Pub Date : 2021-07-04DOI: 10.1080/09699260.2021.1952415
Jason Mills
An editorial is presented on the theoretical foundations for self-care practice. Topics include the effective self-care practice may not be so common for healthcare professionals, the primary focus of self-care discourse has largely been concerned with collective practicalities in the clinical practice milieu, and the realms of theory and theory development for self-care among healthcare professionals are relatively underdeveloped.
{"title":"Theoretical foundations for self-care practice","authors":"Jason Mills","doi":"10.1080/09699260.2021.1952415","DOIUrl":"https://doi.org/10.1080/09699260.2021.1952415","url":null,"abstract":"An editorial is presented on the theoretical foundations for self-care practice. Topics include the effective self-care practice may not be so common for healthcare professionals, the primary focus of self-care discourse has largely been concerned with collective practicalities in the clinical practice milieu, and the realms of theory and theory development for self-care among healthcare professionals are relatively underdeveloped.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"29 1","pages":"183 - 185"},"PeriodicalIF":1.7,"publicationDate":"2021-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1952415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47924459","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}
Virtual simulation can provide high-quality learning experiences through innovative and engaging activities while also overcoming some of the constraints associated with physical simulation. We developed a virtual community, called Birley Place, to facilitate simulation-based learning activities. Adopting a novel approach, we modelled the virtual community on the large metropolitan city in which our institution is based. Publicly available health and population data were used to ensure that the homes, businesses and services in the community were representative of distinct socioeconomic areas of our city. The residents of the virtual community were also matched with the real-world areas based on health and lifestyle data. Our virtual community is used to facilitate learning activities across our health and social care degree programmes. In this article, we summarise how we developed Birley Place, before providing one example of how it is used to facilitate the delivery of a large-scale interprofessional education project. Birley Place is an innovative tool for delivering online and virtual simulation. The use of this virtual community facilitates learners' understanding of the connection between settings and health status.
虚拟仿真可以通过创新和引人入胜的活动提供高质量的学习体验，同时还能克服与物理仿真相关的一些限制。我们开发了一个名为 Birley Place 的虚拟社区，以促进基于模拟的学习活动。我们采用了一种新颖的方法，以我校所在的大都市作为虚拟社区的模型。我们使用了公开的健康和人口数据，以确保社区中的住宅、商业和服务能够代表我们城市中不同的社会经济区域。虚拟社区的居民也根据健康和生活方式数据与现实世界中的地区进行了匹配。我们的虚拟社区用于促进我们的健康和社会护理学位课程的学习活动。在本文中，我们将总结如何开发 Birley Place，然后举例说明如何利用它来促进大型跨专业教育项目的实施。Birley Place 是一种创新的在线虚拟仿真工具。使用这一虚拟社区有助于学习者理解环境与健康状况之间的联系。
{"title":"Birley Place: a virtual community for the delivery of health and social care education.","authors":"David J Wright, Leah Greene, Kirsten Jack, Eleanor Hannan, Claire Hamshire","doi":"10.1136/bmjstel-2020-000849","DOIUrl":"10.1136/bmjstel-2020-000849","url":null,"abstract":"<p><p>Virtual simulation can provide high-quality learning experiences through innovative and engaging activities while also overcoming some of the constraints associated with physical simulation. We developed a virtual community, called Birley Place, to facilitate simulation-based learning activities. Adopting a novel approach, we modelled the virtual community on the large metropolitan city in which our institution is based. Publicly available health and population data were used to ensure that the homes, businesses and services in the community were representative of distinct socioeconomic areas of our city. The residents of the virtual community were also matched with the real-world areas based on health and lifestyle data. Our virtual community is used to facilitate learning activities across our health and social care degree programmes. In this article, we summarise how we developed Birley Place, before providing one example of how it is used to facilitate the delivery of a large-scale interprofessional education project. Birley Place is an innovative tool for delivering online and virtual simulation. The use of this virtual community facilitates learners' understanding of the connection between settings and health status.</p>","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"15 1","pages":"627-630"},"PeriodicalIF":1.1,"publicationDate":"2021-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87549887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-21DOI: 10.1080/09699260.2021.1922146
Mahrley T. Provido-Aljibe, Choon Meng Yee, Zhi Jun Carin Low, A. Hum
