019;143(1):e20183310 DOI: https:// doi. or g/ 10. 1542/ peds. 2018- 3310 PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2019 by the American Academy

2019 American Academy of Pediatrics

118. Palliative care

/10.1056/NEJMra1404684 http://www.ncbi.nlm.nih.gov/pubmed/26287850?tool=bestpractice.com To palliate comes from the Latin word 'palliare', meaning 'to cloak', or to ease symptoms without curing the underlying disease. The primary goal of palliative care is to provide quality of life for the patient and family 2018 19. A good death at home: home palliative care services keep people where they want to be A good death at home: home palliative care services keep people where they want to be | Evidently (...) Palliative care Top results for palliative care - Trip Database or use your Google+ account Liberating the literature ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search numbers in the top search box and pressing the search button. An example search might look like (#1 or #2

2018 Trip Latest and Greatest

119. Indicators of integration at ESMO Designated Centres of Integrated Oncology and Palliative Care Full Text available with Trip Pro

Indicators of integration at ESMO Designated Centres of Integrated Oncology and Palliative Care A recent international consensus panel identified 13 major indicators to assess the level of integration between oncology and palliative care. We examined these indicators among European Society for Medical Oncology (ESMO) Designated Centres (ESMO-DCs) of Integrated Oncology and Palliative Care (PC) and determined the centre characteristics associated with greater integration.This is a preplanned (...) secondary analysis of a recent survey to characterise the structure, processes and outcomes of the palliative care programmes at ESMO-DCs. We assessed the level of integration using 13 major indicators. We calculated two Palliative Care and Oncology Integration Indexes consisting of all 13 indicators (PCOI-13, range 0-13) and 9 of the 13 indicators (PCOI-9, range 0-9), with a higher index indicating greater integration.The survey response rate was 152/184 (83%). Among the 13 major indicators

2018 ESMO open

120. A narrative literature review of palliative care regarding patients with idiopathic pulmonary fibrosis Full Text available with Trip Pro

A narrative literature review of palliative care regarding patients with idiopathic pulmonary fibrosis The aim of this study was to examine the reported characteristics of extant studies on palliative care for patients with idiopathic pulmonary fibrosis.Narrative review.A comprehensive search of the following electronic databases in English and Japanese commenced from 2002 - December 2017. Eligibility criteria was determined by the inclusion and exclusion criteria.Nineteen articles were (...) eligible. The characteristics of palliative care for patients with idiopathic pulmonary fibrosis were symptoms relief, start time of palliative care and palliative care needs of patients and care partners. Also, patients' education of disease management including advanced care planning and developing a palliative care system by the healthcare provider including multidisciplinary professional teams was identified. The care provided was a "care conference" and integrated palliative care was carried out

2018 Nursing open