Context Ketamine at sub-anesthetic doses is a potent analgesia. Its use in cancer pain remains equivocal with protocols varying in patient selection, starting dose, titration, duration of use and adjustment of co-analgesics. Objective To study the impact of a standardised Ketamine Step Protocol on cancer pain in a Palliative Care Unit (PCU). Methodology This is a prospective cohort study of a standardised Ketamine Step Protocol which was developed in a PCU for use in cancer pain. The subcutaneous ketamine infusion was standardised at a starting dose of 75 mg over 24 hours with Haloperidol 5 mg as prophylaxis against psycho-mimetic side effects. Incremental doses of ketamine followed the daily stepwise protocol. Result Of the 48 patients analysed, 41 (85.4%) had neuropathic cancer pain. The median Palliative Performance Scale score (PPSv2) was 40%. Mean Numerical Rating Score (NRS) improved from 6.74 to 2.61 (P < 0.0001) with a mean percentage reduction of 58.05%. The final mean daily ketamine dose needed to achieve stable pain control was 137.50 mg/day (±81.54). 31(62.5%) patients achieved pain control by day 3. The mean Morphine Equivalent Daily Dose (MEDD) reduction was from 130.34 mg to 107.33 mg (P < 0.002) with a percentage reduction of 18.85%. More than half of our patients completed the 5 d protocol with mild to moderate side effects not warranting urgent medical intervention nor termination of the ketamine protocol. Conclusion Use of a standardised Ketamine Step Protocol showed a statistically significant reduction in pain and MEDD in patients with predominantly neuropathic cancer pain. It also demonstrated a safe and effective method for opioid reduction after commencement of parenteral ketamine. Key Message How can a standardised ketamine protocol impact on cancer pain control? Our study shows that: Parenteral ketamine is a potent analgesic which significantly reduced pain in patients with cancer neuropathic pain. This study also demonstrated a safe and effective method for titration of opioids after parenteral ketamine is started. Concurrent use of psychotropics also helps to reduce psycho-mimetic side effects, increasing tolerability to ketamine.
{"title":"The impact of a standardised ketamine step protocol for cancer neuropathic pain","authors":"Mahrley T. Provido-Aljibe, Choon Meng Yee, Zhi Jun Carin Low, A. Hum","doi":"10.1080/09699260.2021.1922146","DOIUrl":"https://doi.org/10.1080/09699260.2021.1922146","url":null,"abstract":"Context Ketamine at sub-anesthetic doses is a potent analgesia. Its use in cancer pain remains equivocal with protocols varying in patient selection, starting dose, titration, duration of use and adjustment of co-analgesics. Objective To study the impact of a standardised Ketamine Step Protocol on cancer pain in a Palliative Care Unit (PCU). Methodology This is a prospective cohort study of a standardised Ketamine Step Protocol which was developed in a PCU for use in cancer pain. The subcutaneous ketamine infusion was standardised at a starting dose of 75 mg over 24 hours with Haloperidol 5 mg as prophylaxis against psycho-mimetic side effects. Incremental doses of ketamine followed the daily stepwise protocol. Result Of the 48 patients analysed, 41 (85.4%) had neuropathic cancer pain. The median Palliative Performance Scale score (PPSv2) was 40%. Mean Numerical Rating Score (NRS) improved from 6.74 to 2.61 (P < 0.0001) with a mean percentage reduction of 58.05%. The final mean daily ketamine dose needed to achieve stable pain control was 137.50 mg/day (±81.54). 31(62.5%) patients achieved pain control by day 3. The mean Morphine Equivalent Daily Dose (MEDD) reduction was from 130.34 mg to 107.33 mg (P < 0.002) with a percentage reduction of 18.85%. More than half of our patients completed the 5 d protocol with mild to moderate side effects not warranting urgent medical intervention nor termination of the ketamine protocol. Conclusion Use of a standardised Ketamine Step Protocol showed a statistically significant reduction in pain and MEDD in patients with predominantly neuropathic cancer pain. It also demonstrated a safe and effective method for opioid reduction after commencement of parenteral ketamine. Key Message How can a standardised ketamine protocol impact on cancer pain control? Our study shows that: Parenteral ketamine is a potent analgesic which significantly reduced pain in patients with cancer neuropathic pain. This study also demonstrated a safe and effective method for titration of opioids after parenteral ketamine is started. Concurrent use of psychotropics also helps to reduce psycho-mimetic side effects, increasing tolerability to ketamine.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"4 - 10"},"PeriodicalIF":1.7,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1922146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43186093","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}
Pub Date : 2021-05-21DOI: 10.1080/09699260.2021.1922795
L. Willmott, B. White, Rachel Feeney, K. Chambaere, P. Yates, G. Mitchell, D. Piper
Little is known in Australia about current practice relating to medical end-of-life decisions preceding patient deaths. This study aimed to translate and culturally adapt a European questionnaire on medical end-of-life decisions and end-of-life care to the Australian context, producing a questionnaire to assess current medical practice in Australia and enable comparison with international studies. Following initial research team review, an English translation of the questionnaire was culturally adapted using four waves of cognitive pre-testing interviews with members of the target community: Australian doctors (n=27) from different specialties, clinical settings and geographical locations. Cognitive interviewing was used to identify potential problems with the translated questionnaire by examining the cognitive processes participants used to answer questions. Two experts in end-of-life research provided feedback on the questionnaire after the third wave of cognitive interviews. Research team review occurred again after the third and fourth waves of cognitive interviews. Interview notes were reviewed, coded and analysed using content analysis. A consensus approach was used to identify necessary adaptations, with all members of the research team endorsing the adaptations. Following cognitive pre-testing, an online version of the questionnaire was piloted with doctors, nurses and health law researchers (n=13). Improvements to questionnaire wording, flow/routeing and design were identified during the cognitive interviewing and piloting process and implemented. Saturation in terms of face and content validity and acceptability of the questionnaire was achieved after four rounds of cognitive interviews. Participants generally agreed that the adapted questionnaire instructions were easy to follow, the questions were easy to understand, they felt comfortable answering all the questions, and the online questionnaire format was user friendly. The time taken to complete the questionnaire (average 9.2 min) was also acceptable to participants. Cognitive interviewing was a suitable method for identifying and solving challenges with comprehension and applicability of the questionnaire within the Australian context. The final questionnaire was well accepted by doctors and is now being used in a study exploring the incidence and nature of medical end-of-life decisions involving adult patients in one Australian state (Victoria). This questionnaire may be suitable for use or further adaptation in research in other English speaking jurisdictions.
{"title":"Collecting data on end-of-life decision-making: Questionnaire translation, adaptation and validity assessment","authors":"L. Willmott, B. White, Rachel Feeney, K. Chambaere, P. Yates, G. Mitchell, D. Piper","doi":"10.1080/09699260.2021.1922795","DOIUrl":"https://doi.org/10.1080/09699260.2021.1922795","url":null,"abstract":"Little is known in Australia about current practice relating to medical end-of-life decisions preceding patient deaths. This study aimed to translate and culturally adapt a European questionnaire on medical end-of-life decisions and end-of-life care to the Australian context, producing a questionnaire to assess current medical practice in Australia and enable comparison with international studies. Following initial research team review, an English translation of the questionnaire was culturally adapted using four waves of cognitive pre-testing interviews with members of the target community: Australian doctors (n=27) from different specialties, clinical settings and geographical locations. Cognitive interviewing was used to identify potential problems with the translated questionnaire by examining the cognitive processes participants used to answer questions. Two experts in end-of-life research provided feedback on the questionnaire after the third wave of cognitive interviews. Research team review occurred again after the third and fourth waves of cognitive interviews. Interview notes were reviewed, coded and analysed using content analysis. A consensus approach was used to identify necessary adaptations, with all members of the research team endorsing the adaptations. Following cognitive pre-testing, an online version of the questionnaire was piloted with doctors, nurses and health law researchers (n=13). Improvements to questionnaire wording, flow/routeing and design were identified during the cognitive interviewing and piloting process and implemented. Saturation in terms of face and content validity and acceptability of the questionnaire was achieved after four rounds of cognitive interviews. Participants generally agreed that the adapted questionnaire instructions were easy to follow, the questions were easy to understand, they felt comfortable answering all the questions, and the online questionnaire format was user friendly. The time taken to complete the questionnaire (average 9.2 min) was also acceptable to participants. Cognitive interviewing was a suitable method for identifying and solving challenges with comprehension and applicability of the questionnaire within the Australian context. The final questionnaire was well accepted by doctors and is now being used in a study exploring the incidence and nature of medical end-of-life decisions involving adult patients in one Australian state (Victoria). This questionnaire may be suitable for use or further adaptation in research in other English speaking jurisdictions.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"83 - 93"},"PeriodicalIF":1.7,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1922795","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44845646","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}
Pub Date : 2021-05-08DOI: 10.1080/09699260.2021.1919046
Hayato Takayama, K. Kawahara, K. Fushimi
The number of elderly people aged 65 and over is increasing in Japan. Elderly, terminal patients in acute care hospitals receive aggressive therapy treatments, leading to higher national medical costs; however, reports indicate that patient discussions regarding end-of-life medical care can reduce unnecessary aggressive therapies. This study investigated whether the presence of home-based medical care impacted the use of aggressive therapies in terminal, elderly patients who had died of pneumonia during hospitalization. Japanese Diagnosis Procedure Combination (DPC) patient data were obtained for the period April 2014 to March 2017. We conducted a multicenter, cohort study of inpatients aged 65 years or older who were hospitalized for pneumonia and subsequently died. We analyzed the relationship between pre-hospitalization, home-based medical care, and aggressive therapies during the terminal stages of pneumonia using the chi-square test, t-tests, and logistic regression analyses. Data extracted included 13,582 cases of patients with pneumonia over the age of 65 years. The mean patient age was 83.1 (±7.02) years, 64.7% were male, 47.8% underwent ambulance transport, and 17.2% had home-based medical care. Aggressive therapy was administered in 33.3% of the cases. Effects of the independent variables on incidence of aggressive therapy were observed in 2,332 cases (17.2%; OR: 0.879; 95% CI: 0.791-0.977). Odds ratios were higher for patients undergoing ambulance transport, a higher Barthel index, and a higher A-DROP. We found that incidences of aggressive therapy during terminal stages of pneumonia were significantly lower for elderly patients who received home-based medical care prior to hospitalization.
{"title":"Relationship between pre-hospitalization home-based medical care of elderly patients who died from pneumonia and inpatient aggressive therapy in Japan","authors":"Hayato Takayama, K. Kawahara, K. Fushimi","doi":"10.1080/09699260.2021.1919046","DOIUrl":"https://doi.org/10.1080/09699260.2021.1919046","url":null,"abstract":"The number of elderly people aged 65 and over is increasing in Japan. Elderly, terminal patients in acute care hospitals receive aggressive therapy treatments, leading to higher national medical costs; however, reports indicate that patient discussions regarding end-of-life medical care can reduce unnecessary aggressive therapies. This study investigated whether the presence of home-based medical care impacted the use of aggressive therapies in terminal, elderly patients who had died of pneumonia during hospitalization. Japanese Diagnosis Procedure Combination (DPC) patient data were obtained for the period April 2014 to March 2017. We conducted a multicenter, cohort study of inpatients aged 65 years or older who were hospitalized for pneumonia and subsequently died. We analyzed the relationship between pre-hospitalization, home-based medical care, and aggressive therapies during the terminal stages of pneumonia using the chi-square test, t-tests, and logistic regression analyses. Data extracted included 13,582 cases of patients with pneumonia over the age of 65 years. The mean patient age was 83.1 (±7.02) years, 64.7% were male, 47.8% underwent ambulance transport, and 17.2% had home-based medical care. Aggressive therapy was administered in 33.3% of the cases. Effects of the independent variables on incidence of aggressive therapy were observed in 2,332 cases (17.2%; OR: 0.879; 95% CI: 0.791-0.977). Odds ratios were higher for patients undergoing ambulance transport, a higher Barthel index, and a higher A-DROP. We found that incidences of aggressive therapy during terminal stages of pneumonia were significantly lower for elderly patients who received home-based medical care prior to hospitalization.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"29 - 36"},"PeriodicalIF":1.7,"publicationDate":"2021-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1919046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45109656","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}
Pub Date : 2021-05-04DOI: 10.1080/09699260.2021.1917798
Jennifer Smith
{"title":"Re-framing self-care: Deepening the quality of our own care","authors":"Jennifer Smith","doi":"10.1080/09699260.2021.1917798","DOIUrl":"https://doi.org/10.1080/09699260.2021.1917798","url":null,"abstract":"","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"29 1","pages":"127 - 129"},"PeriodicalIF":1.7,"publicationDate":"2021-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1917798","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47515124","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}
Pub Date : 2021-05-04DOI: 10.1080/09699260.2021.1919856
D. Gundersen, Charlotta, Lindvall
The purpose of the scoping review was to synthesize peer-reviewed literature of daughters’ experiences of maternal bereavement. The search was conducted across eight databases and included peer-reviewed, qualitative research that reported on daughters’ experiences of the death of their mother. The review identified 21 studies. Experiences included recurrent grief including secondary losses, difficulties establishing and maintaining relationships, and intrapersonal and daily lifestyle changes. Implications for maternal loss during adolescence, and recommendations for those supporting women whose mothers have passed away have been provided. Further research is needed to identify the experiences of loss at different developmental stages.
{"title":"Bibliography","authors":"D. Gundersen, Charlotta, Lindvall","doi":"10.1080/09699260.2021.1919856","DOIUrl":"https://doi.org/10.1080/09699260.2021.1919856","url":null,"abstract":"The purpose of the scoping review was to synthesize peer-reviewed literature of daughters’ experiences of maternal bereavement. The search was conducted across eight databases and included peer-reviewed, qualitative research that reported on daughters’ experiences of the death of their mother. The review identified 21 studies. Experiences included recurrent grief including secondary losses, difficulties establishing and maintaining relationships, and intrapersonal and daily lifestyle changes. Implications for maternal loss during adolescence, and recommendations for those supporting women whose mothers have passed away have been provided. Further research is needed to identify the experiences of loss at different developmental stages.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"29 1","pages":"160 - 182"},"PeriodicalIF":1.7,"publicationDate":"2021-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1919856","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43590643","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}
Pub Date : 2021-05-03DOI: 10.1080/09699260.2021.1919045
Rana Yamout, M. Viallard, Samer Hoteit, H. Abou-Zeid, F. Shebbo, N. Naccache
Morphine is the first line drug for moderate to severe pain; however, due to side effects it may contribute to discomfort. Dexmedetomidine has both sedative and analgesic actions with a morphine sparing effect and can be used in metastatic cancer patients with intractable pain. This pilot project primarily aims to evaluate the effect of dexmedetomidine on pain treatment in patients with metastatic cancer. In addition, the work aims to determine its impact on anxiety and quality of communication of patients with their family members. Patients between 18 and 75 years, with metastatic cancer, who failed multiple pain treatments at home and admitted to the hospital for pain management were included. Patients were allocated randomly to Group A (who received morphine plus normal saline solution) or Group B (who received morphine plus dexmedetomidine) for pain management. The Visual Analogue Score (VAS) was used to assess pain intensity, a 5-point sedation scale was used to assess sedation level, and the Hamilton scale was used to assess anxiety. Results have shown that morphine consumption was reduced at different time points up to 48 h, p < 0.005 in both groups. There was a trend in decreasing pain scores after 36 h in both groups. All patients in Group A required rescue pain treatment; however, in Group B, this percentage was lower (67%). Communication was better in patients allocated to Group B than patients in Group A. To conclude, dexmedetomidine was safe and has exerted an opioid-sparing effect in patients with metastatic cancer with keeping their anxiety levels within an acceptable range.
{"title":"Does the addition of dexmedetomidine to morphine have any clinical benefit on the treatment of pain in patients with metastatic cancer? A pilot study","authors":"Rana Yamout, M. Viallard, Samer Hoteit, H. Abou-Zeid, F. Shebbo, N. Naccache","doi":"10.1080/09699260.2021.1919045","DOIUrl":"https://doi.org/10.1080/09699260.2021.1919045","url":null,"abstract":"Morphine is the first line drug for moderate to severe pain; however, due to side effects it may contribute to discomfort. Dexmedetomidine has both sedative and analgesic actions with a morphine sparing effect and can be used in metastatic cancer patients with intractable pain. This pilot project primarily aims to evaluate the effect of dexmedetomidine on pain treatment in patients with metastatic cancer. In addition, the work aims to determine its impact on anxiety and quality of communication of patients with their family members. Patients between 18 and 75 years, with metastatic cancer, who failed multiple pain treatments at home and admitted to the hospital for pain management were included. Patients were allocated randomly to Group A (who received morphine plus normal saline solution) or Group B (who received morphine plus dexmedetomidine) for pain management. The Visual Analogue Score (VAS) was used to assess pain intensity, a 5-point sedation scale was used to assess sedation level, and the Hamilton scale was used to assess anxiety. Results have shown that morphine consumption was reduced at different time points up to 48 h, p < 0.005 in both groups. There was a trend in decreasing pain scores after 36 h in both groups. All patients in Group A required rescue pain treatment; however, in Group B, this percentage was lower (67%). Communication was better in patients allocated to Group B than patients in Group A. To conclude, dexmedetomidine was safe and has exerted an opioid-sparing effect in patients with metastatic cancer with keeping their anxiety levels within an acceptable range.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"29 1","pages":"272 - 277"},"PeriodicalIF":1.7,"publicationDate":"2021-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1919045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47228704","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}
Pub Date : 2021-04-29DOI: 10.1080/09699260.2021.1905146
G. Mitchell, Megdelawit Melaku, A. Moss, Glenda Chaille, Blessing Makoni, Lannette Lewis, Allyson Mutch
Residential aged care facilities (RACFs) face severe challenges in the provision of high-quality end of life care. A pilot of a nurse-led end-of-life palliative care consultative service (CiMaS) supporting RACFs was conducted in three RACFs in the West Moreton Region of Queensland, Australia, from May 2018. We conducted a mixed method evaluation comprising: a chart audit of deaths in the 12 months before and after the intervention; focus groups with RACF staff; and interviews with facility directors, primary family members and GPs. Quantitative and Qualitative data were assessed separately with statistical and thematic analyses respectively. The RACFs cared for 277 residents. There were 24 pre-intervention deaths and 44 in the intervention period (28 (64%) referred to CiMaS). There was widespread support for the service. Families felt supported and knowledgeable about what was happening. Care plans were almost always recorded in health records. Patients’ symptoms appeared to be better recognised and managed. Staff and Facility managers felt more support than previously, with more responsive and reliable out of hours support. There were significant care improvements in patients not referred to CiMaS, suggesting a learning effect. GPs observed improvements in nursing staff confidence and support to families. Transfers to hospitals fell by two-thirds for both referred and non-referred patients compared with the year before implementation. The program was both efficient and effective.
{"title":"Evaluation of a commissioned end-of-life care service in Australian aged care facilities","authors":"G. Mitchell, Megdelawit Melaku, A. Moss, Glenda Chaille, Blessing Makoni, Lannette Lewis, Allyson Mutch","doi":"10.1080/09699260.2021.1905146","DOIUrl":"https://doi.org/10.1080/09699260.2021.1905146","url":null,"abstract":"Residential aged care facilities (RACFs) face severe challenges in the provision of high-quality end of life care. A pilot of a nurse-led end-of-life palliative care consultative service (CiMaS) supporting RACFs was conducted in three RACFs in the West Moreton Region of Queensland, Australia, from May 2018. We conducted a mixed method evaluation comprising: a chart audit of deaths in the 12 months before and after the intervention; focus groups with RACF staff; and interviews with facility directors, primary family members and GPs. Quantitative and Qualitative data were assessed separately with statistical and thematic analyses respectively. The RACFs cared for 277 residents. There were 24 pre-intervention deaths and 44 in the intervention period (28 (64%) referred to CiMaS). There was widespread support for the service. Families felt supported and knowledgeable about what was happening. Care plans were almost always recorded in health records. Patients’ symptoms appeared to be better recognised and managed. Staff and Facility managers felt more support than previously, with more responsive and reliable out of hours support. There were significant care improvements in patients not referred to CiMaS, suggesting a learning effect. GPs observed improvements in nursing staff confidence and support to families. Transfers to hospitals fell by two-thirds for both referred and non-referred patients compared with the year before implementation. The program was both efficient and effective.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"30 1","pages":"229 - 237"},"PeriodicalIF":1.7,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09699260.2021.1905146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48546285","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}
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